How the spate of anti-LGBTQ legislation is affecting patients — and therapists

The LGBTQ+ community is struggling.

Last year saw a record number of anti-LGBTQ bills introduced in state legislatures: a total of 510, up from 180 the previous year, according to data from the ACLU .

Many of those bills had a healthcare component, limiting the ability of transgender individuals to access gender-affirming care. And the sum total of all of them has worsened the mental health crisis among LGBTQ individuals.

As many as 41% of young people who identify as LGBTQ struggled with suicidality last year, including half of transgender and nonbinary individuals, according to The Trevor Project , an advocacy group focused on this issue. Meanwhile, 56% of individuals who wanted to access mental healthcare weren’t able to get it.

Compounding the issue is the challenge of finding culturally-competent care, especially outside of major cities.?

Healthcare professionals still have limited training in LGBTQ health — and while things are improving, movement has been slow. While the vast majority of U.S. medical schools cover the topic, a 2020 paper found that students were receiving just 2.22 hours each year of LGBTQ-related education. Granted, that number was up from five hours, total, a decade ago.?

The situation is similar at nursing schools. Also in 2020, another survey in the Journal of Nursing Education found that most programs teach less than five hours of LGBTQ-related content, with smaller schools and those located in the South providing fewer educational hours than their counterparts. Two-thirds of programs at both the graduate and undergraduate level said they did not believe they had sufficient content to prepare their students for their future jobs.

But the survey did include this bright spot: 70% of nursing programs said they were interested in expanding LGBTQ content. And two years later, 美国纽约大学 and the University of Pennsylvania School of Nursing made headlines for adding an LGBTQ course to their curricula.

But it's not just patients who are struggling. LGBTQ clinicians are also feeling the weight of the current political environment, whether that's patients who refuse to see them, concern for their physical safety or feeling like their decisions are under greater scrutiny.

This Pride Month, I had a chance to chat with Anna Paganelli , a licensed marriage and family therapist based in Santa Cruz, Calif. We talked about not only the mental health crisis in this community but how these issues affect therapists who identify as LGBTQ. You can read our conversation below.

The following transcript has been edited for length and clarity.

LinkedIn News: What are some of the unique challenges that LGBTQ+ patients face?

Paganelli: The biggest one has to do with coming out; it can be fairly fraught. Queer people aren't always accepted, especially if you're younger and you have a family that may not be as supportive, or you're in a school system that isn't as supportive as you might like.

One of the big questions right now has to do with all the anti-LGBTQ legislation coming out that is really oppressive to people. It's frightening if you're trans or nonbinary and seeing that upswing. It makes us more afraid. It's much more stressful. You worry about whether you're going to be safe physically and mentally.

LinkedIn News: LGBTQ individuals already have a higher risk of anxiety, depression and suicidality. How are things now with the spate of anti-LGBT legislation that we’re seeing?

Paganelli: ?It is so much worse. It's so much worse. People are so much more scared and feeling more isolated and more afraid about coming out. The stress of it has really been difficult. The issues around suicidality — and you can see this from all the studies — it's not about being queer itself. It's about how that fits within the communities that you're in.?

LinkedIn News: You're in California. Are you getting more calls from out-of-state individuals?

Paganelli: We get a lot of calls about it. There's a huge effort from therapist organizations to make sure that we reach people who are looking for therapists. There is the dearth of therapists for people who are in more rural places, both in and outside of California. It's just extraordinary; it's going way back in the wrong direction. Fortunately, one of the things that has been terrific is telehealth.?

Some people are licensed in multiple states and sometimes you can get exceptions [to work with underserved communities], but in general you're working with clients who are within your state. It makes it much easier for clients in California and in states that have legislation that is very supportive. But we do hear about it worsening significantly in other states and a lot of people honestly are leaving states where they don't feel like their kids or they can get the care that they need.

LinkedIn News: The trend in primary care these days is integrated care. What should primary care clinicians take away from this conversation?

Paganelli: Make sure that you are aware of the queer resources in your community. Familiarize yourself with the therapists who work with kids, who work with adults, who work with older adults, who have some background in working with queer clients. And then work back and forth collaboratively with them. If you have any concern about mental health, especially around suicidality, make sure you're working closely with the therapist.

LinkedIn News: ?How does the current legislative environment affect therapists?

Paganelli: That one really depends on where you are. In a state like California, it’s a non-issue relative to other places. Some of the legislation now [in other states] is super frightening. It's not just the legislation; it's the way that legislation affects people's behavior. We've been able to track for years that when anti-queer legislation passes, the amount of violence towards queer people goes way up and it's everything from people accusing you of predatory behaviors to people not wanting to send their kids there, or people not wanting to come to you.

What I hear from friends who are in other states is you get much more afraid about who comes into your office and also what your documentation is like. You can be put under much more scrutiny in certain states these days if you're a queer therapist.

LinkedIn News: Are there ways to protect yourself as an LGBTQ therapist?

Paganelli: The big sea change that has happened has been that people who are not queer have become so much more supportive. There's so much less of a binary of queer and not-queer; that used to be really profound, and it's just not there as much.

People who are not queer also continue to show support in so many ways — from the little things like Pride flags to bigger things like not standing back when there's anti-queer legislation happening. If people continue to stand up and be public about it, it really helps make it a safe space for therapists as well to be able to practice. And it also helps make it more possible for us to help the community.