Abstract
As concepts of mental health have advanced and social change has evolved, social psychiatry has adapted and influenced the contemporary delivery of mental health care to the sexual and gender minority (SGM) community.
A neoteric understanding of sexual orientation was crucial in delineating a contemporary redefinition of that which constitutes a mental disorder when homosexuality was declassified in 1973. Subsequently, affirmative therapies emerged. Gender identity disorder was replaced by gender dysphoric disorder. Same-sex marriage, previously a fanciful notion, became legally recognized on a national basis. New and existing journals began to convey a corpus of novel research in sexual and gender minority studies that would be incorporated into educational curricula. And, SGM psychiatrists were, at last, free from the implications of pathology, to become active and open participants in the profession.
Few classes of people within our society have undergone such dramatic change, even within the last decade. These gains have affected the well-being of SGM individuals in complex ways. This chapter explores these issues from a community psychiatry perspective, giving the community psychiatrist an essential perspective and understanding as providers of care to the SGM community.
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References
Auer MK, Fuss J, Höhne N, Stalla GK, Sievers C (2014) Transgender transitioning and change of self-reported sexual orientation. PLoS One. 9(10): e110016. Published online 2014 Oct 9. https://doi.org/10.1371/journal.pone.0110016 PMCID: PMC4192544
Bailey JM et al (2016) Sexual orientation, controversy, and science, Psychological Science in the Public Interest, 17(2) 45–101
Bayer R (1981) Homosexuality and American Psychiatry, Basic Books, New York
Bränström R, Pachankis JE (2020) Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. Am J Psych 177 (8): 727–734.
Burkhart PL, Reuss S (1993). Successful Strategic Planning: A Guide for Nonprofit Agencies and Organizations. Newbury Park: Sage Publications
Byers, D. S., Vider, S., & Smith, A. (2019). Clinical activism in community-based practice: The case of LGBT affirmative care at the Eromin Center, Philadelphia, 1973–1984. American Psychologist, 74(8), 868–881
Chivers ML (2004) A sex difference in the specificity of sexual arousal. Psychological Science 15(11):736–44
Cochran SD, Mays VM (1994). Depressive distress among homosexually active African American men and women. Am J Psych. 151:524–529
Cochran SD, Mays VM, Sullivan JG (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 71(1):53–61.
Cochran SD, Mays VM (2006). Estimating prevalence of mental and substance-using disorders among lesbians and gay men from existing national health data. In, Omoto AM & Kurtzman HS (Eds.), Contemporary perspectives on lesbian, gay, and bisexual psychology. Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (p. 143–165). American Psychological Association
Coffman KB, Coffman LC, Keith M. Marzilli-Ericson (2017) The size of the lgbt population and the magnitude of anti-gay sentiment are substantially underestimated. Management Science 63 (10): 3168–3186
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, et al (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J of Transgenderism, 13(4): 165–232. https://doi.org/10.1080/15532739.2011.700873
Connolly MD, Zervos MJ, Barone CJ, Johnson CC, et al (2016) The mental health of transgender youth: Advances in understanding. J Adolesc Health, 59(5):489–495
Cooper LA, Roter DL, (2003). Patient-provider communication: The effect of race and ethnicity on process and outcomes of healthcare. In Smedley BD, Stith AY, Nelson AR (Eds.) Unequal Treatment: Confronting Racial and Ethnic Disparities In Health Care. The National Academies Press: Washington, DC, 552–593.
Corrigan P, Thompson V, Lambert D, Sangster Y, Noel JG, Campbell J (2003). Perceptions of discrimination among persons with serious mental illness. Psychiatric Services, 54, 1105–1110
D’Augelli AR, Pilkington NW, Hershberger SL (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17(2):148–67
Daniel H, Butkus R et al (2015) Lesbian, gay, bisexual, and transgender health disparities: executive summary of a policy position paper from the American College of Physicians Ann Intern Med. 163(2):135–7
Deacon SA, Reinke L, Viers D (1996). Cognitive-behavioral therapy for bisexual couples: Expanding the realms of therapy. The American J of Family Therapy. 24(3):242–258
Dhejne C, Vlerken RV, Heylens G, Arcelus J (2016) Mental health and gender dysphoria: A review of the literature. Int Rev Psychiatry, 28(1):44–57
Diaz RM, Ayala G, Bein E, Henne J, Marin BV (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. Am J Pub Health 91:927–932
Evans-Polce RJ, Kcomt L, Veliz PT, Boyd CJ, McCabe SE (2020) Alcohol, tobacco, and comorbid psychiatric disorders and associations with sexual identity and stress-related correlates. Am J Psych 177 (11): 1073–1081
Falco KL (1996). Psychotherapy with women who love women. In, Cabaj RP, Stein TS (Eds.) Textbook of Homosexuality and Mental Health. Washington, DC: American Psychiatric Association Press
Feinstein BA, Dyar C (2017). Bisexuality, minority stress, and health. Current sexual health reports, 9(1): 42–49.
Ferris JL (2006). The nomenclature of the community: An activist’s perspective. In Shankle MD (Ed.), The Handbook of Lesbian, Gay, Bisexual and Transgender Public Health: A Practitioner’s Guide to Service. The Haworth Press, Binghamton, NY, 3–10.
Flood S, King M, Rodgers R, Ruggles S, Warren JR (2020) Integrated public use microdata series, current population survey: Version 8.0 [dataset]. Minneapolis, MN: IPUMS. https://doi.org/10.18128/D030.V8.0
Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, Hoy-Ellis CP (2013) Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health.103(10):1802–1809.
Fredriksen-Goldsen K I, Cook-Daniels L, Kim H J, et al. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54(3), 488–50
Gooren LJ, Delemarre-van de Waal HA (2007). Hormone treatment of adult and juvenile transsexual patients. In, R Ettner, S Monstrey, Eyler AE (Eds.) Principles of Transgender Medicine and Surgery. Routledge: NY, 73–88
Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M (2011) Injustice at every turn: a report of the national transgender discrimination survey. National Center for Transgender Equality and National Gay and Lesbian Task Force. Washington, DC.
Greene N, Jackson JW, Dean LT (2020) Examining disparities in excessive alcohol use among black and hispanic lesbian and bisexual women in the united states: an intersectional analysis. J Stud Alcohol Drugs. 81(4):462–470
Haas AP, Eliason M, Mays VM, et al (2011) Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex, 58:10–51.
Hellman, R.E., Sudderth, L., & Avery, A.M. (2002). Major mental illness in a sexual minority psychiatric sample. Journal of the Gay and Lesbian Medical Association, 6, 97–106.
Hellman RE, Klein E (2004) A program for lesbian, gay, bisexual, and transgender individuals with major mental illness, J of Gay & Lesbian Psychotherapy, 8(3–4): 67–82
Hellman RE, Klein E, Huygen C, Chew M, Uttaro T (2010). A study of members of a support and advocacy program for LGBT persons with major mental illness. Best Practices in Mental Health: An International Journal. 6(2): 13–26.
Hellman, RE (2019) The way of the world: how heterosexism shapes and distorts male same-sexuality, a thesis, J of Gay & Lesbian Mental Health. 23(3):349–359.
Herek GM (2000). The psychology of sexual prejudice. Current Directions in Psychological Science, 9, 19–22
Herek GM (2002) Heterosexuals attitudes toward bisexual men and women in the United States. J Sex Res. 39(4):264–74
Israel T, Walther WA, Gortcheva R, Perry JS (2011): Policies and practices for lgbt clients: Perspectives of mental health services administrators, J of Gay & Lesbian Mental Health, 15(2): 152–168
Jamison KR (2006). The many stigmas of mental illness. Lancet, 367: 533–534.
Jeffries IV, WL, Dodge B (2007). Male bisexuality and condom use at last sexual encounter: results from a national survey. Journal of Sex Research. 44(3): 278–289
Kidd SA, Howison M, Pilling M, Ross LE, McKenzie K (2016). Severe mental illness in LGBT populations: A sco** review. Psychiatric Services 67(7): 779–783.
Kim H J, & Fredriksen-Goldsen, KI (2013). Nonresponse to a question on self-identified sexual orientation in a public health survey and its relationship to race and ethnicity. Am J of Public Health, 103(1), 67–69
Koh AS, Ross LK. (2006). Mental health issues: a comparison of lesbian, bisexual and heterosexual women. J Homosexuality 51:33–57
Lauman, EO, Gagnon, JH, Michael, RT, Michaels, S (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.
Lecomte T, Wilde JB, Wallace CJ (1999) Mental health consumers as peer interviewers. Psychiatric Services. 50:693–695
Lenning E (2009). Moving beyond the binary: Exploring the dimensions of gender presentation and orientation. International Journal of Social Inquiry. 2 (2): 39–54
Lykens JE, LeBlanc AJ, & Bockting WO (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT health, 5(3): 191–196.
Mueller SC (2020) Mental health treatment utilization in transgender persons: what we know and what we don’t know. Am J Psych 177 (8): 657–659.
National Center for Health Statistics (2017) Sexual orientation and attraction. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nsfg/key_statistics/s_2015-2017.htm#sexualorientationandattractionNational
LGBT Health Education Center (2020) Neurodiversity & gender-diverse youth: An affirming approach to care. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2020/08/Neurodiversity-and-Gender-Diverse-Youth_An-Affirming-Approach-to-Care_2020.pdf
National Institutes of Health (2019) Sexual and Gender Minority Populations in NIH-Supported Research, August 28, 2019, https://grants.nih.gov/grants/guide/notice-files/NOT-OD-19-139.html
Nowaskie D (2020) A national survey of U.S. psychiatry residents’ LGBT cultural competency: The importance of LGBT patient exposure and formal education, J of Gay & Lesbian Mental Health, 24:4, 375–391.
Olysager F, Conway L (2008). Transseksualiteit komit vaker voor dan u denkt. Een nieuwe kijk op de prevalentie van trasnsseksualiteit in Nederland en Belgie (Transsexualism is more common than you think. A new look at the prevalence of transsexualism in the Netherlands and Belgium). Tijdschrift voor Genderstudies (Dutch Journal for Gender Studies). 11(2):39–51
Omoto AM, Kurtzman HS (Eds.) (2006). Sexual Orientation and Mental Health: Examining Identity and Development in Lesbian, Gay, and Bisexual People. Washington, DC: American Psychological Association.
Pachankis, J E (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313–330.
Pfafflin F (2007). Mental health issues. In Ettner R, Monstrey S, Eyler AE (Eds) Principles of Transgender Medicine and Surgery. New York: Routledge
Plöderl M, Tremblay P (2015) Mental health of sexual minorities. A systematic review, International Review of Psychiatry, 27 (5): 367–385
Potter J (2010). Meeting the healthcare needs of LGBT populations: An end to invisibility. Grand Rounds. University of Louisville, Department of Medicine, April 8, 2010
Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G (2016) Non-binary or genderqueer genders, Int Rev of Psych, 28:1, 95–102
Ritter, K.Y., Terndrup, A.I. (2002). Handbook of Affirmative Psychotherapy with Lesbians and Gay Men. New York: The Guilford Press
Rogers EM, Bhowmik DK (1970). Homophily-heterophily: relational concepts for communication research. Public Opinion Quarterly, 34(4):523–538
Romanelli, M, Hudson K D (2017). Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American Journal of Orthopsychiatry, 87(6), 714–728.
Rosenthal A M, Sylva D, Safron A, Bailey J M (2011) Sexual arousal patterns of bisexual men revisited. Biological Psychology, 88, 112–115.
Russell ST, Fish JN (2016) Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Ann Rev Clin Psychol 12 (1):465–487
Sandfort TGM, de Graaf R, Bijl RV, Schnabel P (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands mental health survey and incidence study (NEMESIS). Archives of General Psychiatry, 58(1): 85–91.
Sarno EL, Newcomb ME, Feinstein BA, Mustanski B (2020) Bisexual men’s experiences with discrimination, internalized binegativity, and identity affirmation: Differences by partner gender. Arch Sex Behav. 49(5):1783–1798.
Sausa, LA (2005). Translating research into practice: Trans youth recommendations for improving school systems. The Journal of Gay and Lesbian Issues in Education, 3(1): 15–28.
Schrimshaw EW, Siegel K, Downing M, Jr., Parsons, JT (2013). Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. Journal of Consulting and Clinical Psychology, 81(1): 141–153
Semlyen J, King M, Varney J et al (2016) Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry 16 (67). https://doi.org/10.1186/s12888-016-0767-z
Shipherd JC, Green KE, Abramovitz S (2010). Transgender clients: Identifying and minimizing barriers to mental health treatment. Journal of Gay & Lesbian Mental Health, 14, (2): 94–108
Simoni JM Walters KL (2001). Heterosexual Identity and Heterosexism: Recognizing Privilege to Reduce Prejudice. Journal of Homosexuality, 1(1): 157–173.
Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S (2003). Sexual orientation and self-harm in men and women. American Journal of Psychiatry, 160:541–546
Trinh MH, Agénor M, Austin SB, Jackson CL (2017) Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: a nationally representative cross-sectional study. BMC Public Health.17(964) https://doi.org/10.1186/s12889-017-4937-9
Valentine SE, Shipherd JC (2018) A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 66:24–38.
Volpp SY (2009). Bisexuals. In, Ruiz P, Primm A (Eds.) Disparities in Psychiatric Care: Clinical and Cross-Cultural Perspectives. Philadelphia: Lippincott Williams and Wilkins
Warner J, McKeown E, Griffin M, Johnson K, Ramsay A, Cort C, King M (2004). Rates and predictors of mental illness in gay men, lesbians, and bisexual men and women: Results from a survey based in England and Wales. Br J Psych 185:479–485
Weinberg MS, Williams CJ, Pryor DW (1994). Dual Attraction. New York, NY: Oxford University Press.
Whaibeh E, Mahmoud H, Vogt EL (2020) Reducing the treatment gap for lgbt mental health needs: the potential of telepsychiatry. J Behav Health Serv Res 47: 424–431.
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Hellman, R. (2022). Clinical Issues and Programming for Sexual and Gender Minority Populations. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_49
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