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Psychiatric-Mental Health Nursing

27.4 Mental Health in the LGBTQIA+ Community

Psychiatric-Mental Health Nursing27.4 Mental Health in the LGBTQIA+ Community

Learning Objectives

By the end of this section, you will be able to:

  • Define sexual orientation and gender identity
  • Identify mental health concerns of persons within LGBTQIA+ communities
  • Discuss nurses’ role in mental health care of LGBTQIA+ clients

Understanding the intersection of mental health and members of the lesbian, gay, bisexual, Transgender, Queer, Intersex, and questioning LGBTQIA+ community is essential for any health-care professional, particularly in the field of psychiatric-mental health nursing. The LGBTQIA+ community, composed of individuals with diverse sexual orientations, gender identities, and gender expressions, has long experienced unique mental health challenges, often stemming from societal discrimination, stigma, and a lack of acceptance. By recognizing the distinct challenges faced by LGBTQIA+ individuals and offering evidence-based strategies for support, future nurses will be empowered to deliver compassionate, inclusive, and culturally competent care that promotes mental well-being and resilience among LGBTQIA+ individuals.

Sexual Orientation and Gender Identity

Sexual orientation and gender identity are two distinct aspects of a person’s being, often related to their understanding of self and their experiences in the world. An individual’s emotional, romantic, and sexual attraction to others is their sexual orientation. It encompasses a range of orientations, including heterosexual (attracted to the opposite sex or gender), lesbian or gay (attracted to the same sex or gender), and bisexual/pansexual (attracted to more than one gender or any gender). People can also identify as asexual, which means they experience little to no sexual attraction to any gender. Sexual orientation is innate and not a choice; it is an integral part of a person’s identity, independent of their gender identity (Human Rights Campaign, n.d.).

The sex category, typically male or female, that is assigned to an individual at birth based on physical and biological characteristics, such as genitalia and chromosomes is their assigned sex. An individual’s deeply held sense of their sex, which may or may not align with the sex assigned to them at birth, is their gender identity. Individuals who have a gender identity that matches their assigned sex at birth (e.g., a person assigned female at birth identifies as a woman) are considered cisgender. Individuals who have a gender identity that differs from their assigned sex (e.g., a person assigned male at birth identifies as a woman) are considered Transgender. People who do not exclusively identify as male or female and may have a gender identity that falls outside the traditional binary understanding of gender are considered nonbinary, also known as genderqueer, genderfluid, or agender. The umbrella term, queer, can encompass various nonheteronormative sexual orientations and gender identities, often used as a self-identifier by individuals who don’t fall within traditional categories. Other terms may include androgyny, meaning no distinction between male and female, third gender, meaning a separate gender apart from male or female, and two spirit, meaning incorporating qualities of both binary genders, sometimes used by Indigenous people.

Intersex is a general term used to describe people whose sex traits, reproductive anatomy, hormones, or chromosomes are different from the usual two ways human bodies develop. Some intersex traits are recognized at birth, while others are not recognizable until puberty or later in life. Intersex people and transgender people are not the same (and they are not interchangeable terms); many transgender people have no intersex traits, and many intersex people do not consider themselves transgender. Furthermore, most recent literature refers to the atypical conditions themselves as "differences of sex development," (DSD); nurses may find relevant guidance and evidence with that terminology, even though many intersex people do not use it to refer to themselves and some reject the terminology (Sandberg, 2022; Davis, 2013).

Wellness and aspects of being through the life span are critical considerations in understanding mental health within the LGBTQIA+ community. LGBTQIA+ individuals often face unique challenges and experiences related to sexual orientation, gender identity, and societal attitudes, which can have a significant impact on their mental well-being.

Coming Out and Identity Formation

Coming out, or the process of disclosing one’s LGBTQIA+ identity, can be a pivotal moment in an individual’s life. It can lead to feelings of self-acceptance and liberation, but it can also be a source of stress and anxiety, particularly when faced with potential rejection from family and friends. Therefore, support during this period is crucial for positive mental health outcomes.

Adolescence and Young Adulthood

LGBTQIA+ youth are at a higher risk of experiencing bullying, discrimination, and rejection, which can lead to mental health challenges like depression, anxiety, and suicidal thoughts (CDC, 2023b). Providing safe spaces, inclusive sex education, and access to mental health services is essential during this critical developmental stage (CDC, 2023b).

Relationships and Community

As LGBTQIA+ individuals form relationships and seek community, they may face discrimination, exclusion, or a lack of legal recognition, which can impact their mental well-being. Supportive relationships and involvement in LGBTQIA+ organizations or communities can be protective factors for mental health (Ceatha et al., 2021).

Older Adults and Identity

LGBTQIA+ individuals may face unique challenges in older age, including potential social isolation, lack of culturally competent health care, and discrimination in long-term care facilities. Addressing these issues is vital for the mental health of older LGBTQIA+ adults (Masa et al., 2024).


Many LGBTQIA+ individuals belong to multiple marginalized groups, such as people of color, immigrants, or individuals with disabilities. Intersectionality adds layers of complexity to their experiences because they may face discrimination based on multiple aspects of their identity, which can contribute to mental health disparities (Funer, 2023).

Resilience and Empowerment

Despite the challenges, many LGBTQIA+ individuals demonstrate resilience and empowerment by embracing their identities, advocating for their rights, and seeking support when needed. Building on these strengths is a vital aspect of promoting mental health and well-being.

Culturally Appropriate Care

Mental health professionals and health-care providers must be sensitive to the unique culture and experiences of LGBTQIA+ individuals. This includes understanding the impact of discrimination, addressing concerns related to gender identity or sexual orientation, and offering affirming and inclusive care.

Mental Health Issues and Stigma Against People in LGBTQIA+ Communities

People within the LGBTQIA+ communities frequently grapple with elevated rates of mental health issues, often stemming from the pervasive discrimination, stigma, minority stress, and social rejection they may encounter. LGBTQIA+ individuals are not a homogenous group, and mental health experiences are shaped by intersecting identities, such as race, ethnicity, socioeconomic status, and disability. Intersectional factors can compound the challenges faced by LGBTQIA+ individuals. These stressors and unique obstacles can lead to heightened rates of anxiety, depression, and even suicidality among LGBTQIA+ individuals (Funer, 2023).

Higher Rates of Mental Health Conditions

Research consistently indicates that LGBTQIA+ individuals experience higher rates of mental health conditions compared with the general population (Medina-Martínez et al., 2021). Common mental health issues include depression, anxiety, substance misuse, and suicidal ideation. These disparities are often attributed to the stressors associated with societal discrimination and minority stress.

Some individuals experience gender dysphoria, a psychiatric disorder where the individual feels significant distress or discomfort due to the incongruence between their assigned gender at birth and the gender with which they identify (Turban, 2022). The distress associated with gender dysphoria can impact various aspects of an individual’s life, including emotional well-being, mental health, and social functioning. It’s important to note that gender dysphoria is a recognized medical condition, and not every Transgender or gender diverse individual experiences gender dysphoria.

Social Isolation and Internalized Stigma

Some LGBTQIA+ individuals experience social isolation due to a lack of acceptance from their families, communities, or cultures (Firk et al., 2023). This isolation can contribute to feelings of loneliness and depression. Moreover, internalized stigma occurs when LGBTQIA+ individuals internalize negative beliefs and stereotypes about their own sexual orientation or gender identity. This self-stigmatization can lead to feelings of shame, low self-esteem, and poor mental health.

Finding supportive LGBTQIA+ communities and networks can be crucial for combating social isolation and internalized stigma.

Barriers to Accessing Care

Barriers to mental health care can include a lack of culturally competent providers, concerns about stigma and discrimination from health-care professionals, and financial barriers. These obstacles can prevent LGBTQIA+ individuals from seeking and receiving the care they need.

Marginalization and Stereotyping

Marginalization and stereotyping exert a profound impact on the mental health of individuals within LGBTQIA+ communities, erecting significant barriers to accessing mental health care and contributing to mental health disparities. Exclusion, discrimination, and the denial of rights, or marginalization, often leads to feelings of isolation and low self-esteem. It can contribute to mental health issues, such as depression and anxiety (Green et al., 2021). Individuals may refrain from seeking mental health care due to fears of encountering further discrimination from health-care providers. Stereotyping, involving generalized assumptions based on LGBTQIA+ identity, likewise perpetuates stigma and bias, dissuading individuals from seeking mental health support out of concern for judgment or prejudice (Anzani et al., 2024).

Marginalization and stereotyping collectively obstruct access to care, resulting in delayed interventions and exacerbated mental health conditions. Addressing these issues necessitates promoting LGBTQIA+ inclusivity, educating society on acceptance, providing cultural competency training for health-care providers, and creating safe, affirming spaces for mental health care within LGBTQIA+ communities to reduce mental health disparities and ensure equitable access to care.

Minority Stress

The unique stressors and adverse mental health outcomes experienced by individuals in marginalized and stigmatized groups is called minority stress (Goldbach, 2021). LGBTQIA+ individuals may face minority stress due to their sexual orientation or gender identity. It encompasses stress-inducing experiences like coming out, experiencing discrimination and microaggressions, and fearing rejection. Minority stress can lead to adverse mental health issues and contribute to disparities in health-care access and outcomes.

The Nurse’s Role

Client-centered care is of paramount importance for LGBTQIA+ clients in mental health settings because it acknowledges and respects their unique experiences and needs (American Nurses Association [ANA], 2018). Providing care that is client-centered means actively listening to clients, understanding their specific concerns related to sexual orientation and gender identity, and tailoring treatment plans accordingly. It fosters a trusting and affirming therapeutic relationship, which is essential for individuals to feel safe discussing their mental health challenges, coming out experiences, or questions or concerns about their gender. By prioritizing the client’s voice and perspective, health-care providers can offer more effective and compassionate care, ultimately improving mental health outcomes and reducing disparities for LGBTQIA+ individuals (ANA, 2022).

Diverse and Culturally Competent Interventions

Providing inclusive and culturally competent nursing care is imperative when supporting individuals within the LGBTQIA+ community. Nurses play a pivotal role in ensuring that the care they deliver is respectful, affirming, and responsive to the diverse needs of LGBTQIA+ clients. This involves adopting a multifaceted approach that acknowledges the unique experiences and challenges faced by individuals across various gender identities and sexual orientations. From fostering open communication to understanding the nuances of gender-affirming care, the nurse’s toolkit encompasses a myriad of specific, diverse, and culturally appropriate interventions. There are many specific, diverse, and culturally competent interventions for the nurse to implement when assisting LGBTQIA+ clients (National LGBT Health Education Center, n.d.), such as:

  • Affirming language and pronouns: Use respectful and gender-affirming language. Always ask for and use the client’s preferred name and pronouns. This simple gesture helps build trust and respect.
  • Cultural sensitivity training: Health-care providers should undergo training on LGBTQIA+ cultural competency to understand the unique challenges, experiences, and health disparities faced by this community. This training should include awareness of intersectionality, or the overlapping identities that affect individuals’ experiences.
  • Safe and inclusive spaces: Create an environment that is visibly LGBTQIA+-friendly. Display inclusive signage, pamphlets, or materials that signal acceptance and provide privacy for sensitive discussions.
  • Inclusive assessment: Ask open-ended questions about the client’s experiences, including coming out, family support, and discrimination. Understanding their lived experiences is crucial for tailoring interventions effectively.
  • Mental health support groups: Offer LGBTQIA+-specific mental health support groups or therapy options where clients can connect with others who share similar experiences. This can reduce isolation and provide a sense of community.
  • Education and resources: Provide educational materials and resources about LGBTQIA+ mental health, including information about coming out, gender dysphoria, and the unique stressors faced by LGBTQIA+ individuals.
  • Crisis intervention: Be prepared to provide crisis intervention with sensitivity to LGBTQIA+ issues. LGBTQIA+ individuals may face unique stressors, such as rejection from family or a lack of social support.
  • Transgender health care: For Transgender clients, ensure access to gender-affirming care, including hormone therapy and surgical referrals when appropriate. Understand the importance of gender-affirming care in mental health outcomes.
  • Family support and education: Offer family therapy or support groups to help families better understand and accept their LGBTQIA+ loved ones. A supportive family can have a significant impact on an individual’s mental health.
  • Advocacy: Advocate for LGBTQIA+ clients within the health-care system to ensure they receive equitable and respectful care. Address any discriminatory practices or barriers to care.
  • Crisis helplines: Provide information about LGBTQIA+ crisis helplines and support services for individuals who may be facing immediate mental health challenges (Bass & Nagy, 2023).


LGBTQIA+ nurses may encounter several challenges within the health-care profession. Discrimination and bias, whether from colleagues or clients, can create a hostile work environment. The decision to disclose one’s LGBTQIA+ identity at work can be a dilemma, often driven by concerns about potential discrimination or bias. Some health-care institutions may lack inclusive culture, making it difficult for LGBTQIA+ nurses to feel accepted and respected. Additionally, experiencing discrimination or bias can take a toll on mental health, leading to stress, anxiety, or depression.

To address these challenges, LGBTQIA+ nurses can tap into various resources. Joining LGBTQIA+ support groups, both within and outside the workplace, can provide a safe space for networking, sharing experiences, and seeking guidance. Professional associations like the National LGBTQIA+ Health Education Center offer resources and support specifically tailored to LGBTQIA+ health-care professionals, including nurses. Seeking out employers with LGBTQIA+-friendly policies and practices, such as nondiscrimination policies and diversity training, can contribute to a more inclusive work experience. Utilizing mental health services or counseling can help address the emotional toll of discrimination, while continuous education on LGBTQIA+ health issues and cultural competency empowers nurses to advocate for their clients and themselves.


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