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LGBT and Mental Health Treatment: Learning to Trust Your Therapist

People of different gender and sexual orientations (often referred to as LGBT) suffer from mental health issues more frequently than the general population. This is not due to characteristics innate in LGBT identities and orientations. Rather, in contending with oppression, threats from others, and a need to keep secrets from those close to them; mental illnesses such as depression and anxiety are, unfortunately, to be expected. LGBT and mental health is a serious topic that certainly deserves much more attention.

It is important that LGBT people and allies are aware of the high rates of mental illness in the LGBT community. This way, they can work to prevent mental illness through therapy, as well as treat mental illness when it occurs.

LGBT Community

Before we talk about LGBT and mental health, we need to clarify exactly who we are referring to. The LGBT community is large and complex. Standing for Lesbian, Gay, Bisexual, and Transgender; the term groups an incredibly diverse group of people together. For example, lesbian, gay, and bisexual are all terms for sexual identities, whereas transgender is a term for a gender identity. Often, Q is added to LGBT, as an acronym for queer (to form LGBTQ). Queer, previously used as a slur, has been claimed with pride by people with different sexual and gender identities. It is inclusive of anyone who does not feel comfortable identifying with heterosexual, cisgender society.

Unfortunately, grouping all of these orientations and identities together inevitably leads to some getting more attention than others. Gay and lesbian people are greater in number and more visible than bisexual and transgender people. People also tend to overlook other sexual orientations, such as as asexual, entirely. The same is true with those who identify as “gender fluid” or “non-conforming.”

Let’s take a quick look at what constitutes a gender identity and sexual orientation, as well as the differences between them.

Gender Identity and Sexual Orientation

Gender identity refers to how one identifies in the context of long-held gender norms. While most people identify as either male or female, according to the physical characteristics with which they were born, there is a significant minority who do not relate to these binaries. For example, transgender people often feel as if they were born in the wrong body. These people identify as a gender that is in conflict with their physical characteristics and what they were assigned at birth. Gender fluid people do not identify with one or another gender, but rather see characteristics of both in themselves.

It is a little more complicated with those who were born with physical characteristics of both or neither sexes. These individuals have to come to terms with an identity that cannot fit into “old” societal norms.

Sexual orientation refers to a person’s physical and romantic attractions. Whereas the majority of the population is attracted to people of the opposite sex and gender, a significant proportion is attracted to others of the same sex, or of either sex. This can also lead to questioning regarding one’s gender identity, as they may have characteristics or mannerisms at odds with what is expected of their gender by society.

LGBT Pride

A major factor in the connection between LGBT and mental health is that LGBT people have been shamed into hiding their orientation and identity for many years. These sexual orientations and gender identities have been termed “unnatural” or “disgusting” by religious and political figures, as well as by family members and associates. The shame with which they grow up is part of what leads to mental illness and difficulties being open about themselves. As part of a drive to eliminate this sense of shame, LGBT people have focused on generating pride in their orientations and identities. They hold parades to celebrate being themselves and to show the world that they are proud to be who they are.

LGBT Flags

The most well-known LGBT flag is the rainbow flag. It is made up of red, orange, yellow, green, blue, and purple. Variations of the flag exist to represent different causes, such as a black stripe to represent those lost to AIDS; and a blue, pink, and white flag to represent transgender rights.

LGBT Community

LGBT Mental Health Issues

The connection between LGBT and mental health matters begins due to a number of factors. Mostly, these factors are connected to homophobia from the outside world, as well as internalized homophobia.


Despite major progress over the past few decades, LGBT people still face tremendous prejudice from certain sectors of society. In many religious or conservative communities, there is still a stigma surrounding LGBT people. Even in progressive sectors of society, LGBT people might face a certain amount of prejudice. This can happen in school, at college, at work, and anywhere in between. The LGBT and mental health connection is an unsurprising consequence of these attitudes.

Stigma against LGBT people can lead to fear of physical or emotional threats, prejudice in job interviews, family conflict, and much more.

Minority Stress

The term “minority stress” refers to the vulnerable position members of the LGBT community are put into. It accounts for much of the connection between LGBT and mental health.

Minority stress includes everything including: “social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social exclusion, and family rejection.”


Another important factor that leads to high levels of mental illness in the LGBT community is the secrecy with which they are often forced to live. Many LGBT people grow up with the belief that their very nature is shameful. They therefore hide who they are; often attempting to change their mannerisms, way of speaking, and suppressing preferences or desires that go against what seems “acceptable” to society.

Even when a loved one offers to listen, they fear sharing this particular secret (they may also fear accidentally letting it slip). For this reason, LGBT people don’t share their feelings, and they can become very isolated as a result. This isolation increases their risk of ending up with conditions like depression and anxiety, and it can lead to dysfunctional relationships.

Mental Health Statistics

LGBT people are three times more likely to suffer from a mental health condition. The risk of depression is particularly high in bisexual people, with 40.1% of respondents to surveys having been diagnosed with depression. This may be due, in part, to a societal misunderstanding of bisexuality (even among LGBT people). People often argue that bisexual individuals are simply too afraid to come out fully as gay or lesbian, and this is certainly not the case.

Gay and lesbian individuals experience depression at a rate of one in every three people. Furthermore, 31.4% of transgender and gender non-conforming people have been diagnosed with depression. Although, this number may be influenced by disparities in care and a common fear that they will be discriminated against or even put in danger.

Substance Abuse Statistics

Substance abuse statistics are also significantly higher in the LGBT community. In fact, 20% to 30% of LGBT people abuse substances, as compared to a much lower 9% of people in the general population. Substance use often begins as a method for coping with stigma, discrimination, isolation, and bullying.

Disparities in Care

Unfortunately, despite discrimination being illegal in the U.S., LGBT people still often experience disparities in care. Some healthcare providers outright deny care to LGBT people, due to religious or societal beliefs. Others provide care begrudgingly, making it clear that they are against the patient. There are still professionals who offer so-called “conversion therapy,” despite consistent research indicating that the practice only causes harm, and virtually no evidence that people can successfully change their sexual orientation or gender identity.

Part of the problem is that until the 1970s, homosexuality was considered to be a mental illness. Transgenderism has also been regarded as a mental condition. While psychiatry has evolved and changed its approach, the aftereffects live on.

Healthcare providers may also simply not know how to provide adequate care for LGBT people. They may not understand the lived experience of an LGBT person. Consequently, they can sometimes be insensitive or unaware of their particular struggles.

Disparities in care may explain why their risk of suicide is much greater (although fewer transgender and gender non-conforming people are diagnosed with depression than other members of the LGBT community). In one survey, more than half of male transgender teens reported having attempted suicide. A percentage of 41.8% of non-binary or non-conforming youths surveyed, had attempted suicide. LGBT people are more likely to be refused treatment and, oftentimes, they avoid it altogether (out of fear). They are, therefore, not diagnosed with depression at an accurate rate.

Suicide Risk in LGBT People

Suicide is one of the leading causes of death in LGBT people between the ages of 10 and 24. The risk is much greater if they have experienced rejection by their families due to their orientation or gender identity. Also, as mentioned before, transgender and gender non-conforming individuals face the highest suicide rates in the LGBT community.

Disparities in care play a part in the high suicide rates. Since LGBT people might not get adequate care, even when they seek it out, their chances of feeling hopelessness and despair are higher.

Young People in the LGBT Community

The LGBT and mental health connection is particularly clear with LGBT youth. Young people in the LGBT community face struggles that older LGBT people no longer do. They often face discrimination and bullying from peers at school or in the community. The worst part? They often do not have the resources to cope with it. Teachers and other adult authority figures may not understand well enough to help, or may agree with the attitudes expressed by those perpetrating the bullying.

Furthermore, LGBT youths may face rejection and discrimination at home. Due to their particular vulnerability, this rejection can lead to problems that seem insurmountable. Youths who are kicked out of their homes for identifying as LGBT often end up homeless, unable to finish school, and inevitably find it difficult to trust others.

Fortunately, there are organizations set up to help LGBT people who have been rejected by their families. It Gets Better and The Trevor Project provide 24 hour call-lines for LGBT youths in crisis. There are also, in many cities in the U.S. and worldwide, shelters for LGBT youths who have no other safe place to go.


LGBT and Mental Health

Because of the connection between LGBT and mental health, it is important that the community is aware of the potential mental health risks and that they know what to do when they need help.

When It’s Time to Get Help

It is time to get help when you:

  • are struggling to contain emotions that threaten to overwhelm
  • no longer enjoy activities which used to bring you pleasure
  • are tired and lackluster
  • have no one you can talk to openly about your LGBT struggles
  • feel isolated
  • are thinking about or engaging in self-harm
  • have considered or attempted suicide
  • are using alcohol or drugs to cope with your emotional difficulties


Therapy can provide the perfect opportunity to speak through your issues in a safe place. Seeing a therapist with LGBT knowledge and experience can give you the support you need. Speaking about your issues is the first step towards healing. Therapy gives you the space to talk as well as resources to help you learn to cope.

Support Groups

Support groups provide an excellent opportunity to learn that you are not alone. Speaking with others who are going through the same difficulties can be very helpful when struggling with isolation. It can also help to hear how others are learning to manage their own situations.

Finding the Best Mental Health Care Provider

It is not uncommon for LGBT people to fear being open, even with a licensed mental health professional. While discrimination is illegal, the ongoing stigma surrounding LGBT issues still influences some individuals, in spite of the directives of healthcare bodies. It is important that you know how to find an LGBT-friendly therapist you can trust.

LGBT-Friendly and Culturally Competent Providers

Look for a therapist who is LGBT-friendly, has experience working with other LGBT people, and who understands the particular struggles the LGBT community experiences. Ideally, they provide this information on their bios or websites and, in general, their reviews or testimonials confirm this.

Someone You Can Trust

You can trust a licensed mental health professional’s commitment to keeping your sessions confidential. They are legally bound to do so. Providers who are LGBT-friendly and experienced are trustworthy; not just in their commitment to confidentiality, but in their competence in helping you with your issues.

You Should Feel Comfortable With Your Therapist

It is crucial that you feel comfortable with your therapist. You should be able to share without fear of consequences. If you still wish to withhold your trust until you have sussed them out, discuss your feelings around this with them in the session.

LGBT and Mental Healthcare

LGBT people are at a higher risk of mental illness, and awareness about this is important. There are now many mental healthcare providers who can be trusted to be culturally aware and LGBT-friendly, or who are members of the LGBT community themselves. There is no shame in asking for help when struggling with these, sometimes monumental, challenges. Start searching for the therapist who is perfect for you today.

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