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Providing Mental Health First Aid to LGBTQ+ Communities

Reducing stigma and creating a person-first approach are central tenets of Mental Health First Aid (MHFA). Abiding by them will help guide honest, non-stigmatizing conversations with members of the lesbian, gay, bisexual, transgender, queer/questioning, intersex (LGBTQ+) or sexual orientation and gender identity (SOGI)[1] communities in the United States.

Each individual is unique, and it is important to tailor your support to that person’s needs without making assumptions about their identities or communities. This blog post includes recommendations, guidelines and facts that can inform your conversations as you provide or teach Mental Health First Aid.

Mental health challenges in LGBTQ+ people

LGBTQ+ experiences and identities are not mental health challenges, nor do they cause them. However, people in the LGBTQ+ communities are at an increased risk of depression, anxiety, eating disorders, substance use challenges, suicidal thoughts and behaviors, and nonsuicidal self-injury (MHFA, 2020). Risk factors include discrimination, prejudice and abuse. For example, due to stigma and discrimination, transgender youth are as much as four times more likely than their non-transgender peers to experience depression and suicidality (Reisner et. al., 2015).

Keep in mind, not all people experience distress related to their LGBTQ+ experience. Do not assume that LGBTQ+ experiences are connected to any mental health problems or distress a person may be experiencing.

Substance Use in the LGBTQ+ Communities

Substance use in the LGBTQ+ communities is greater than in the general population. Drug and alcohol use is particularly concerning in young adults, whose brains are still developing. According the MHFA Adult Manual (MHFA, 2020), substance use often begins in adolescence or early adulthood, and 75% of substance use challenges begin by the time a person is 27 (MHFA, 2020).

In a March 2021 webinar for the National Council for Mental Wellbeing, Steve Haden, CEO of Envision You, a Colorado nonprofit, noted that whereas the general population experiences a substance use challenge at rate of about one in nine (11.1%); that figure jumps to one in 4 (25%) in the LGBTQ+ communities (National Council for Mental Wellbeing, 2021).

Similarly, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey on Drug Use and Health (2020), shows 16.5% (2.1 million people) of those who identify with the lesbian, gay and/or bisexual communities reported substance use disorder — 49.7% with illicit drugs, 70.2% with alcohol use, and 19.9% with both.

Chapter 10 of the MHFA Adult Manual (MHFA, 2020) goes into detail about applying the MHFA Action Plan (ALGEE) in situations involving substance use.

Supporting the person who is LGBTQ+

Person-first language is a core principle of MHFA. Start by treating the person you’re helping as a person, rather than defining them by their LGBTQ+ experience.

Although no one is obligated to share their experiences, helping the person to feel comfortable in your presence can go a long way toward an open exchange of feelings and thoughts. You can contribute to an open environment:

  • Affirm and acknowledge the person’s LGBTQ+ experience. Denying a person’s sexual or gender identity is disrespectful and might escalate a crisis situation.
  • Ask them what help they need, rather than making assumptions.
  • Respect their choices in clothing, name and pronouns, even if you don’t understand or feel comfortable with them.
  • Listen nonjudgmentally: You do not need to have answers or provide advice.
  • Do not offer your opinion on the person’s LGBTQ+ experiences.
  • Do not express judgement about the person’s LGBTQ+ experiences.
  • Do not refer to your own religious or moral beliefs about people who are LGBTQ+.
  • Do not give the person the impression that being LGBTQ+ is a “deviation from the norm.”
  • Do not say things that are intended to reassure, but are mostly unhelpful or patronizing like, “Some of my best friends are gay.”

Some of the supports that non-LGBTQ+ people use may not be appropriate for an LGBTQ+ person. For example, if the person’s family of origin has rejected them because of their LGBTQ+ identities or experiences, encourage the person to seek support from other sources. One place to start might be the LGBT National Help Center. (See Resources for hotlines serving adults, young adults under 25 and adults over 50.)

However, do not assume that the broader LGBTQ+ community will be supportive of the person you are helping. People who are transgender or intersex and identify as heterosexual may not feel part of either the LGBTQ+ or straight communities. Similarly, a bisexual person may not feel part of either the LGBTQ+ or straight communities, because they can face prejudice from both. These are two examples of an infinite number of situations one may experience.

Seeking treatment for mental health challenges

You should know about sources of information and resources relevant to the mental health of LGBTQ+ people, including local services and professionals that specialize in working with people who are LGBTQ+ or are LGBTQ+-inclusive.

Do not assume that all “LGBTQ+-inclusive” services are appropriate for the person’s specific experience. Help the person find resources and services relevant to their experience, where available, e.g., gender-affirming services. If a person is reluctant to use an LGBTQ+-specific service, help them find other services that are LGBTQ+-inclusive.

You should be aware of the potential barriers limiting access to professional help for LGBTQ+ people, such as actual or anticipated discrimination, and ask them if there are any barriers preventing them from receiving the support they need. If the person lives in a rural area, they may face additional challenges, including geographical isolation and limited access to mental health services.

If appropriate services are not available, or the person is not comfortable accessing face-to-face services because of their LGBTQ+ experience, consider recommending online resources, including online counseling.

If the person is in a mental health crisis situation, you can enlist the help of others without sharing the person’s LGBTQ+ experience. You should also be aware of the possibility of family (family of origin or family of choice) or intimate partner violence and, if needed, offer contacts for appropriate services.

If you are a Mental Health First Aider, thank you for choosing to #BeTheDifference.

If you have not taken MHFA or are interested in MHFA for a specific population, find a course today.

References

Blazucki, S., McMillan, J. (editors). (2020, December). NLGJA: The Association of LGBTQ Journalists Stylebook on LGBTQ Terminology. https://www.nlgja.org/stylebook/

GLAAD. (n.d.) GLAAD media reference guide – transgender. GLAAD. https://www.glaad.org/reference/transgender

Mental Health First Aid Australia. (2016). Considerations when providing mental health first aid to an LGBTQ+ person. Melbourne: Mental Health First Aid Australia.

Mental Health First Aid USA. (2021, February 16). Supporting Black participants during MHFA trainings. Mental Health First Aid USA. https://instructors.mentalhealthfirstaid.org/blog/supporting-black-participants-during-mhfa-trainings

Mental Health First Aid USA. 2020. Mental Health First Aid USA for Adults Assisting Adults. Washington, DC: National Council for Behavioral Health.

National Alliance on Mental Illness (NAMI). (n.d.). Identity and Cultural Dimensions: LGBTQI. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI

National Center for Transgender Equality. (n.d.) Frequently asked questions about transgender people. National Center for Transgender Equality. https://transequality.org/issues/resources/frequently-asked-questions-about-transgender-people

National Council for Mental Wellbeing (2021, March 16). CoE Office Hour: Strategies for improving care to LGBTQI communities. (Recorded webinar.)

Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M. J. (2015, January 7). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56(3), 274-279. doi: https://doi.org/10.1016/j.jadohealth.2014.10.264

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. (2020). National survey on drug use and health: lesbian, gay, & bisexual adults. https://www.drugabuse.gov/drug-topics/substance-use-suds-in-lgbtq-populations.

US Department of State Bureau on Educational and Cultural Affairs. (n.d.). Sexual orientation and gender identity (SOGI) terms and definitions. https://eca.state.gov/files/bureau/sogi_terminology.pdf

Resources

GLAAD (glaad.org)

GLAAD works through entertainment, news, and digital media to share stories from the LGBTQ community that accelerate acceptance.

Human Rights Campaign (hrc.org)

By inspiring and engaging individuals and communities, the Human Rights Campaign strives to end discrimination against LGBTQ people and realize a world that achieves fundamental fairness and equality for all. HRC envisions a world where lesbian, gay, bisexual, transgender and queer people are ensured equality and embraced as full members of society at home, at work and in every community.

LGBT National Help Center (glbthotline.org)

The Lesbian, Gay, Bisexual and Transgender (LGBT) National Help Center, founded in 1996, is a non-profit organization that provides peer support, community connections and information to people who have questions regarding sexual orientation and/or gender identity. Among other services, the LGBT National Help Center operates the LGBT National Hotline (888-843-4564), the LGBT National Youth Talkline (800-246-7743) and the LGBT National Senior Hotline (888-234-7243).

National Alliance on Mental Illness (NAMI) (nami.org)

NAMI, the National Alliance on Mental Illness, is a grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

National Center for Transgender Equality (transequality.org)

The National Center for Transgender Equality (NCTE) advocates to change policies and society to increase understanding and acceptance of transgender people.

PFLAG (pflag.org)

PFLAG is the first and largest organization for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, their parents and families, and allies.

The Trevor Project (thetrevorproject.org)

The Trevor Project is a national organization providing crisis intervention and suicide prevention services to LGBTQ young people. Trained counselors are available 24/7 to support people under 25 who are in crisis, feeling suicidal, or in need of a safe and judgment free place to talk. Call 866-488-7386 or text “START” to 678-678.

[1]  The US Department of State’s Bureau on Educational and Cultural Affairs uses SOGI to discuss its work in the US and abroad to support these communities. A list of terms and definitions may be found at sogi_terminology.pdf (state.gov)