Difficulty Accessing Affirming Mental Health Care for the LGBTQIAP+ Community


Wanda is an 18-year-old pansexual woman who is just starting college several states away from her hometown. Since she was 16 years old, she has been receiving mental health counseling in her hometown for symptoms of depression and anxiety. Now that she is at college, she decides to seek out a new therapist whose office is just a short walk from her school. She’s very nervous going into her first appointment. When she meets with her therapist for the first time, the therapist asks if she has a boyfriend. Wanda feels a little offended that the therapist did not read the paperwork where she indicated that she is pansexual, but she decides to answer the question politely and tells her new therapist that she is pansexual and has a girlfriend. The therapist looks up, shakes her head, and says, “Wait. Pansexual? I thought a girl dating a girl means you’re a lesbian, right? Is pansexual what you kids are calling it now?” Wanda feels both angry and scared. It was difficult to find someone who had openings within walking distance of her new school. Should she try to make this work? Or should she start the long process of trying to find someone new again?

Ashley is a 37-year-old woman who comes into therapy for the first time because of feeling lost, hopeless, and depressed. Things seem to be going well with her therapist as they work together on coping skills for her emotions and ideas for becoming more active in her life again. Ashley knows she has been worried and concerned about her gender identity for a long time, and finally after a few months she gets up the nerve to talk about this with her therapist. The therapist seems very understanding and affirming. Together, they decide to try out using the name “Ash” in session, along with they/them pronouns. Ash tells the therapist this is just to try things out, and only in session. Ash isn’t ready for any other people to use the new name and pronouns yet. Ash leaves that session feeling much happier. However, the next week, Ash receives a phone call from the scheduling/billing professional at the therapist’s office. This staff person uses the name “Ash” on the phone. Ash realizes that the therapist must have talked to the staff person or changed the name in the office’s database. Ash feels betrayed and outed. Is this fixable? Is it time to begin the long process of finding someone new? Will the next therapist even be any more knowledgeable?


Mental Health in the LGBTQIAP+ Community

Folks in the LGBTQIAP+ community are more likely than average to have mental health concerns and challenges. Adults who have a minority sexual orientation (lesbian, gay, bisexual, pansexual, asexual, etc.) are at 2-3 times the risk of having symptoms of anxiety and depression and are at 3-5 times the risk of having suicidal thoughts compared with heterosexual adults. Adults who are transgender or non-binary are at 4 times the risk of having symptoms of anxiety and depression and are at 12 times the risk of having suicidal thoughts compared with cisgender adults (those whose gender identity matches the sex assigned to them at birth).

Teens in the LGBTQIAP+ community are at even higher risk. The Trevor Project’s 2022 Survey on LGBTQ+ Youth Mental Health surveyed 34,000 LGBTQIAP+ people ages 13 to 24 across all 50 states. Of the total number of respondents, 45% were BIPOC (Black, Indigenous, and People of Color) and 48% were transgender or non-binary. The survey found that, in the last 12 months:

  • 73% experienced anxiety
  • 58% experienced depression
  • 45% experienced suicidal thoughts
  • 48% engaged in self-harm (60% of transgender youth)
  • 60% were unable to get requested mental health services
  • 73% experienced discrimination due to their identity
  • 36% were physically threatened or harmed due to their identity

There are many reasons that folks in the LGBTQIAP+ community are faced with a higher level of mental health challenges. These include societal oppression, religious oppression, discrimination in schools, workplaces, and other organizations, rejection by family and friends, bullying, hate crimes, extremely negative portrayals in the media, microaggressions, anti-LGBTQIAP+ laws, policies, and court decisions, and many other factors.

One factor that is less often talked about, however, is difficulty accessing appropriate mental health care.


Discriminatory Mental Health Care and the LGBTQIAP+ Community

There are unfortunately many ways that folks in the LGBTQIAP+ community experience discrimination from mental health care providers, ranging from the obvious to the insidious. Some of these include:

  • Refusal to provide treatment due to the client’s identity or identities.
  • Purposely humiliating the client due to their identity or identities.
  • Blaming the client for “choosing” an identity that “causes them problems”.
  • Asking inappropriate and intrusive questions about body parts, surgery, medical treatments or other information that the client wishes to keep private.
  • Asking inappropriate questions about sexual activity that the client wishes to keep private.
  • Repeated accidental or intentional use of deadname or incorrect pronouns.
  • Repeated accidental or intentional use of offensive or non-affirming terminology.
  • Repeated accidental or intentional failure to use the correct terminology as requested by the client.
  • Assuming that all clients are cisgender and heterosexual.
  • Assuming sexual orientation and/or gender identity based on name, manner of dress or presentation, current or former partners, or other external factors.
  • Assuming that all mental health issues for someone who has a minority sexual orientation and/or gender identity stem from their identity or identities.
  • Avoiding discussing sexual orientation and/or gender identity because the provider is uncomfortable with these topics.
  • Focusing too heavily on discussing sexual orientation and/or gender identity when the client would like to discuss other topics.
  • Refusing to acknowledge the client’s family members if they do not fit into the provider’s worldview or biases.
  • Refusing to consult for clients seeking gender-affirming care.


Affirming Mental Health Care for LGBTQIAP+ Clients

At the Rollins Counseling Center, we understand how difficult it can be to find a caring, accepting therapist who celebrates your authentic self. We are here to provide culturally competent, affirming mental health care for clients in the LGBTQIAP+ community. We have a number of therapists who are members of the community themselves, as well as those who are trained allies to the community. It would be an honor to support you as you find more peace, contentment, and ease in your life, no matter where you are on your journey. Please feel free to reach out today!



References and Further Reading

  1. Wittgens C, et al. Mental health in people with minority sexual orientations: A meta-analysis of population-based studiesActa Psychiatr Scand. 2022;145(4):357-372.
  2. Witcomb GL, et al. Levels of depression in transgender people and its predictorsJ Affect Disord. 2018;235:308-315.
  3. Herman JL, et al. Suicide thoughts and attempts among transgender adults: findings from the 2015 U.S. Transgender Survey. UCLA: The Williams Institute; 2019.
  4. The Trevor Project. 2022 Survey on LGBTQ+ Youth Mental Health.