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The
following are suggested guidelines toward effective and culturally competent
treatment with LGBT mental health consumers.
•
Use inclusive language. In many clinics and inpatient
units, male patients are routinely asked, “Are you married, or do
you have a girlfriend?” Many LGBT consumers will interpret this as
a signal that the care provider is unwilling to hear about relationships
that fall outside a heterosexual paradigm, and some of them will be
silenced. Using more inclusive language, such as “Are you in a relationship
right now?” or “What kind of people do you tend to have relationships
with?” is a simple change that may have far-reaching results.
•
Be aware of subtle signals you may be sending. Nearly
all LGBT people at some point in their lives have lost or disrupted
relationships with friends, family members, or religious communities
over disclosure of their sexual or gender identity. As a result, many
of them are hypervigilant toward possible clues as to whether a given
person may or may not be accepting and supportive of them. The use
of routine language such as that in the previons example can unintentionally
telegraph a heterosexist point of view. Conversely, hanging even a
small pro-LGBT flyer in yoru waiting room, or posting information
about LGBT resources in your community, may make LGBT consumers feel
that their disclosures are welcome.
•
Welcome and normalize LGBT disclosures . A tentative
disclosure of LGBT identity or experience can be welcomed with a simple
“I’m glad you told me that.” This can be followed with the same kind
of questions that would follow upon any consumer’s mentioning of a
relationship or experience, such as “What’s he like?” or “Where did
you meet her?” Showing a LGBT consumer that you are willing to put
yourself in his or her shoes (e.g., “That must have really hurt,”
or “That’s great, I’m happy for you!”) can have a tremendous effect
on the working alliance and undo some of the estrangement from the
mental health establishment that many LGBT consumers experience.
•
Utilize knowledge about consumer sexuality in discharge planning.
At Rainbow Heights Club, a number of consumers have a long
history of decompensations and hospitalizations, and yet have long
standing, supportive, monogamous relationships. If you are working
with consumers, the person’s romantic partner, as well as their network
of friends, are all potential members of your treatment team. Partners,
loved ones, friends, and family can provide crucial information, invaluable
support for treatment compliance, and ongoing monitoring of the consumer’s
mental status. Welcoming these collateral contacts and taking them
seriously can amplify the effectiveness of your work and generate
improved outcomes.
•
Avoid overpathologizing – and underpathologizing. Some
care providers pathologize any aspect of a consumer’s expression of
sexual or gender identity, interpreting it as further evidence of
the person’s illness. But efforts to express sexuality and find connections
with others are often the locus of a great deal of creativity, resilience,
courage, and even playfulness. These qualities deserve our support
and admiration. Conversely, however, it is not helpful to assume that
every expression of a consumer’s sexuality or gender identity is to
be celebrated. Any such activity should be pragmatically evaluated
in terms of its effects on the consumer’s physical and emotional health,
self-esteem, and relationships.
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