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An estimated 5.6% of the U.S. adult population identifies as lesbian, gay, bisexual, or transgender, and LGBTQ+ self-identity is highest among Gen Z-ers and increasing among children and adolescents. Individuals who identify as LGBTQ+ experience health disparities linked to societal stigma and discrimination in their home, school, and work environments that is associated with higher rates of mental health problems. Compared to the general population, LGBTQ+ individuals experience higher rates of tobacco, alcohol, and illicit drug use as well as higher rates of depression, suicidal ideation, and suicide attempt. Lack of acceptance by healthcare providers and lack of access to culturally competent and supportive healthcare providers compounds the mental health challenges that LGBTQ+ persons face. These barriers and outcomes are exaggerated among certain subgroups due to intersectionality of LGBTQ+ identity with various demographic and social determinants of health such as race/ethnicity, sex-at-birth, and age.

Our department is committed to the health and well-being of all of North Carolina’s citizens, and to providing culturally competent care to all our patients. Nearly 400,000 North Carolinians age 13 or older identify as LGBTQ, and 44,750 North Carolinians identify as Transgender (U.S. rank, 16th). According to the 2019 Southern LGBTQ Health Survey, LGBTQ North Carolinians experience higher rates of depression (68%), anxiety (59%), suicidal ideation (33%), self-harming behaviors (24%), and PTSD (5%) than their LGBTQ counterparts from nearby states, with even higher rates among Black, transgender, and Black-transgender North Carolinians.

To address the unique mental health needs of LGBTQ+ North Carolinians, UNC Psychiatry faculty and staff advocate for ease of access to gender diverse youth and provide state-wide consultations for patients, families, and providers. We provide community collaborations for whole person care throughout the state for LGBTQ+ youth. The department officially established transgender care in 2003 and the Gender Equality Wellness Initiative (GEWI) in 2017. GEWI was established with a mission of providing coordinated evidence-based care for gender diverse individuals ages 4-30 years (and their families) who are exploring or undergoing gender affirming treatment in North Carolina and the local Southeast region We follow AMA and APA guidelines of care, established in 2015. The impact of the COVID-19 pandemic this group has been unprecedented, and the department has increased services and accessibility through expanded telehealth to better serve this and many other vulnerable populations. Currently, 700+ gender diverse and transgender youth are in active collaborative care with psychiatry, endocrinology, and family medicine. We actively engage in continuing education and scholarly efforts related to LGBTQ+ mental health by providing lectures on gender dysphoria in the transgender patient with autism, contributing to parent and family resource articles on youth exploring gender expression.

 

Tips for Affirmative Therapists

Talk about your LGBTQ affirmative stance to colleagues, potential clients, family, and friends.

Be aware of your own heteronormative and gender normative assumptions.

Know the LGBTQ resources in your local community.

Acknowledge that each person has a unique story related to personal discovery and disclosure of their sexual orientation and/or gender identity.

Know the differences between sexual orientation and gender identity.

Use correct terminology. When in doubt about how to talk about identity, ask!

Ensure that intake forms include a blank option for gender and acknowledge LGBTQ relationships.

Access LGBTQ affirmative continuing education.

 

LGBT Youth Resources from the CDChttps://www.cdc.gov/lgbthealth/youth-resources.htm

APA workshop on Preventing health risks and promoting healthy outcomes among lesbian, gay, bisexual, transgender and questioning students.

https://www.apa.org/pi/lgbt/programs/safe-supportive/training/respect-workshop