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Clinical Issues and Programming for Sexual and Gender Minority Populations

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Textbook of Community Psychiatry

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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

    Article  PubMed  Google Scholar 

  • Bayer R (1981) Homosexuality and American Psychiatry, Basic Books, New York

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Burkhart PL, Reuss S (1993). Successful Strategic Planning: A Guide for Nonprofit Agencies and Organizations. Newbury Park: Sage Publications

    Book  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Chivers ML (2004) A sex difference in the specificity of sexual arousal. Psychological Science 15(11):736–44

    Article  PubMed  Google Scholar 

  • Cochran SD, Mays VM (1994). Depressive distress among homosexually active African American men and women. Am J Psych. 151:524–529

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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.

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • Feinstein BA, Dyar C (2017). Bisexuality, minority stress, and health. Current sexual health reports, 9(1): 42–49.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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.

    Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Herek GM (2000). The psychology of sexual prejudice. Current Directions in Psychological Science, 9, 19–22

    Article  Google Scholar 

  • Herek GM (2002) Heterosexuals attitudes toward bisexual men and women in the United States. J Sex Res. 39(4):264–74

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Jamison KR (2006). The many stigmas of mental illness. Lancet, 367: 533–534.

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Kidd SA, Howison M, Pilling M, Ross LE, McKenzie K (2016). Severe mental illness in LGBT populations: A scoping review. Psychiatric Services 67(7): 779–783.

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Koh AS, Ross LK. (2006). Mental health issues: a comparison of lesbian, bisexual and heterosexual women. J Homosexuality 51:33–57

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Lecomte T, Wilde JB, Wallace CJ (1999) Mental health consumers as peer interviewers. Psychiatric Services. 50:693–695

    Article  PubMed  Google Scholar 

  • Lenning E (2009). Moving beyond the binary: Exploring the dimensions of gender presentation and orientation. International Journal of Social Inquiry. 2 (2): 39–54

    Google Scholar 

  • Lykens JE, LeBlanc AJ, & Bockting WO (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT health, 5(3): 191–196.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Pfafflin F (2007). Mental health issues. In Ettner R, Monstrey S, Eyler AE (Eds) Principles of Transgender Medicine and Surgery. New York: Routledge

    Google Scholar 

  • Plöderl M, Tremblay P (2015) Mental health of sexual minorities. A systematic review, International Review of Psychiatry, 27 (5): 367–385

    Article  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Ritter, K.Y., Terndrup, A.I. (2002). Handbook of Affirmative Psychotherapy with Lesbians and Gay Men. New York: The Guilford Press

    Google Scholar 

  • Rogers EM, Bhowmik DK (1970). Homophily-heterophily: relational concepts for communication research. Public Opinion Quarterly, 34(4):523–538

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Rosenthal A M, Sylva D, Safron A, Bailey J M (2011) Sexual arousal patterns of bisexual men revisited. Biological Psychology, 88, 112–115.

    Article  PubMed  Google Scholar 

  • Russell ST, Fish JN (2016) Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Ann Rev Clin Psychol 12 (1):465–487

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Simoni JM Walters KL (2001). Heterosexual Identity and Heterosexism: Recognizing Privilege to Reduce Prejudice. Journal of Homosexuality, 1(1): 157–173.

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Volpp SY (2009). Bisexuals. In, Ruiz P, Primm A (Eds.) Disparities in Psychiatric Care: Clinical and Cross-Cultural Perspectives. Philadelphia: Lippincott Williams and Wilkins

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Weinberg MS, Williams CJ, Pryor DW (1994). Dual Attraction. New York, NY: Oxford University Press.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Ronald Hellman

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  1. Ronald Hellman
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Editors and Affiliations

  1. Clinical Professor of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Wesley E. Sowers

  2. Clinical Professor of Psychiatry, New York University Grossman School of Medicine | NYU Langone Health, New York, NY, USA

    Hunter L. McQuistion

  3. Clinical Professor of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA

    Jules M. Ranz

  4. Professor Emerita of Psychiatry, Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Jacqueline Maus Feldman

  5. Vice Chair/Professor, Department of Psychiatry, Case Western Reserve School of Medicine, Ohio, OH, USA

    Patrick S. Runnels

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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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