sidebar - LGBTI Medical & Mental Health
“[D]espite some recent advances in understanding and acceptance, LGBT [lesbian, gay, bisexual, and transgender] individuals remain subject to the traumas of negative stereotyping, rejection, marginalization, and discrimination—all of which impede help-seeking behaviors. To compound the problem, LGBT individuals with mental health problems, addictions, or both, may experience additional forms of prejudice and discrimination related to each of those conditions … SAMHSA [Substance Abuse and Mental Health Services Administration] convened the dialogue to develop and/or enhance partnerships among people in recovery, to identify specific factors at the individual and systems levels that can promote or hinder recovery for LGBT individuals, and to help participants gain a better understanding of a variety of perspectives and experiences in advancing recovery for LGBT individuals. In addition, by convening a range of stakeholders to address collaboratively the critical need for improving services, supports, and systems designed to address the mental health and addiction recovery needs of LGBT individuals, SAMHSA anticipated that the suggestions and recommendations summarized in this monograph would serve as a starting point for individuals and organizations interested in taking concrete action to improve recovery opportunities for LGBT individuals. This booklet is comprised of four sections: overview; dialogue themes and findings—eight major themes, personal-level factors that promote or impede recovery, and system and contextual factors that promote or impede recovery; recommendations for action—major and strategic; and milestones in the LGBT mental health consumer movement.
"Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date … "This investigation sought to describe characteristics associated with JI in a sample of veterans with TG identification and to determine whether health disparities exist when compared to non-TG veterans with a JI history" (p. 297, 298). Results are presented regarding: characteristics of TG and non-TG veterans; sample characteristics of justice involved (JI) TG and non-TG veterans; characteristics of justice involved TG and justice involved non-TG veterans; and the effects of TG status and VJP [Veteran Justice Programs] involvement on medical and mental health problems. Findings suggest that TG veterans are more like to be involved with the justice system, to have been homeless at one time or another, and/or experienced sexual assault while serving in the military compared to non-TG JI (justice involved) veterans. TG JI veterans also at increased risk for depression, posttraumatic stress syndrome (PTSD), serious mental illness, suicide, hypertension, and obesity. "These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans" (p. 297).
"Claims of inadequate health care and safety afforded to transgender inmates have become the subject of litigation. This article reviews 129 unsolicited letters from transgender inmates writing … to identify their concerns. Among the letters reviewed were reports from 10 inmates who had filed lawsuits naming departments of correction (DOCs) as defendants, claiming inadequate access to transgender health care. Five of these lawsuits have gone to trial. In all of those cases, the defendant settled the matter or was found liable as of the time of this report. Claims of inadequate care for transgendered patients that have sufficient merit to be fully litigated in U.S. courts appear likely to produce verdicts in favor of plaintiff inmates. The information gleaned from reviewing letters from transgendered inmates may alert staffs of DOCs to concerns worth addressing proactively to avoid the costs associated with transgender-related lawsuits" (Author Abstract p. 334).
“The overall goal of the SOC [Standards of Care] is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment … While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population” (p. 1). Sections of this publication are: purpose and use of the SOP; global applicability; the difference between gender nonconformity and gender dysphoria; assessment and treatment of children and adolescents with gender dysphoria; mental health; hormone therapy; reproductive health; voice and communication therapy; surgery; postoperative care and follow-up; lifelong prevention and primary care; applicability of SOP to people living in institutional environments; and applicability of SOP to people with disorders of sex development. Appendixes include: glossary; overview of medical risks of hormone therapy; summary of criteria for hormone therapy and surgeries; and evidence for clinical outcomes of therapeutic approaches.