26/01/2022 | Writer: Alp Kemaloğlu
Psychologist Alp Kemaloğlu wrote about access to mental health care and barriers for LGBTI+s for equality.
LGBTI+s are marginalized and exposed to inequalities while benefiting from health care as usual, just like receiving any kind of service. LGBTI+s are more likely than the general population to report unfavorable experiences of healthcare including poor communication from health professionals and dissatisfaction with treatment and care received (Zeeman et all., 2019). In particular, discrimination at the institutional level is in question, beyond the personal attitude and behaviors of health professionals, considering the services received from health organizations. Thus, LGBTI+s may avoid medical treatment, which is one of their basic needs and fundamental rights, including emergency care.
On the whole, we observe byzantine interaction of social, cultural and political factors considering the inequalities experienced in the field of mental health, just like any health care in general. This interaction, itself, may become fully effective on the stress experienced by LGBTI+s as a result of being targeted, discrimination at individual and organization levels, stigma and prejudice in relation to heteronormativity (the assumption, in social and cultural norms and social structure, that prioritize and give preference to heterosexuality), sexual orientation, gender identity, sex characteristic and gender expression.
Considering heterosexuality as a norm, causes the assumption that everyone is heterosexual and cisgender and not intersex by default, LGBTI+s are also considered within the context of heteronormativity when they want to access mental health care, their gender identity is disregarded (Utamsingh et all., 2016). This common assumption, itself, and the protocols and procedure based upon it, sometimes may become a source of anxiety (being obliged to come out), sometimes fair source of anger (tolerating the ignorance of social service expert or trying to provide missing information in order to receive quality service) and sometimes a risk factor itself (doing themselves or someone else injury instead of preferring to receive a support, as result of anxiety and anger experienced, for LGBTI+s.
All kind of exclusive, in the context of sexual orientation, gender identity, sex characteristic and gender expression, mental health care continue to consider LGBTI+s as “exception” in best-case scenario, and as “non-normal”, which has been going on for centuries and surviving until recent history, in the worst case. Unfortunately it seems impossible to overcome the hegemony of heteronormativity in the mental health field, unless mental health professionals stumble into LGBTI+s during their education and professional period and they improve themselves off theirs’s own bat, about LGBTI+ people and community.
Stigma, prejudice and discrimination perform as interpersonal, social and organizational tools for bringing the ones, who don’t act in harmony with the norms assumed by majority, in line. LGBTI+s are too often exposed to these tools as they are not considered to be within these imaginary norms. Unfortunately, this encountering penetrates all aspects of the life and they become chronic. As a result of this repetitive encountering that LGBTI+s are exposed to because of the misbeliefs and myths about their existence, an intensive stress source, which doesn’t affect the rest of the society, occurs in their lives. The concept called as minority stress (we notice the influence of community health care perspective in the entitling of the theory however I am going to ignore it because it is out of question for this article) is defined as one of the main barriers for LGBTI+s in accessing mental health (Meyer, 2003).
These negative practices, which are frequently experienced in social life, causes that LGBTI+s worry about being exposed to similar behaviors by mental health professionals likewise. Microaggressions (like abstaining from talking the issues related to sex and sexuality) gone forth between mental health professional and LGBTI+, who received the health care, are also samples of negative experiences in daily life, beside obvious discrimination (i.e refuse to treat). Being aware of these negative experiences and the possibility of experiencing these kind of negative attitudes during health care, complicate to access these service for LGBTI+s. Unfortunately people, themselves, are usually held responsible for overcoming this difficulty and accessing to service needed.
LGBTI+s are likely to report unfavorable experiences of accessing health care. These experiences are related to poor communication with health professionals and dissatisfaction with the treatment and care received. Data such as the fact that LGBTI+s report two or three times more psychological and emotional problems compared to general population (King et all., 2008) underline the gravity of this issue. Indeed it is possible to explain the inadequacy of the steps taken, under the conditions that the need is so visible, through the factors underlying this inequality, however it is impossible to understand it.
As LGBTI+-inclusive education practice has not come in from the cold yet neither in Turkey nor in the world, mental health professionals have to improve themselves in this respect. I think it is necessary to question some norms and beliefs both individually and all across trade bodies, universities and the other educational programs. In my opinion some facts should be acknowledged and announced loudly in the meantime. The first of these facts is abandoning the gender binary classification, considering gender as binary: male or female. This renunciation has to include respecting non-binaries without mincing matters, by leaving all kind of biological, social and derivative essentialism aside. Since exceptional or conditional admittance automatically results in making them invisible. And consequently, we are left with a system where we cannot reach those in need, and only privileged cisgender heterosexuals have no trouble taking advantage of it.
Diversity of sexual practices are also disregarded systematically as the diversities of gender. I use the verb “disregarded” because the non-heterosexual relations, that we may observe in the nature, become discredit, inhibited and punishable behaviors in one way or another when it comes to human relationships, heaven knows why. Similarly, idealizing any form of relationship (monogamy) or the belief that each person has to have a partner, may help us to question the reasons why LGBTI+s cannot receive the service they need, in a broad perspective.
Looking at inequality experienced, with a clinical lens may affect the dissatisfaction of LGBTI+s while accessing to mental health care in two ways. The first one is not (being able) to perform a service related to the problems which are out of reach in the grand scheme of things, and the second one is not to treat LGBTI+ existence on the whole at the clinic unless it is associated with “pathology”. Considering mental health as an inseparable part of one’s well-being would be beneficial instead of approaching it as a tool for eliminating the problems from a medical point of view. By this means we may enable people to state their requirements and to be respected as they deserve.
This outline, which I tried to give, basically tells us two main points. The first one is that LGBTI+s are exposed to discrimination, which is also closely associated with social justice, due to their existence, and as a result of this LGBTI+s are left alone with the responsibility of their attitudes and behaviors. Taking legal measures in order to prevent discrimination based on gender identity, sexual orientation, gender expression and sex characteristic is a way to eliminate this inequality. In addition, health institutions (from hospitals to nursing homes) which have relative autonomy in determining their internal process, may think over how to be inclusive while performing a service and they may improve on immediately. This will result in a harmony between laws and daily life, they will be able to integrate quickly. Surely legislative change is a process which take a long time. Thus, an institutional intervention, which may be justified with the “doing no harm” principle, to prevent inequality, without waiting for the process stage, is an ethical responsibility indeed.
The studies shows that discrimination, itself, and the stress experienced by LGBTI+s related to it, negatively affect the mental health of LGBTI+s in addition to the issue of social justice. This makes another aspect of the ongoing inequality visible. In other words, these negative experiences which have political, social and legal dimensions, become a factor that may affect the mental health of LGBTI+s on its own. Thereby considering the causes of stress specific to LGBTI+s while planning the services, for which mental professionals provide information as an expert, may be another way to eliminate this inequality.
Despite all the negative impact ongoing at the background of the narration, happily some individual and organizational steps are taken thanks to the solidarity of LGBTI+ community, whose visibility increase due to all barriers, and the growing attention among mental health professionals. On top of some studies of associations which are the arbiters of international field like Practice Guidelines for LGB Clients (2021), which was published by American Psychological Association (APA), trainings and workshops, which are oriented to provide inclusive and non-discriminative service in the mental health field for LGBTI+s and hosted by non-governmental organizations in Turkey, offer unique opportunities to disseminate the exact information locally, to transform the attitude and behaviors of mental health professionals, and to give voice to the difficulties experienced in the field. Accordingly organizations like May 17 Association, SPoD (Social Policies, Gender Identity, and Sexual Orientation Studies Association), Kaos GL, Young LGBTI+, Free Colors Association, form a basis for mental health professionals beside their activities for strengthening LGBTI+ community. In addition an inclusive platform, where mental health professionals can share their knowledge and experiences, is offered for the professionals who work in an empowering way and act as an activist (in my opinion). After all, I think it is essential to establish a collaboration between mental health organizations and active LGBTI+ organizations in order to provide a non-discriminative mental health service which is free from phobia and I hope that long-term meetings would realize between these organizations.
American Psychological Association, APA Task Force on Psychological Practice with Sexual Minority Persons. (2021). Guidelines for Psychological Practice with Sexual Minority Persons. Retrieved from www.apa.org/about/policy/psychological-practice-sexual-minority-persons.pdf.
Utamsingh, P. D., Richman, L. S., Martin, J. L., Lattanner, M. R., & Chaikind, J. R. (2016). Heteronormativity and practitioner-patient interaction. Health communication, 31(5), 566–574. https://doi.org/10.1080/10410236.2014.979975
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC psychiatry, 8, 70. https://doi.org/10.1186/1471-244X-8-70
Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. https://doi.org/10.1037/0033-2909.129.5.674
Zeeman, L., Sherriff, N., Browne, K., McGlynn, N., Mirandola, M., Gios, L., Davis, R., Sanchez-Lambert, J., Aujean, S., Pinto, N., Farinella, F., Donisi, V., Niedźwiedzka-Stadnik, M., Rosińska, M., Pierson, A., Amaddeo, F., & Health4LGBTI Network (2019). A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. European journal of public health, 29(5), 974–980. https://doi.org/10.1093/eurpub/cky226
*This article was produced with the financial support of the European Union. Its contents are the sole responsibility of Kaos GL Association and do not necessarily reflect the views of the European Union.
Tags: human rights, health