Fighting bias and stigma to ensure LGBTQIA+ children and adolescents get the mental health care they need
Billie Henderson was 15, a sophomore in high school, an honor roll student, and nationally ranked video gamer. But she wasn’t happy. She struggled with anxiety and depression, both amplified by the fact that, at the time, Billie was coming out as transgender. She was also anorexic. Billie told her mother that she simply didn’t think she deserved to eat. Her mother, a behavioral health professional, urged Billie to seek help.
But finding a psychologist who could help Billie proved to be difficult. In fact, one therapist, after reviewing Billie’s file, told the family that it wouldn’t be a good fit. It was because she was transgender.
“A lot of people are afraid to work with trans teens,” says Billie. “They say they don’t have the experience. But how do you get the experience if you don’t work with trans teens?”
Even child and adolescent therapists who agreed to see Billie weren’t addressing all her needs. They all tried to fit her unique situation into a standard form of treatment. Finally, she came to Providence, where, for the first time, care providers took time to really know Billie and meet her where she was.
Billie isn’t alone. Across the country, there is a growing need for behavioral health care services for LGBTQIA+ patients. In addition to the mental health issues that affect all ages, genders, races, religions, and ethnicities, the LGBTQIA+ population has specific needs that aren’t often addressed with current behavioral health protocols — especially LGBTQIA+ youths.
A lot of people are afraid to work with trans teens. They don't have the experience.
One major issue is transphobia and homophobia inherent in the health care providers. This is especially prevalent in, though certainly not limited to, rural areas where access to any mental health care is already severely limited.
“Providers need training,” says Heather Rodriguez, assistant professor of social work and sociology at Walla Walla University and Providence partner in the Reach Out Walla Walla program. “People are entitled to their beliefs, but you don’t have the right to impose those beliefs onto others. Put your moral compass in your pocket when you’re treating someone. You’re not there to judge — you’re there to help them.”
Even providers who aren’t overtly biased against LGBTQIA+ patients may unintentionally cause harm. Inattention to a patient’s confidentiality and inadvertently outing a patient by using their birth name or wrong pronoun or simply not having a safe, gender non-binary bathroom in the office.
And then there is the question of the mental health counseling itself. Rodriguez says it’s crucial for providers to understand that LGBTQIA+ patients suffer from the same mental health problems that afflict all children and adolescents. “You can’t pathologize it,” she says. “They’re not coming to you because they are gay, they are coming to you because their parents are getting divorced.”
But at the same time, it’s important to understand that the experience of being gay or trans in an unaccepting family or community can affect, and in some cases cause or significantly exacerbate, other mental health issues.
“Mental health issues are compounded by trauma,” says Rodriguez. “It adds layers if you live in an abusive home. You have to treat the individual’s unique needs. What is their story? What do they need to feel like a whole person?”
That’s the type of care Billie got when she came to Providence, which seeks to provide safe and affirming quality health care and mental health services to LGBTQIA+ patients, friends, and families. They make an effort to recruit, retain, and support an LGBTQIA+-inclusive workforce and train physicians and staff members about disparities that hurt LGBTQIA+ communities. And perhaps most crucially, they meet patients where they are and tailor treatment to their individual needs. Billie is still receiving care from Providence and says she appreciates that, “they talk to kids who are suffering and learn their habits.”
“Our commitment is to care for each patient as a whole person,” says Dr. Ira Byock, who leads the Providence system’s efforts to enhance the care and experience for non-binary and transgender patients. “We are implementing guidance and best practice recommendations, educating clinicians, staff as well as patients, and establishing Patient-Family Advisory Councils to review education materials, routinely inform our practices and improve patient experience.”
People are entitled to their beliefs, but you don't have the right to impose those beliefs onto others.
Our commitment is to care for each patient as a whole person.
If you or someone you know is in need of assistance with mental health concerns, please visit work2bewell.org/wellnessresources. Please know there’s always help available whenever you need to talk to someone. Reach out to the Crisis Text Line (Text TALK to 741741) or the National Suicide Prevention Lifeline at 1-800-273-TALK to talk to someone who can help.