Podcast: Mental Health and the LGBTQ+ Community

Jeff talks to Dr. Jeff Day about mental health and the LGBTQ+ community. Jeff Day touches upon some of the challenges that the LGBTQ+ community members face regarding mental health, and the challenges they come across in receiving care. He also offers his recommendations of resources that can help make these challenges easier to work through.

Jeff Day, DNP, AGPCNP-BC, CNEcl, is a doctor of nursing practice and a clinical assistant professor at NYU Rory Meyers. He is an expert in the field of LGBTQ+ medical care and is chair of the Nursing Section of GLMA (Gay & Lesbian Medical Association). He also launched and teaches one of the first elective courses on LGBTQ+ Health in the country at NYU Rory Meyers.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Jeff Bell: Welcome, and thanks for joining us. My name is Jeff Bell, and on behalf of McLean Hospital, I’d just like to say it’s great to have you with us for another episode of our educational webinar series. Our focus today, mental health and the LGBTQ+ community.

Now, mental health challenges certainly impact people of all sexual orientations and gender identities, but the research is clear. It says that members of the LGBTQ+ community face these challenges at higher rates than heterosexual and cisgender individuals.

Why? Well, the experts point to stigma and discrimination as likely contributing factors. They also note that many in this community face additional barriers to treatment.

Our goal today is to explore the most prevalent mental health challenges facing those who identify as LGBTQ+ and discuss where they can turn for help. We also want to share some tips for supporting someone in this community.

So, for all of this, we are going to bring in Jeff Day, a Doctor of Nursing Practice, a sought-after expert in LGBTQ care as well. He is a Clinical Assistant Professor at NYU Rory Meyers College of Nursing, and he’s doing some groundbreaking work to help prepare nursing students to meet the needs of LGBTQ+ individuals. Jeff, I am so grateful to have you with us today.

Jeff Day: I’m happy to be here. Thank you so much. And thank you to those attendees, I appreciate it.

Jeff Bell: Well, listen, before we dive in, I want to ask you to help clarify some of the vocabulary used in discussions involving the LGBTQ+ community. So how about I give you a term, and you give us a definition. We’ll do a couple of rounds of this.

Jeff Day: Sure.

Jeff Bell: Okay, let’s start with sexual orientation.

Jeff Day: Sexual orientation. The desire one has for emotional, romantic, and/or sexual relationships with others.

Jeff Bell: Gender identity.

Jeff Day: Gender identity is one’s psychological sense of self. So, who one knows themselves to be based on how much they align or don’t align with what they understand to be the options for gender.

And there are two that sort of break down under gender identity that I’d like to share with you. They include cisgender and transgender.

Cisgender is a person whose gender identity matches the sex that they were assigned at birth. And a folk who is transgender is someone whose gender identity differs from the sex that was assigned to them at birth.

Jeff Bell: Finally, LGBTQ+, including the plus. Will you break all that down for us?

Jeff Day: Absolutely. An LGBTQIA+ breakdown. Let’s see, lesbian is the L. Lesbian is a woman or non-male who is attracted to other women or non-males. Some prefer to identify as gay women, who, along with bisexual women, comprise women who have sex with women or sexual minority women. You may hear those terms as well.

The G stands for gay. It is an umbrella term used more specifically to describe men who are attracted to men, who, along with bisexual men, comprise men who have sex with men or sexual minority men.

The B is for bisexual, who is someone attracted to those of their same gender as well as those of a different gender.

Transgender, which I touched on a moment ago, someone whose gender identity differs from the sex that they were assigned at birth.

Q actually has two meanings. The first is queer. Queer is a term that’s been reclaimed by our queer youth. It was heretofore a negative term, but since has been brought back into the vernacular.

Queer stands for sexual orientation that is not exclusively heterosexual or straight. It includes terms that you may have been hearing, non-binary, gender fluid, or gender nonconforming identities.

The other Q is questioning. So, a time in many people’s lives when they question or experiment with their gender expression, gender identity, and/or sexual orientation.

We’re now at the I. I stands for intersex. And intersex is an individual whose genitals, chromosomes, internal reproductive organs, or sexual anatomy, does not seem to fit the typical definitions for female or male sex.

The A is for asexual, also known as ace, and that is someone who experiences little or no sexual attraction.

And then the plus includes all the existing sexual orientation and/or gender identities that words cannot yet fully describe. And an example is two-spirit. Two-spirit is an umbrella term which bridges indigenous and western understandings of gender and sexuality.

Jeff Bell: Wow. Well, thanks for breaking all that down for us. Language matters when we’re talking about any topic in mental health, and certainly in this one. And while we’re speaking about language, I want to ask you about personal gender pronouns. Where are we currently with the use of them, and what do you want us to know about those pronouns?

Jeff Day: Sure. So, those pronouns that are familiar to all of us include she, her, hers, he, him, his. There are others that are out there. Too many to name. The ones that I think are new that are most common would be ze. So it would be ze, zem, zer. You may have heard per, so per, per, pers.

But what I’d really like to share with you with regards to pronoun is it’s no longer “preferred” pronoun. So, when you are interviewing a client or meeting a friend for the first time, rather than asking, “What are your preferred pronouns,” simply ask, “What are your pronouns?”

Jeff Bell: What if, for folks who are not part of this community, they feel uncomfortable using a particular term, what is your guidance to them in terms of not wanting to offend somebody, wanting to get it right, and not knowing what to do?

Jeff Day: Yes. The very best thing that I found in my clinical practice is to give a disclaimer. This language is new to me. I want to make sure that I don’t do anything to offend you. If I make a mistake, please just let me know, and I will do what I can to correct it, and know that I certainly don’t mean to step on anybody’s toes.

Jeff Bell: By way of perspective, Jeff, what do we know about the size and the composition of the LGBTQ+ community?

Jeff Day: Hmm. Okay. This gets to be a little tricky. I thought perhaps this question would come up. We do not a great job of collecting what we call SOGI data in this country. SOGI is sexual orientation, gender identity and expression data. It’s not showing up on our US census, so we’re not collecting that data. All of that to say, we don’t have precise numbers.

However, we do have some studies that give us an inkling of how large these communities are in our country. I pulled some of those for you. The first is a Gallup poll. It’s the most recent, it was in 2022. And they estimate that there are 7.1% LGBT folks here in the United States, which is roughly double what we had in 2012. And interestingly, 21% of those who identified as LGBT also identified as Gen Z. So those who were born between 1997 and 2003, an almost full quarter of those who are LGBT are from the Gen Z generation.

Jeff Bell: Hmm.

Jeff Day: Yeah. The-

Jeff Bell: Jeff.

Jeff Day: Yeah, sorry. Go ahead.

Jeff Bell: No, please, you go ahead.

Jeff Day: I just had two more studies that touch on the others, Is and As in the acronym. The first is from Amnesty International. This was in 2018. They actually did a study of intersex folks. And what they found was that it’s roughly 1.7% of the worldwide population. Curiously, approximately the number of redheads that we have.

And then finally, there was a study out of Williams Institute, which is through UCLA Law School. This was in 2016. And they found that 3.6% of those who are assigned male at birth identify as gay or bisexual, 3.4% assigned female at birth identify as lesbian or bisexual, 1.8% adults identify as bisexual, and 0.3% identify as transgender. And that all comes again with that disclaimer that we don’t have really good data.

There’s very good news, however. The Census Bureau releases something called Household Pulse Surveys. And the most recent one was regarding COVID-19.

And thanks to changes in legislation, they now include questions such as, what sex were you assigned at birth on your original birth certificate? Do you currently describe yourself as male, female, or transgender? And which of the following best represents how you think of yourself?

And choice of answers would be gay or lesbian, straight, not gay or lesbian, bisexual, something else, or I don’t know. And yes, those questions are by no means perfect, perhaps not even all inclusive, but they’re better than what we’ve had in the past, and it’s going to lead to much better data.

Jeff Bell: Jeff, now that we’ve had a chance to talk a little bit about the LGBTQ+ community, I want to ask you specifically about some of the life challenges that can impact this community in terms of how that might lead to some mental health challenges. Discrimination, stigma, where do we stand with that in 2023?

Jeff Day: Discrimination and Stigma, yes. So I culled some societal factors that include discrimination and stigma I’d like to share with you. So top of the list, not necessarily in any order or rank, is unemployment. We find that there is a 9% rate of unemployment in those who are LGBT, versus 5% in the straight community. We’re also terribly underinsured in the community. 18% of folks who identify as LGBT are underinsured.

And that number gets even larger for the trans community. In the trans community, 21%, almost a quarter, report medical mistreatment, and therefore medical mistrust. So not wanting to go to the provider in the first place because of fear of the discrimination that you mentioned. There’s also 22% of us who live in poverty, and income less than 24,000 a year. It’s 25% in the LGBT community, versus 18% in the non-LGBT community.

There is a big spike in hate crimes. 17% of folks who responded said that they had been a victim of a hate crime. Lots of us in foster care. 30% have come through the foster care system. 40% are un-domiciled. 31% to 43% bullied, as you mentioned, harassment.

There’s also intimate partner violence. And intimate partner violence in the lesbian, gay, bisexual women, and transgender, non-binary community is 50%. And then finally, food insecurity is a big societal factor. We have 27% in the LGB community who report food insecurity, versus 15% in the straight community.

Jeff Bell: Jeff, when you look at the trend line of these challenges, are things moving in the right direction?

Jeff Day: Things are not moving in the right direction, I’m sorry to report. I will pick out hate crimes to be more specific. Hate crimes are on the rise in this country, just in general. We see it in many different populations, but especially those who are historically excluded groups, and that would certainly include LGBTQ folks.

Jeff Bell: What about coming out in 2023? Are we seeing more acceptance of some of these community members when they share their identities with family members, for example?

Jeff Day: Are we seeing more acceptance in those coming out to their community, family? It’s a little bit challenging for me to answer this question because I’m in a bit of a bubble. I live in New York City. It’s a very welcoming and comforting city, wherein folks are able to, many times, come out to their family without ramifications, without repercussions.

And the students who I meet, who are young, don’t seem to have any difficulty doing that. My sense is that’s very different in other parts of the country. I think we’re still met with bullying and harassment when coming out to family members.

Jeff Bell: In terms of these life challenges that you’ve kind of run through with us, are there resources out there available to members of the community that can be helpful in terms of addressing some of these life challenges?

Jeff Day: I have some LGBTQ mental health resources, specific to mental health, but not necessarily specific to food insecurity, or medical mistreatment or mistrust.

Jeff Bell: And before we move forward from some of these life challenges, let me kind of put you on the spot and ask what’s missing from the equation right now? What would help address some of these life challenges?

Jeff Day: Very good question. I think changes in the political landscape will help to improve some of these societal factors. That’s going to be the number one thing that I can imagine. Also education. I speak from experience that educating the young minds is going to make a very big difference in the future.

Jeff Bell: Well, let’s segue then into some of these specific mental health challenges that manifest themselves for members of the LGBTQ+ community. What stands out to you? What tops the list?

Jeff Day: Oh, my goodness. Depression. It’s certainly not the most prevalent of all of the mental health issues in the LGBT community, but it is two times the 12-month prevalence and lifetime risk of heterosexual people.

Variables that are associated with depression include history of suicide attempt, child abuse, sexual dysfunction, a recent history of anti-gay threats or violence, not identifying as gay, queer, or homosexual, excuse me, and feeling alienated from the gay community.

Jeff Bell: You mentioned a number of mental health challenges in particular. What are some of the resources available for folks who are facing those issues?

Jeff Day: Sure. So some LGBTQ+ mental health resources. At the top of the list is the Trevor Project. Pardon me. The Trevor Project is the first nationwide, around-the-clock crisis and suicide prevention helpline for LGBTQ+ youth. So they are well positioned to deal with the spike in depression that we see in the community, as well as some of the other mental health challenges.

Another resource is the Trans Lifeline. The Trans Lifeline provides trans peer support, and it is run by and for trans people. I just want to loop back for one second and say about the Trevor Project, they’re unique in that they have a text feature. So those who are young and very text savvy are able to text any concerns that they may have.

Another is the LGBT National Health Center. All volunteers identify as part of the LGBTQIA+ family. It is free, confidential support, peer information, and local resources. There is Pride Counseling, which is online therapy to members of the LGBTQ+ community.

I would recommend gay student alliances as well. Gay student alliances are student-run organizations that unite LGBTQ and allied youth to build community. You usually see them in middle schools, high schools, colleges, and universities.

There is GLSEN, spelled G-L-S-E-N. GLSEN is ensuring LGBT students are able to learn and grow in a school environment free from bullying and harassment.

There’s GLMA, spelled G-L-M-A, also known as Health Professionals Advancing LGBTQ+ Equality. We connect people, I say we because I’m involved in the organization, connect people who are lesbian, gay, bisexual, and transgender with welcoming healthcare providers. So, if you’re looking for a healthcare provider, including a mental health provider, you can reach out to GLMA. There’s a very long list. You can actually drill down using filters to find what you’re looking for.

I would be remiss if I didn’t mention 988, which is the relatively new countrywide hotline for those who might be experiencing suicidal thoughts or depression.

For those who, in the community, are experiencing substance use disorder, there’s Alcoholics Anonymous, which we’ve heard of.

And then there are two texts that I wanted to mention. The first is the “GLMA Handbook on LGBT Health.” They have a robust chapter on mental health. And then finally, one that we might consider the Bible is “The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health.”

Fenway is an organization located in Boston, they’re dedicated to LGBTQ+ health, and their book is chef’s kiss when it comes to all things, including mental health.

Jeff Bell: Jeff, before we move on, you mentioned substance use disorders. What should we know about the LGBT community vis-a-vis those substance use disorders?

Jeff Day: Substance use disorders, certainly that they are there. It’s something that requires attention. It is a means of dealing with the feelings that come with being LGBT in a nation that’s not necessarily welcoming of that identity.

Jeff Bell: I want to ask you next about some of the challenges for folks in the LGBTQ+ community who are looking for mental health treatment. What are some of the unique challenges that they’re facing that their cisgender and heterosexual peers might not?

Jeff Day: Right. So the main challenge is, what is this therapist going to think of me? What is this therapist going to offer me? What is this therapist going to say? So I’d like to offer, if I may, some screening questions that one might ask of potential therapists. Would that be okay?

Jeff Bell: Absolutely.

Jeff Day: So the first is, and I’m going to use queer, but you can use any of the LGBT rainbow or non-binary, but how would you describe your experience treating clients who share my queer identity?

So putting it out in the beginning, your identity and how is it normally respected in the office. Another question is, what training or evidence-based treatment do you or your practice have for issues that may arise related to queer health and wellness?

One, or another, excuse me, that is an important one, is what is your position on so-called conversion therapy? These are attempts to change a client’s sexual orientation, or gender identity, or gender expression. And then others, like how would you express your experience using gender neutral pronouns, things of that nature.

Jeff Bell: And just to reiterate this, ‘cause this is such an important point in terms of self advocacy. If a professional is uncomfortable with those questions, that’s on them. Is that safe to say?

Jeff Day: It’s on them, and they’re not right for you.

Jeff Bell: So, it’s a matter of kind of pushing through some discomfort and asking these screening questions, ‘cause in the long run, they’re going to make a huge difference.

Jeff Day: Absolutely. And this is, by definition, challenging, because we’re having to out ourselves to a complete stranger. But oftentimes, these screening questions can be done over the phone. So there is anonymity that’s involved, and hopefully will make it a little bit more comfortable of a process.

Jeff Bell: What is your sense, Jeff, and this is perhaps an anecdotal question, but what is your sense of the level of training out there within the professional community right now for addressing the specific needs of the LGBTQ+ community?

Jeff Day: It depends on the discipline. I know that in medical school, they get a total of, on average, this is according to a study, 4.5 hours of LGBTQ+ content in their entire medical training. In nursing, it’s anywhere between 1.5 hour and 2 hours. So relative to medical training, that’s a little bit better.

I don’t have a sense of mental health providers. My gut tells me that it’s better, that there is more training in the mental health community, but I can’t really speak to that.

Jeff Bell: I do want to mention something very important, ‘cause a question just came in. Folks are asking, “Where can I get a list of those resources that Jeff just went through?” We’re going to be posting those, along with the video from this webinar, on the McLean website. So very important, they will be available for you.

Jeff, speaking of provider training, this is a great segue, you have developed a groundbreaking program at NYU Rory Meyers College of Nursing, where you work as a Clinical Assistant Professor. Tell us about this elective that you have created for nursing students.

Jeff Day: I’d be happy to, I love to talk about it. I started at Meyers in 2016, and began teaching a course called Pathophysiology, which is, we know physiology is how things work well, pathophysiology is when things don’t go so well. And have taught that course since. And in 2019, I was teaching patho, which, by the way, is a first sequence course. So brand new baby nurses are coming in to learn.

And I made it my mission when I started at Meyers to use more inclusive language in front of the classroom, and use terminology, such as they, them pronouns, assigned male at birth rather than man, things of that nature.

And one day after class, three students came bouncing down to the podium to say, “Dr. Day, we really appreciate you’re using this language. We recognize that you’re doing it. It makes us feel included. Have you ever thought about teaching a course on this?” I had not, but that planted the seed.

And so in 2019, I began my odyssey of putting together an LGBTQ+ health elective course for the nursing school. It was, at times, a labor of love. I felt like I was on my own out there because to my knowledge, there wasn’t one already in place in the nation. And so I just sort of made my way, relying on colleagues who are also experts in LGBTQ+ health to help me come up with the syllabus, to come up with course outcomes.

And then I put together those topics that I wanted to discuss or that I felt were important to discuss in the course, and then glued it all together.

It did require jumping through some hoops. We have what’s called a baccalaureate work group at Meyers, and it has to be presented there. It then has to go through the faculty council. It then has to go to the state.

The state, in order to provide credits for the course, must approve of the course. Fortunately, they were able to do that, and in fall 2022, we had a start. This semester, spring 2023, is my second semester running the course

Jeff Bell: Wow, that’s fabulous. Give us an idea of some of the topics that you cover in the course.

Jeff Day: Sure. The first week, of course, is an introduction, getting to know a little bit about terminology, getting to know about each other. The second week is a week dedicated to the ADDRESSING Model. The ADDRESSING Model was created by Pamela Hays. Pamela Hays, who I believe is a psychotherapist out of Washington, put together the ADDRESSING Model to weed out things like bias, and discrimination, and privilege.

And my strong belief is that unless you tease these things out, unless you bring this junk to the surface, it’s almost impossible to step on that and step beyond it in order to deliver good quality care. So we had this experiential moment in our second week.

And then weeks beyond that, excuse me, I focus on transgender care, of course, intersex care. Most folks have not heard about intersex individuals, so that’s one that students are really engaged in. I do talk about HIV, but I talk about it in the setting of a death sentence, if you will, to now a chronic disease, and how that has evolved.

We do talk about mental health. I talk about young adults in the LGBTQ+ community, older adults. I also have guest speakers from various colleges throughout the country. I have one guest speaker who’s coming in this semester from Pride and Plasma, an organization that fights against the blood donation ban. Which looks like it’s going to be overturned in March. That’s a good thing.

And also, we have a clinical partner, that’s NYU Langone Hospital. And NYU Langone has an LGBTQ+ liaison. His name is Kevin Moore, marvelous human being, has welcomed me over to NYU Langone to bring my students and give them a real sense of what it’s like to care for this population.

It’s a little bit challenging, because we can’t do a survey when folks come into the hospital and say, “Are you gay? Would you be willing to have somebody observe you?” But there are units, such as gender-affirming surgery units, where we know folks are parts of the community or members of the community, and we can hopefully work with them to enlighten our students.

Jeff Bell: Because this is so groundbreaking, I have to ask you, what kind of reaction are you getting from your colleagues? Are you hearing from folks outside of your campus about wanting to start a similar program at theirs, for example?

Jeff Day: The response from colleagues has been very positive. It has spurred great discussions. One of them is, should we even have an LGBTQ+ health elective, or should the information be weaved through the curriculum? So that’s one discussion that I’ve had with colleagues about the course. A lot of interest.

There are online... Sorry. I’m not sure the word I’m looking for. News places, such as Upworthy, such as “Them,” who reached out to me for interviews. There is an organization called MEET NYU. They reached out to me to learn a little bit more about the course. Oh, news organization. That’s what I’m looking for. Yes. Easy, right? I’ve had about 10 or 11 news organizations who have reached out to me to learn a little bit more about the course.

So it’s been extremely gratifying to not only share this information with my students, but throughout the country.

Jeff Bell: Give us an example of what you would hope to come out of this, in terms of what a student might take from the course and apply in their own practice.

Jeff Day: Aside from the nuts and bolts, of course, I want them to know what types of medications you might expect in a patient who is transitioning medically in the trans community. And these are things that are important to know.

But what I really want our students to take away is a sense of empathy, and compassion, and understanding for this community. My fear is that those things are lacking in healthcare, particularly in other parts of the country. So if I can turn out students who develop that, who flex those muscles, and then hopefully share it with their colleagues, I feel like I’ve done a good job.

Jeff Bell: Hmm. Well, it’s fascinating. And I assume that you’re hoping to continue this into the future?

Jeff Day: Yes. The hope is, well, actually, the reality is it gets offered in the fall and in the spring each year. It has been green lit, it’s a go, and I see nothing holding us back.

Jeff Bell: Excellent. Well, congratulations on all that. That’s quite an accomplishment you’ve managed to pull off there. I want to zero in on some specific tips for those who are in our audience today, whether they are providers, or parents, or educators, or individuals who identify as LGBTQ+.

Let’s start with the latter there. If somebody is on the call right now and is a member of the LGBTQ+ community wanting to seek some mental health treatment and sort of intimidated by the whole process, can you speak directly to that person and offer some guidance?

Jeff Day: Absolutely. I would say begin with GLMA. And again, we’re going to make these resources available to you.

Jeff Bell: We will.

Jeff Day: It’s a simple internet search. You’ll be able to find providers in your area. The good news is, if any good news came out of COVID, very little, but this one piece of good news that I have found is that therapists now can work anywhere, and it doesn’t require you’re sitting on a couch in the same office.

So you can find a therapist that is of your particular taste and interest in a land far away, and still be able to work with them. So if for any reason you, as an LGBTQ+ person, cannot find a therapist in your area that you feel comfortable with, broaden your search. Look all throughout the nation. They’re out there, they’re wonderful, they’re waiting to take care of you, and it just takes a phone call.

Jeff Bell: You mentioned the screening questions, and I want to circle back to those for a moment here. I think it’s so important that any individual in any situation in the mental health world self-advocates, and again, asks questions of a potential therapist.

What are some other, perhaps not screening questions, but other considerations when you are looking for a particular therapist. What does that fit need to be?

Jeff Day: That’s an interesting question. I mean, the obvious is you must feel comfortable, and that means different things to different people. And I’m thinking back to the ADDRESSING exercise that I just did on bias, and how we look for in-group bias, right? We look for people who are like us, and that may be exactly what we need in a therapist in order to take care of us.

Jeff Bell: Great answer. Let’s talk about educators, and from your perspective, what they can do to best support members of the LGBTQ+ community, specifically the younger ones who are growing up and might be confused by a number of their challenges as they’re going through life.

Jeff Day: So educators of those who are young and may be coming to terms with their sexuality or gender identity is to be supportive. And I know that’s a huge answer, a broad answer, but ways we can be supportive are to get involved in things like gay student alliances.

Getting involved in organizations like PFLAG, formally known as Parents and Friends of Lesbians and Gays. So really identifying yourself as an ally to the community, so that it’s easier for young folks to reach out to you for guidance and understanding.

Jeff Bell: How about family members wanting to support a member of the family who identifies as LGBTQ+?

Jeff Day: Family members, certainly PFLAG, which I mentioned, formally Parents and Friends of Lesbians and Gays. I would say look for those folks who are in the community outside of the family and use them as a resource. So, if you have a family member who’s coming out to you as trans or as gay, if there are questions that you have, or that you don’t understand, reach out to folks in the community who are outside of the family.

One thing that we find time and time again in the literature is that those who are in the community sort of get tired of being the teachers, right? They need to be the ones who get the support. So, if you can look outside of the family to the community to learn a little bit more about it so that you can make your family member feel more comfortable, I think that would be a wonderful thing.

Jeff Bell: And how about just folks in general who are aware of what’s happening with hate crimes, for example, or other issues around the LGBTQ+ community, and want to help make a difference and aren’t quite sure how to do that?

Jeff Day: Right. I’ll be perfectly frank with you, I am probably the least qualified to answer this question. I tend not to be politically active by design. I want to take care, in a different way, of the LGBTQ+ community. I’ve been criticized for that in the past, and that’s fair criticism. But I do believe that political action is important. It’s just not my forte, so I can’t really honestly speak to that.

Jeff Bell: I appreciate the answer, and I probably should have been a little bit more clear in there. Not necessarily political support, but just even societal support, supporting local Pride efforts, for example.

Jeff Day: Oh, interesting. So supporting local Pride efforts, certainly. So one thing that stands out to me when I’ve been to Gay Pride parades is the folks who come who identify as allies. There are few things that get a lump in my throat like seeing a grandma with a sign that says, “My grandson is gay and I love him,” or whatever the sign is of the day.

Very, very important to... We talk about heightening the awareness of the gay and lesbian, or the person in the community, but also heightening one’s awareness as an ally is crucial.

Jeff Bell: Jeff, let me circle back to some topics that we’ve touched on and drill down a little deeper here. You talked about the challenge of depression for those in the LGBTQ+ community. What specifically do you want us to know about that particular mental health challenge, and why it can be specifically more acute for somebody in this community?

Jeff Day: It is more acute for folks in this community because we have, and we haven’t really touched on this, we have a higher rate of suicidal ideation and successful suicide in the community. So there is an urgency to depression that may not be as urgent for other populations.

Suicide in the LGBTQ community, two times the prevalence of suicidal ideation as heterosexuals. LGB folks are six times more likely to report one or more lifetime attempts by age 21.

And one really startling piece of information is that trans folks, 47%, almost half of trans folks have considered or attempted suicide in the past three years. So, if that doesn’t drive home what’s so important about treating depression, I don’t know what would.

Jeff Bell: And Jeff, this would be an important time for us to put those resources back out again. You’ve mentioned them a couple of times. There are text lines, there are hotlines that folks can call if in fact they are feeling challenged on that front.

Jeff Day: Absolutely. There are those that are trans-specific. So for the 47% who may be experiencing those feelings, or concerns, or thoughts, you can reach out to somebody who knows you, just by virtue of picking up the telephone or texting.

Jeff Bell: And we’ll have those resources available on our website as well. Is there a concern ever with kind of lumping all these particular identities under one umbrella and looking at it as a model of the LGBTQ+ community? Are there distinct differences between the various subsets of this umbrella?

Jeff Day: There are. The population that I’m thinking about specifically is intersex. And there has been some debate about whether intersex belongs under the LGBTQIA+ umbrella or not. It is a conversation that occurs within the intersex community.

They don’t necessarily identify as having a different sexual orientation or a different gender identity, so do we belong? I can’t really speak to that, as I’m not a person of intersex experience. I can tell you from personal experience, I’m happy to have as many people under that umbrella as possible to make things better.

Jeff Bell: And I suppose the flip side of that, the benefit of doing this as one community is to give strength in numbers and be able to advocate on a number of fronts as one unit.

Jeff Day: Absolutely. So we know that gay, lesbian, bisexual, and trans folks have been organized for a long period of time. And as intersex, and I use intersex as an example, as intersex individuals are looking for advocacy and advancement in the community, perhaps being under that heading is a positive experience for them.

Jeff Bell: Jeff, let me ask you this. We’ve been talking about some specific mental health conditions and diagnosable challenges in the mental health world. What about folks who are just struggling with their mental wellbeing, and perhaps might not hit that threshold of a clinical disorder, for example? What are your thoughts in terms of just general mental health wellbeing practices?

Jeff Day: General mental health wellbeing practices, it goes back to the things that we’ve heard about. Get good sleep, get some exercise, have some healthy food. Those things are going to be important in boosting your mental health. So those folks who don’t necessarily tip the scales into depression, or anxiety, or eating disorders, body dysmorphia, things like that, would really benefit from the things that grandma taught us would make us healthy.

Jeff Bell: Makes sense. Let’s pull back the lens a little bit and talk broadly about the, not only the mental healthcare profession, but just medicine in general. And you’ve been doing this work on the physical health side of things quite a bit with the nursing program. What do you want us to know about the bigger picture of medicine in the LGBTQ+ community?

I mean, you’ve talked about some of the specific things you’re doing for nursing practitioners, for example. What about MDs and hospital staff? What are some other areas, some other frontiers for making some positive advancements for the LGBTQ+ community?

Jeff Day: I think that, having more LGBTQ+ liaisons in community hospitals, in other healthcare facilities is key. We need someone there to advocate for those LGBT patients who are coming in who may not feel comfortable. That’s extraordinarily important in the healthcare setting.

Jeff Bell: You are doing work specifically again, in the nursing side of things. And it dawns on me that that’s a very important area in terms of your interaction with clients, with patients.

In fact, probably, to some degree, more of an interaction than the MDs and the anesthesiologists and so forth. You are having these intimate relationships with your patients. Talk about that dynamic, and why it’s so important to train nurses in particular to have some of these appreciations of the challenges for the LGBTQ+ community.

Jeff Day: Vital, crucial, whichever word is strongest, is how I would describe the need for nurses to be well prepared at the bedside. And to be prepared for what you might see, and I’ll share an anecdote with you. I used to work in trans healthcare, in folks who came in for gender-affirming surgery. And I would take care of them when they came back from surgery to manage any post-op complications, to prevent post-op complications, and to make sure that they were prepared to go home.

What I wasn’t prepared for was walking into a patient’s room one day, they were fresh out of surgery and starting to wake up, out of the recovery room, but starting to wake up. I walked into introduce myself, and explain my role and my care, and I saw balloons everywhere.

There were balloons that were tied to the side rails of the bed, and they said happy birthday. And it was our patient’s rebirth. It was their opportunity to be the woman that she always was. And it really hit me hard. So, we are undoubtedly in a blessed space as nurses to experience those kinds of things and to treat patients compassionately.

Jeff Bell: Paint the picture for us of what this could look like in the best scenario down the road for an LGBTQ+ individual getting medical care treatment. What would things look like differently than they do today?

Jeff Day: Wow, Jeff, that’s a great question, and it brings up a great debate. It is, do we need to have separate clinics for folks who are LGBTQ+, or do we need to weave their healthcare through the healthcare system that we have now? Very similar to that debate of elective versus weaving through the curriculum.

I don’t really come down on one side or another. I do believe that we need both. We need to do a better job, in general hospital care, of taking care of these LGBTQ+ folks.

But there are needs that are specific to this community that may only be understood by the community itself. And for that reason, I believe having specialized clinics is very important to the community.

And we have, for instance, here in New York City, we have Callen-Lorde, which is an LGBT+ healthcare center. Fenway, which I mentioned before, who created the book, they actually have an LGBTQ health center in Boston. So I think those things are incredibly important, but we need to do a better job of weaving that care through general hospitals here in the United States.

Jeff Bell: How satisfied are you that that discussion is taking place right now at the highest levels in terms of policy makers?

Jeff Day: I think it’s happening at the highest levels. I’m thinking of Dr. Rachel Levine, who is our... Oh, my goodness, I’m so sorry. I believe Attorney General, I could be mistaken. But a trans woman at the highest levels of government who is making a difference, making a change in the care of specifically trans folks in this nation.

Jeff Bell: Before we start wrapping up, I want to circle back to some miscellaneous questions that I didn’t get a chance to get to yet, and then also ask for your thoughts on what we haven’t covered. I’d like to ask you specifically to speak to mental health providers who might be on the call right now. What would you like them to be doing to better prepare themselves for dealing with the specific challenges of an individual who identifies as LGBTQ+?

Jeff Day: I would say to mental health providers, do what I did when it came to putting this course together, and that is educate thyself. And I can give you an excellent resource for doing that. I believe it’s LGBTQIAhealtheducation.org.

And again, we’ll make sure that you’ll get these resources. But that is through Fenway, in Boston. They have a wealth of information. They have an entire education arm that includes lots of webinars, and there are webinars there that are specific to mental health.

And if you’ll just take some time out of your day, go to one of those webinars, spend an hour learning a little bit about the community, I believe that you’ll do a better job taking care of them.

Jeff Bell: Jeff, I don’t know if you have an answer for this one, but a question did come in. “Do you know of any Spanish-speaking therapists or mental health resources for the LGBTQ+ community?”

Jeff Day: I don’t specifically. And I’m sorry to keep harping on GLMA, but I bet, I don’t know for sure because I haven’t looked for Spanish speaking myself, but if you go to GLMA.org, they have over on the right side of their homepage, a new find a provider link. If you click on that, I can almost guarantee you that they’re going to have Spanish speaking in there somewhere.

Jeff Bell: I wanted to ask you about the importance of peer support for anybody dealing with mental health challenges in the LGBTQ+ community. From your perspective, how important is it to be able to talk openly with somebody who might necessarily understand what you are going through?

Jeff Day: It is important, and data has proven that. We have at NYU something called the Wellness Exchange. And the Wellness Exchange is an opportunity for students, for all students, not just GLBT students, but for all students. But LGBT students can reach out as well. They can do it by text or they can go into an office. They have peer support there. Extremely important at letting our folks know that we’re not alone.

Jeff Bell: I also wanted to circle back and ask for a little bit more information about something you raised earlier, which is the concern for some individuals about disclosing their sexual orientation to a therapist. Do you get the sense that that is a problem for members of the LGBTQ+ community seeking care? That they’re distrustful of the therapy situation itself to the extent that they might be uncomfortable sharing where they stand?

Jeff Day: I think it’s different for different populations within the community. We are in a space, in 2023, in the United States, where it’s easier to say queer or gay than it was years past. And I have to believe that going into a therapist’s office and revealing that is going to be a little easier.

What we’re finding, sadly, is that the same cannot be said for trans folks. Not only is it not easier, it’s getting harder for trans folks with the legislation that’s coming down the pipeline in this country. So the courage that it takes for a trans person to step into an office and reveal that information, I can’t imagine it. I’m in awe of that.

Jeff Bell: So, Jeff, before we wrap up, I do want to ask you to share with us any kind of closing thoughts in terms of the big picture of mental health in the LGBTQ+ community. We’ve covered a lot of ground, but what stands out to you as the key takeaway from our conversation today?

Jeff Day: I want to say that the key takeaway from the conversation is that there is, and this sounds a little sappy, I grant you, but there is hope. There is hope out there in the medical community. There is hope in the nursing community, in the mental health community.

Folks are coming into the business who really want to make a change, not just in that community, but in all of their patients. And I think that’s something that we have to look forward to. We’re turning out practitioners now who are far more skilled and advanced in their care than has been in the past. And that’s a very, very good thing.

Jeff Bell: And if we might, let’s wrap things up with a direct message to somebody who is part of this LGBTQ+ community who is struggling right now, and is tuning into this webinar for some more of that hope. What do you specifically want to leave that individual with?

Jeff Day: This is a road that folks have been down before successfully. We have had patients who have gone in for mental health care, who, while maybe scared to reveal that information or that identity, did so, and found very, very good result. So, know that there’s hope out there.

Also know that you can either choose not to have a provider, or at any time, you can change providers. You are not beholden to anyone to meet them once a week and spend a chunk of money to, the stereotype, sit on the couch. You can shift at any time.

The hope is out there. And certainly, if I can be of any help, and I’ll make sure to give my contact information to Jeff, I would be happy to do so.

Jeff Bell: Excellent, and then before we let you go, what’s next for Jeff Day in your work?

Jeff Day: Yeah, great question. I am looking toward... I actually have my eye on a couple of things. There’s a possibility that I will create a graduate course. The LGBTQ+ health elective course is an undergraduate course, but a graduate course would allow me to move into how do you prescribe for folks, things of that nature. So, a grad school, or excuse me, a grad course may be coming down the pike.

Jeff Bell: That sounds great. Jeff, thank you so much for making time to share with us today all your wisdom and thoughts on this very important topic. We really appreciate your time.

Jeff Day: Thank you so much. I appreciate the opportunity.

Jeff Bell: Jeff Day, a Doctor of Nursing Practice and a Clinical Assistant Professor at NYU Rory Meyers College of Nursing. As for those of you who have tuned in today, our sincere thanks on behalf of all of us at McLean Hospital. Have a wonderful day.

Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.