The Lack of Culturally Competent Health-Care Providers Hurts LGBTQ Folks

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Culture & Conversation LGBTQ

The Lack of Culturally Competent Health-Care Providers Hurts LGBTQ Folks

Nathalie Chara

Making trauma support affirming means recognizing historical trauma that stems from generations of anti-LGBTQIA+ violence and discrimination.

We have all faced massive collective and individual trauma in the past year and a half, from personal and economic upheavals wrought by the COVID-19 crisis, to disturbing rises in violent anti-Black and anti-Asian racism, to an upswell of transphobic state legislation.

This has a clear impact on our mental health. In fact, here at the LGBT Community Center in New York City, we’ve seen a 40 percent increase in requests for our mental health counseling services since March 2020. This spike makes clear that the time has come for a wider understanding of the queer community’s experiences of trauma and how to address it. It can be subtle or hard to identify, but just because it’s not always obvious doesn’t mean it’s not happening.

Understanding how sexual orientation, gender identity, and gender expression inform a person’s experience of trauma is crucial to effectively supporting LGBTQIA+ people.

Some experiences of trauma are a direct result of anti-LGBTQIA+ interpersonal or systemic bias. Folks in our community are vulnerable to trauma from a young age, including familial rejection, a lack of supportive educational spaces, invasive and judgmental medical practices, high risk of physical violence for trans and gender expansive community members, and looming threats of punishment and conversion therapy.

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As these young people grow up in a challenging world, systemic oppressions become more prominent in the form of obstacles to job and career development and ongoing challenges to accessing affirming mental and physical health care. Difficulties and prejudices in personal relationships also continue, challenging the development of holistic and happy lives.

Our LGBTQIA+ identities can also compound the impacts of traumatic experiences that may not have been initially related to our queerness. For example, it’s already traumatic for someone to be facing housing instability and using the shelter system; if that person is transgender or gender expansive, they are likely to be assigned to a shelter that does not align with their gender identity. Or if a person who is not “out” is experiencing intimate partner violence, they may be reluctant to report it if doing so would mean revealing their LGBTQIA+ identity and putting themself at risk for rejection or isolation.

Of course, it’s important to recognize that we do not all experience trauma in the same way. No community is a monolith, and our queerness exists alongside other identities that also shape how trauma affects us. Consider the example of an LGBTQIA+ person facing intimate partner violence. If they are also an immigrant, they may be trapped even more firmly in their abusive situation if they are concerned about their immigration status being revealed. Trauma is incredibly complex, which is why loved ones and caregivers must use an intersectional lens to assess needs.

When we are traumatized, our entire being is affected, but the negative impacts may be magnified due to longstanding systemic and interpersonal bias that targets certain specific identities.

Unfortunately, LGBTQIA+ affirmation and intersectionality in trauma support is not at all the norm, especially for health-care providers, as they all too often lack the cultural competency to effectively treat LGBTQIA+ people, even in situations that are not complicated by the presence of active or recent trauma.

For these providers, and for any other professionals supporting our community, such as social workers or counselors, making trauma support affirming means recognizing historical trauma that stems from generations of anti-LGBTQIA+ violence and discrimination, supporting a survivor’s autonomy in their journey, and being cognizant of the power dynamics between a professional caregiver and a trauma survivor. For instance, when working with someone who has survived bodily trauma, one way to support their autonomy is to ask permission before touching any part of their body. Or providers can be mindful of the power they hold relative to the survivor they’re working with by taking the time to explain in detail what will come up next in the course of an appointment.

Possibilities for affirming trauma support extend beyond traditional care settings, however. Affirmation and high-quality care can often be found most readily within the community. For example, at the LGBT Community Center, our community casework program exists specifically to serve LGBTQIA+ survivors of trauma. While our services (including mental health counseling, case management, and financial reimbursement for survivors of crime) are applicable to various kinds of trauma, we always present them with an intersectional, queer-specific lens.

That can look like providing safe spaces tailored to different identities within our communities, such as support groups that are specifically for transmasculine and Spanish-speaking people, or naming and setting boundaries for our shared spaces, in recognition of the multifaceted experiences and needs of the LGBTQIA+ community.

It’s also worth noting the understated, yet powerful impact of being able to process trauma while surrounded by other LGBTQIA+ people, whether they be fellow program participants or service providers. Even the simple act of engaging with someone with shared identity and life experience can provide a much-needed feeling of safety and profound understanding.

Everyone holds a multitude of identities, all of which intersect in different ways to influence how we exist in the world. When we are traumatized, our entire being is affected, but the negative impacts may be magnified due to longstanding systemic and interpersonal bias that targets certain specific identities, such as our sexual orientation, gender identity, and gender expression.

Whether trauma comes from the pain of witnessing relentless violence against our communities, anxiety during a global pandemic, or something else entirely, our LGBTQIA+ identities are inalienable from our experiences of that trauma. The support and treatment we receive must take our queerness into account. This is the key to helping those in need stabilize and move toward healing.