The LGBTQI community represents a diverse set of subgroups, but it also includes the diversity that every other community brings to humanity— people can be part of the community regardless of their race, religion, ethnicity, nationality, class or any other dimension of identity and/or experience. This brings diversity of thought, perspective, understanding and experience to the community that makes it an asset to helping us grow as a world and as people.



However, it is important to note that while the LGBTQI community has many unique assets and gifts, it also faces many unique challenges. For those who identify as lesbian, gay, bisexual, transgender, queer, questioning or intersex (LGBTQI*), it’s important to recognize how your experience of sexual orientation and gender identity relates to your mental health.



Although LGBTQI identities are not commonly included in large-scale studies of mental health, there is strong evidence from recent research that members of this community are at a higher risk for experiencing mental health conditions — especially depression and anxiety disorders. LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender (a person whose sense of gender identity corresponds with their birth sex) individuals to experience a mental health condition.



Many in the LGBTQI community also face discrimination, prejudice, denial of civil and human rights, harassment, and family rejection, which can lead to new or worsened symptoms, particularly for those with intersecting racial or socioeconomic identities.



Here are some of the mental health implications for members of this community.

Important Factors of LGBTQI Mental Health



Rejection

For many in the LGBTQI community, coming out can be a difficult, or even traumatic, experience. It can be difficult to cope with rejection of something as personal as one’s identity from family or close friends. According to a 2013 survey, 40% of LGBT adults have experienced rejection from a family member or a close friend.



LGBTQI youth are also disproportionately harassed at school, both physically and verbally, which can significantly impact their mental health. Additionally, people from the LGBTQI community may face rejection within their workplace or faith community.



Trauma

Homophobia, biphobia, transphobia, bullying and feeling identity-based shame is often traumatic for people.



The LGBTQI community faces many forms of discrimination, including: labeling, stereotyping, denial of opportunities or access, and verbal, mental and physical abuse. They are one of the most targeted communities by perpetrators of hate crimes in the country.



Such discrimination can contribute to a significantly heightened risk for PTSD among individuals in the LGBTQI community compared to those who identity as heterosexual and cisgender.



Substance Use

Substance misuse or overuse, which may be used as a coping mechanism or method of self-medication, is a significant concern for members of this community. LGB adults are nearly twice as likely as heterosexual adults to experience a substance use disorder. Transgender individuals are almost four times as likely as cisgender individuals to experience a substance use disorder. Illicit drug use is significantly higher in high school-aged youth who identify as LGB or are unsure of their identity, compared to their heterosexual peers.



Homelessness

It is estimated that LGBTQ youth and young adults have a 120% higher risk of experiencing homelessness. This risk is especially high among Black LGBTQ youth. Unstable housing is often the result of family rejection and discrimination based on their gender identity or sexual orientation. Many members of this community face the added challenge of finding homeless shelters that will accept them, and experience elevated rates of harassment and abuse in these spaces.



Suicide

Many people in this community struggle in silence — and face worse health outcomes as a result.

The LGBTQI population is at a higher risk than the heterosexual, cisgender population for suicidal thoughts and suicide attempts.

High school students who identify as lesbian, gay or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers.

40% of transgender adults have attempted suicide in their lifetime, compared to less than 5% of the general U.S. population.

Inadequate Mental Health Care

The approach to sexual orientation and gender identity in mental health care often groups together anyone in the LGBTQI community, when these communities are considered at all. This method can be problematic as each sub-community faces unique challenges, rates of mental illness and experiences.



The LGBTQ community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health. The community also has other factors including race and economic status that can affect the quality of care they receive or their ability to access care.



Additionally, members of this community may face harassment or a lack of cultural competency from potential providers. These experiences can lead those who receive treatment to fear disclosing their sexual orientation and/or gender identity due to potential discrimination or provider bias.



Confronting these barriers and mental health symptoms with an LGBTQI-inclusive therapist can lead to better outcomes, and even recovery.

How to Better Support the LGBTQI Community

What Mental Health Care Providers Can Do

Comprehensive and culturally competent treatment is a key part of helping those in this community with their mental health. However, in order to provide such care, mental health care providers must learn what it means to be culturally competent for this community.



Mental health care professionals must address the following:

The challenges of coming out and living as LGBTQI

​The possibility that individuals may lack family, community, and/or workplace support

The implicit (and explicit) bias and stereotyping they have experienced

Additionally, they can work toward creating an environment that makes their patients feel more comfortable being open about their sexual orientation and/or gender identity.

Ask for their patient’s pronouns during the first visit

​Use gender-inclusive language

Clearly display a non-discrimination policy (that explicitly includes discrimination based on sexual orientation and gender identity) and a policy for reporting discrimination

Offer local resources or relevant informational material

What Allies Can Do

Another key part of LGBTQI mental health is feeling supported by family and friends. Allies can do the following to offer their support.

Try to create supportive and inclusive workplaces, neighborhoods, clubs and organizations in your community

Support outlets that help with substance use, addiction and mental illness

Be an advocate in your religious and spiritual community for acceptance, love and support

Speak out against discriminatory language or jokes made at the expense of LGBTQI people

​Support candidates who will prioritize legislation that is supportive of the LGBTQI community and advocate for laws that ban discrimination

We all can do our part to support this community. NAMI recognizes that we don’t have all the answers, so we hope you visit some of the organizations below and review their resources.



*This list of initials is not an exhaustive list of identities included in this community and related groups. We want to be explicit in our support of all people who identify as community members, whether their identity is commonly acknowledged or not. This includes those who are non-binary, two-spirit, third-gender, asexual and more.

Support & Resources