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Why LGBTQ People Don’t Get the Mental Health Care They Deserve

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Greta Christina recently pulled out of her most recent bout with depression. The pansexual writer and activist has struggled with the chronic disease her entire life.

“People think depression means being sad,” she says. “Being sad is being sad. What depression is for me is a reduction of a feeling. It’s more like numbness. You can’t experience pleasure or motivation—very different from sadness.”

A blogger for The Orbit, Christina said that talking about mental health in the LGBTQ community has improved in recent years. But stigma still haunts queer people about admitting if they have a problem.

“Because we are seen by so many people as ill because of our sexual orientation or gender identity, a lot of us are reluctant to come forward about mental illness—like it’s going to make us look bad somehow,” she says. “We know we’re already seen as mentally ill because of our identity, so we don’t want to add that to society. That’s contributed to a lot of shame around it.”

That shame is concealing a community in deep need of care. About half of transgender men and women suffer from depression, slightly less for anxiety. Gay men encounter depression at six times the rate of straight men. Homosexuality alone was considered a mental illness until 1973, and many counselors—often religious affiliated—still treat sexual orientation and gender identity as a pathology today.

“Coming out as mentally ill is very similar to coming out as LGBT,” Christina says. “All coming outs are very similar. You have to do a lot of education. You have to keep doing education with the same people again and again and again because they’re not getting it. There’s a lot of stigma you have to push back against.”

Heina Dadabhoy pushed back against that stigma in a big way. The blogger came out as pansexual and genderqueer after leaving the family faith of Islam. That’s when the panic attacks started.

“I had trouble getting out of bed,” Dadabhoy says. “I had panic attacks. I was out of breath, unable to focus, unable to move. My family told me the reason I was having panic attacks was because I was possessed by a devil—that God was punishing me [for my sexual identity].”

Dadabhoy, who identifies with they/them pronouns, said their anxiety worsened for a year before they sought counseling at their university.

“At first, I just tried to deal with it—tough it out,” they say. “I always thought of myself as a strong person. But then, it got to the point where I couldn’t breathe two, three times a day.”

Even when queer people like Dadabhoy finally decide to seek care, they may not always find what they need.

“When people pluck up the courage to go, there’s often nobody to see,” says Bennet Hennessey, executive director of the Institute of Human Identity in New York. “Clinicians are ignorant of what this community needs. And LGBTQs don’t want to see therapists because their problems become legitimate. Everything suddenly becomes real.” 

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Hennessey and IHI train graduate students on counseling and therapy techniques for the queer community.

“Many are ashamed to seek out care,” he says. “When they do, they need to seek out people that understand them.”

Christina found that care, but the double challenge of being LGBTQ and having a mental illness makes seeking treatment that much harder.

“We’re unwilling to recognize when we have a mental illness and the ways our sexual or gender identity might affect that,” Christina says. “The world sees queer people as damaged. We aren’t damaged, but we are damaged by how the world sees us.”

While LGBTs may have trouble accepting a mental health issue, or feel that their identity prevents them from seeking care, most problems—depression, anxiety, substance abuse—stem from the same place.

“Shame can manifest in a variety of ways,” Hennessey says. “There’s the 90-year-old whose spouse dies and is finally ready to come out. There’s the 17-year-old who is very aware of his identity and wants to understand why he’s so anxious. The underlying cause is often the same—trauma.”

Christina feels the same.

“To straight people, all queer people are defined by our orientation or gender identity,” she says. “It doesn’t occur to them that we have issues, too.”

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