The Presidential Citizens Medal is the second-highest civilian honor in the United States (outranked only by the Presidential Medal of Freedom) and is awarded by the president to citizens who have performed exemplary deeds or services for their country or fellow citizens. On October 20, 2011, President Obama granted Janice Langbehn this award for her efforts to ensure equality for all Americans.
In 2007, Langbehn, her partner Lisa Pond, and their three children were about to depart from Miami on a family cruise when Pond suddenly collapsed and was rushed to Jackson Memorial Hospital. She had had an aneurysm. Hospital personnel would not allow Janice or their children to see Lisa until nearly eight hours after their arrival, even though Lisa’s sister was allowed to visit as soon as she arrived. The next day, Lisa died.1
The citation for Langbehn, read by a military aide, stated, “Janice Langbehn transformed her own profound loss into a resounding call for compassion and equality. When the woman she loved, Lisa Pond, suddenly suffered a brain aneurysm, Janice and her children were denied the right to stand beside her in her final moments. Determined to spare others from similar injustice, Janice spoke out and helped ensure that same-sex couples can support and comfort each other through some of life’s toughest trials. The United States honors Janice Langbehn for advancing America’s promise of equality for all.”2
All LGBT parents will undoubtedly need to seek out medical care at some point for their children and themselves, and most of it will be for far less catastrophic events than Lisa Pond’s case. Still, as the Human Rights Campaign’s 2011 Healthcare Equality Index 2011 reported, LGBT people often decline to seek health care in times of need because they fear discrimination and poor treatment by health-care professionals.3
Are these concerns justified? In 2011 the Stanford School of Medicine’s Lesbian, Gay, Bisexual and Transgender Medical Education Research Group surveyed 175 medical schools in the United States and Canada and found that 33.3 percent of respondents spent zero instructional hours on LGBT health and that, on average, these institutions offered five hours on LGBT issues.4 Senior author Dr. Mitchell Lunn, an internal medicine resident at Brigham and Women’s Hospital/Harvard Medical School said, “We heard from the deans that a lot of these important LGBT health topics are completely off the radar screens of many medical schools.”5
Additionally, research on health issues in LGBT populations is marginal. According to Robert Garofalo, an associate professor of pediatrics at the Northwestern University Feinberg School of Medicine, who reviewed the state of knowledge of LGBT health in 2011, “No matter what we looked at, there was a paucity of research in the available literature.”6 Gaps included
• Most research relies on convenience samples, instead of large, random sample surveys
• Most of the research focuses on adults, not youth
• Most of the survey participants live in large cities (According to Garofalo, “We don’t know what it’s like to be LGBT and live in rural Illinois or the suburbs. There was no literature out there for us to pull from.”7)
• Most of the research on these populations has focused on lesbians and gay men and comparatively little on bisexual and transgender people
In 2010 Lambda Legal released a report detailing the health-care experiences of almost five thousand LGBT individuals and those living with HIV.8 Almost 56 percent of lesbian, gay, or bisexual respondents had at experienced at least one of the following: being refused needed care; health-care professionals refusing to touch them or using excessive precautions; health-care professionals using harsh or abusive language; being blamed for their health status; or health-care professionals being physically rough or abusive.9
Ironically, the majority of respondents of this survey were more privileged than the LGBT population as a whole, with higher proportions holding advanced degrees, having higher household incomes, and having better health insurance coverage. For this reason, Lambda Legal acknowledges its report likely understates the barriers to health care experienced by all LGBT people. For example, in nearly every category, a higher proportion of respondents who are people of color and/or low-income reported experiencing discriminatory and substandard care.10
The Joint Commission, an independent, nonprofit organization that accredits and certifies more than nineteen thousand health-care organizations and programs in the United States, concluded that the “8.8 million lesbian, gay, and bisexual people now estimated to be living in the United States experience disparities not only in the prevalence of certain physical and mental health conditions but also in health care due to lack of awareness and insensitivity to their unique needs. These issues include the denial of visitation access, restrictions on medical decision making for LGBT family members, a distrust of the health care system and hesitation to disclose their sexual orientation or gender identity to medical professionals.”11
Finally, LGBTs are twice as likely as the general population to be underinsured or completely lacking health insurance coverage. There are several reasons for this. First, they are more likely to lose or quit their jobs, to be employed in lower-wage jobs with no benefits, or to not be hired in the first place. Second, many workplaces do not provide spousal health insurance benefits for their employees involved in same-sex relationships. Finally, as a result of the current tax law structure, an employee with a same-sex partner must pay payroll taxes on the cash value of any domestic partner benefits, which increases the cost of insurance for these couples by an average of $1,100 per year, compared with married heterosexual workers.12
As summarized in the 2011 report Changing the Game: What Health Care Reform Means for Lesbian, Gay, Bisexual, and Transgender Americans, “[T]oo many lesbian, gay, bisexual and transgender people were destined to remain uninsured and unable to afford regular checkups and basic medical care. Too many in the LGBT community faced the prospect of continuing to go to bed at night worrying about paying their health care bills, and too many gay and transgender parents envisioned a future where they would continue to be unable to afford to take their children to the doctor.”13
The two years prior to the publication of this book were a period of momentous achievement in health care for LGBT individuals and their families. First, in April 2010, President Obama issued a memorandum calling on the Department of Health and Human Services to create regulations protecting the hospitalization visitation rights of all Americans, a directive that has vast implications for LGBTs. These new rules, which went into effect in January 2011, apply to hospitals participating in Medicaid and Medicare programs (the vast majority of hospitals) and ensure that all patients have their visitation rights respected. The regulations require hospitals to permit patients to designate visitors of their choosing and prohibit discrimination in visitation policies, including sexual orientation and gender identity. Medical facilities must allow equal access for same-sex couples and equal access for same-sex parents.
Second, the Joint Commission aligned its own polices with the new HHS requirements on July 1, 2011, with a goal of creating welcoming and supportive medical institutions for LGBT staff and patients. Among these policies:14
• Hospitals must prohibit discrimination based on sexual orientation and gender identity or expression, and this requirement applies regardless of local law.
• Hospitals should recognize same-sex partners as the patient’s family, including recognizing same-sex marriages, even if these are not recognized by the law of the state in which the hospital is located.
• Hospitals should involve same-sex parents in their children’s care, even those parents who lack legal custody.
Third, LGBT advocates were elated in 2011 when the Institute of Medicine released a 348-page report titled The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding.15 This report repeatedly reveals the current paucity of knowledge regarding LGBT health and the need for much more research. Bradley Jacklin, policy manager at the National Gay and Lesbian Task Force, stated, “This is historic. This is the first time the federal government has laid out a blueprint of the health challenges facing the LGBT community.”16
Finally, the passage of the Affordable Care Act will allow LGBTs and their children access to the health insurance so many currently lack. This health-care reform law, passed in March 2010, expands access to health care for millions of people in America. In conversation with LGBT communities, Kathleen Sebelius, secretary of Health and Human Services, spelled out the specific benefits of the act for LGBTs and their families, including
• Outlawing the practice of rescinding policies because of technical mistakes and banning a lifetime coverage limit
• Ensuring free preventative care and immediately outlawing the practice of denying children policies because of pre-existing conditions
• Ensuring transparency in health-care coverage, including a new online tool for LGBTs to search for insurance companies that offer benefits for same-sex partners
• Investments in the health-care workforce
• Collection and integration of data on sexual orientation and gender identity in national health surveys17
(As this book goes to press, the Affordable Care Act has been found to be constitutional by the Supreme Court of the United States but continues to face political denunciation at the state and national levels.)
Health-care coverage is needed not only for medical problems but also for the treatment of mental health concerns. The LGBT community has consistently been found to have an elevated risk for substance use and mental health conditions such as depression, anxiety, eating disorders, and suicidal ideation, and many sufferers often struggle to pay for these services.18
According to the National Alliance on Mental Illness, 4 million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school, and with peers. Of children ages nine to seventeen, 21 percent have a diagnosable mental or addictive disorder that causes at least minimal impairment. Shockingly, in any given year, only 20 percent of children with mental disorders are identified and receive mental health services.19 According to Mental Health America, estimates of the number of children who have mental disorders range from 7.7 million to 12.8 million.20 The most common mental health concerns for young people are attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, anxiety disorders, depression, bipolar disorder, learning disorders, conduct disorder, eating disorders, oppositional defiant disorder, post-traumatic stress disorder, risk-taking behavior, schizophrenia, and suicide.21
We have almost no information on the mental health needs of LGBT families. While there is no evidence that the children of LGBT parents have more mental health problems or more severe problems than youth raised by straight parents, there is also no evidence that these children have fewer problems. However, we barely have an understanding of the mental health needs of LGBT individuals in general, and the history of LGBT mental health treatment is fraught with discriminatory practices.
In 1973 the American Psychiatric Association (APA) finally removed homosexuality from its manual of mental health conditions. Until this historic moment, gay men and women had been considered mentally ill; the result was that the majority hid their status, voluntarily sought treatment, or were involuntarily institutionalized and received punishing “treatments” such as electroconvulsive therapy (ECT, also known as shock therapy). Following Stonewall, and in tandem with the protest movements sweeping the country in the late 1960s and early 1970s, more and more activist group were vocal in their opposition to the APA’s classification of homosexuality as a disorder. Under intense scrutiny and continually barraged by contingents of gay and lesbian activists willing to engage in organized and confrontational public battles, the APA reevaluated previous studies of gay men and lesbians and acknowledged that they were weak and could certainly not be generalized to the majority of this population. In fact, it was found that most sexual minorities were satisfied with their orientation; for those seeking help, societal homophobia and heterosexism were the root causes of the issues. In 1975, the other APA—the American Psychological Association—came to the same conclusion. The two most respected mental health organizations in the world had agreed that homosexuality was not a disease within two years of each other. This is considered a milestone in the unfolding history of LGBT individuals.
Activists rejoiced, and critics went on the warpath. Even today, almost forty years later, social conservatives and antigay forces decry these decisions. NARTH—an organization that supports reparative therapy (treatment to “cure” gay men and lesbians of their homosexuality) and that has been condemned by accredited mental health institutions at every level—continues to claim that that research has yet to unequivocally prove that same-sex desire is not a pathology.22 Reparative therapy became an issue of national concern in 2011 and 2012 when Michele Bachmann became a presidential candidate. Bachmann’s husband engages in this treatment for men and women who attend his Christian counseling center.
The responses of other organizations are far less reserved than NARTH. For example, the Family Research Council (FRC) brochure The Top Ten Myths About Homosexuality states, “Homosexuals experience considerably higher levels of mental illness and substance abuse than heterosexuals” and that “no other group of comparable size in society experiences such intense and widespread pathology.”23 Furthermore, FRC discounts the role of societal homophobia and heterosexism in the mental health conditions of sexual minorities. FRC also positions itself as one of the staunchest and most vitriolic opponents of findings that biology and genetics play a role in the development of sexuality; its stance is, “No one is born gay.”24 (Readers should be aware that FRC, not surprisingly, is equally strident in its opposition to gay and lesbian families: “An overwhelming body of social science research shows that children do best when raised by their own biological mother and father who are committed to one another in a lifelong marriage.”25)
In 2008, thirteen national organizations (the American Academy of Pediatrics, American Association of School Administrators, American Counseling Association, American Federation of Teachers, American Psychological Association, American School Counselor Association, American School Health Association, Interfaith Alliance Foundation, National Association of School Psychologists, National Association of Secondary School Principals, National Association of Social Workers, National Education Association, and School Social Work Association of America) cooperated to create Just the Facts About Sexual Orientation and You, a document meant to dispel the seemingly never-ending misappropriation and outright deliberate distortion of psychological research regarding LGBTs promulgated by antigay groups such as FRC.26 This document asserted that “the idea that homosexuality is a mental disorder or that the emergence of same-sex attraction and orientation among some adolescents is in any way abnormal or mentally unhealthy has no support among any mainstream health and mental health professional organizations.”27 The coalition also strongly criticized reparative therapy.
This is the juncture at which we find ourselves at present. Forty years of research findings that sexual minorities are just as emotionally stable as their heterosexual counterparts versus a small but tenacious, persistent, and well-funded collaboration of antigay and conservative organizations that often have direct access to legislatures across the country. And this divisive understanding of homosexuality eventually reaches into the very professional domains often needed by LGBT families.
After months of seeing the same magazine titles in the admissions area of a large behavioral health hospital, a gay male staff member unobtrusively inserted a trendy, gay-themed magazine into the pile. This particular periodical was tailored for the fashion-conscious gay man and was no more overtly sexual than the female-oriented magazines that were regularly offered. Still, when a housekeeping member found it, she took it to the head of the admissions department, who tossed it into the trash, muttering that some patients “might be insulted.”
In her interview with me, Danese recalled an experience where the inpatient substance treatment facility her daughter was about to enter was not necessarily LGBT-friendly:
When filling out the forms with the intake person she asked about our daughter’s father; when I told her she had same-sex parents, she seemed baffled and unsure what to do. She hesitatingly smiled and crossed off “name of father” from the application and wrote “name of second mother” instead… Our daughter was allowed one phone call a day, and she told me that the structure of her family was never discussed. What infuriated me the most, though, was that during the first week of treatment a “family day” was held in order to introduce parents and siblings to the essentials of recovery, and the lecturer never once mentioned same-sex parents. She did mention divorced, widowed, and single parents in additional to the traditional two-parent model, but same-sex parents were left untouched.
Ample research underscores this lack of available or well-prepared mental health support. In 2011, almost 28 percent of the respondents to a Lambda Legal health-care survey reported that not enough mental health professionals are available to help them.28 In a 2005 review of the training and education of therapists for clinical competence in working with same-sex-parented families, Jackie Coates and Richard Sullivan of the University of British Columbia found that “knowledge, skills and experience are prerequisites for competent practice and that these are not generally achieved with respect to sexual-minority families through the educational programs of the disciplines most commonly providing family counseling (psychology, medicine and social work). While the codes of ethics of these professions may express value convictions that oblige adherents to practice in such a way as to affirm human dignity in diversity, these convictions alone will not necessarily produce competent practice.”29
And Leslie Calman, executive director of the Mautner Project, writes, “Well-meaning staff may think that by ‘treating everyone alike’ they are being equitable. But if treating everyone alike means assuming everyone is heterosexual, it renders LGBT people invisible and fearful of being stigmatized…. Too often, the failure to clearly signal that it is safe to be open results in a LGBT person’s reluctance to communicate details of her life that her provider ought to know.”30
Some states may even be moving in the opposite direction of inclusive treatment. In May 2011, Arizona enacted a law allowing students in social work and counseling programs to discriminate. Students can now disregard the ethics of national accreditation boards and also avoid repercussions from their respective colleges and universities for refusing to work with clients whose behaviors they deem as contrary to their religious beliefs.31 Thus a social work student performing an internship could refuse to work with a sexual minority if her religious beliefs find his or her behaviors to be immoral.
Religious right groups applaud this measure, and have come to the defense of Julea Ward on this issue. Ward was in an Eastern Michigan University counseling program but was dismissed in March 2009 after she refused, as part of her training, to counsel a gay client. She told school administrators that she could not “affirm any behavior that goes against what the Bible says.”32 During a school hearing on her case, she stated she would not abide by school standards when they contraindicated her religious beliefs. Ward sued, stating that her religious liberty and free speech rites had been violated. She received the backing of the Alliance Defense Fund (ADF), whose website describes it as “a network of more than 2,000 allied attorneys nationwide [that] directly litigates carefully chosen, strategic cases to preserve and reclaim your God-given, constitutionally protected religious freedom, the sanctity of life, marriage, and the family.”33 Other religious right groups massed to support Ward and ADF, including the Justice and Freedom Fund, the Becket Fund for Religious Liberty, the American Center for Law and Justice, and the Foundation for Moral Law. Ward’s proponents believe that the case will eventually reach the US Supreme Court.
According to David Kaplan, chief professional officer of the American Counseling Organization, the organization that accredits EMU, “We train students to understand that the client is more important than they are. Just because someone has different values, doesn’t mean we can’t counsel them. We don’t have to agree with them, but we must accept them for who they are.”34
Affirmations, a Detroit community center for sexual minorities, signed a friend-of-the-court brief in the case of Ward. Kathleen LaTosch, chief administrative officer of Affirmations, knows through her daily encounters just how important the relationship between counselor and client is when LGBT people seek mental health treatment: “There was a time a year ago when we were short of counselors. We couldn’t take clients into our program for about six weeks, so we started to offer suggestions from our referral list. But our clients didn’t want to go anywhere but here. They were willing to be on a waitlist thirty to forty people deep in order to come here. When you’re in counseling, you talk about some really personal, sensitive issues. It’s a very vulnerable place, and you can’t afford to bring negativity into that.”35
LGBT families who have access to treatment facilities specifically catering to sexual minorities are likely to receive respectful treatment. But such access is limited for most families. Instead, they have limited options—sometimes only a single provider that may even not even be near their own home. These families may know nothing about the staff with whom they will interact or even the treatment philosophies that exist there. Some providers hold to the belief that LGBT individuals are incapable of being good parents (or at least good-enough parents). Some hold to the recruitment myth that these parents are conscripting youth into an “alternative lifestyle.” The most common challenge is professionals who focus on parents’ sexuality as the underlying cause for any and all issues occurring in the family—even though it is unheard of to encounter clinicians who immediately assume that children are having problems because they are being raised by straight parents. Families are likely to encounter heterosexism and veiled homonegativity from staff and even other clients.
In A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals, the Center for Substance Abuse Treatment lists specific practices that indicate whether treatment providers have proficiency in treating sexual minorities.36 From my own experience, I find that the following questions from the guide are most telling about any type of treatment facility when contemplating a specific treatment provider:
• Are all staff mandated to participate in trainings relating to sexual minorities?
• Do the forms, brochures, and educational materials assume heterosexuality as the norm?
• Does the facility promote and advertise its LGBT services?
• Does the facility’s referral and resource list offer options relevant to LGBTs?
• Does the facility make family services available for same-sex partners and families of choice during treatment?
• Do education sessions and lectures include LGBT issues?
• Does the facility employ openly LGBT individuals as staff members?
• What are the guidelines for clients regarding homophobic behavior so that LGBT individuals are safe? How are these guidelines enforced?
• Does the facility provide education for heterosexual clients about language and behaviors that show bias toward LGBT people?
• How does the facility investigate complaints of discriminatory practices reported by LGBT clients and family members?
Joe Kort, one of the country’s leading experts on gay-affirmative mental health treatment, notes that such treatment is not a specific modality but rather a way of helping sexual minorities move from shame to pride and undoing the damage of a “homophobic, homo-ignorant society, and heterosexist therapy.”37 Gay-affirmative treatment is an approach underlying the other therapeutic skills and interventions that are the stock and trade of mental health professionals.
According to Kort, there are three principles underlying affirmative treatment:
1. Understanding and combating heterosexism: The American Psychological Association issued a series of sixteen guidelines for working with sexual minorities. In addition to acknowledging that homosexuality and bisexuality are not indicative of mental illness, practitioners are called “to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of lesbian, gay, and bisexual clients.”38 Additionally, the Substance Abuse and Mental Health Services Administration recommends that helping professionals assist their clients in healing from the negative effects of homophobia and heterosexism.
2. Understanding heterosexual privilege: Mental health professionals are reminded that heterosexuals have a gamut of taken-for-granted freedoms that are granted automatically that are not necessarily accessible for LGBT individuals and their families. Assuming LGBT families have the same freedoms as a straight family is a blunder on the part of clinician.
3. Acknowledging one’s own homophobia and homonegativity: The American Psychological Association recommends that “psychologists are encouraged to recognize how their attitudes and knowledge about lesbian, gay, and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated.”39
In sum, an gay-affirmative treatment provider—whether working in a clinic-based setting or out of his or her own office —is an individual who recognizes the societal and community challenges confronting LGBT individuals and their families, who has invested energy in analyzing his or her own preconceptions and emotions about sexual minorities, and who understands that most of the mental health concerns they present with are not caused by their sexuality but rather the impact of heterosexism and homonegativity on these men and women and the children they are raising.
The Human Rights Campaign’s annual Healthcare Equality Index offers readers a snapshot of progress (and lack of) made in treatment centers across the United States.40 A LGBT parent can access information on 375 facilities in twenty-nine states and the District of Columbia. For example, a lesbian mother living in Philadelphia now has access to the following information on the Children’s Hospital of Philadelphia, one of the leading pediatric health-care providers in the region:
• Patient nondiscrimination policies
• Visitation policies
• Cultural competency training and client services
• Employment policies and benefits
This is a great start; unfortunately, the report offers no guidance for LGBT families living in twenty-one states. Furthermore, only several facilities from each state responded to the survey. For example, in Pennsylvania, only two hospitals were willing to describe their efforts, and both are located in Philadelphia. There is no information regarding other health-care facilities in the state. While the number of respondents to HRC’s health-care survey increase each year, a full accounting of facilities across the country in regard to basics such as discrimination policies, visitation policies, staff training, and employment policies and benefits will not be available in the near future.
What, then, are the options for LGBT families who have no access to the treatment facilities measured by the HRC survey or who live in urban areas without recognized specialized treatment providers? In particular, what are the options for families needing medical treatment living in less-than-welcoming communities? Lambda Legal’s 2011 survey found that over half of LGBT respondents indicated that overall community fear or dislike of people like them is a barrier to care.41
Health-care laws vary widely from state to state. For example, the laws of my home state of Pennsylvania do not specifically provide for a partner to make decisions on behalf of an incapacitated same-sex partner. Contact must be attempted with at least five individuals before a partner would have authority. In contrast, the neighboring state of New Jersey has ruled that a civil union partner has the same rights and responsibilities as a spouse with regard to laws relating to emergency and nonemergency medical care and treatment, hospital visitation and notification, and any rights guaranteed to a hospital patient. The Human Rights Campaign is an ideal place to initiate a search on the respective health-care laws for each state and their relevance for LGBTs.
There are several prevailing recommendations in regard to medical treatment that LGBT individuals and families should consider. The first urges that LGBTs create advance health-care directives—documents that spell out what measures a person wants taken when he or she is no longer capable of communicating choices regarding prolonging life and other medical care issues. Unfortunately, surveys over the past decade indicate that only 20 to 30 percent of Americans have formulated advance directives, and people of color and low-income individuals are less likely to have created them than whites.42
Since most medical decision-making law is not inclusive of LGBT families, it is especially important that LGBT families complete directives to ensure their ability to make medical decisions for incapacitated partners. Even if an LGBT individual has created an advance directive, there may be some situations in which health-care providers need additional information in order to decide what action should be taken. A durable power of attorney for health care (also sometimes called a health-care proxy) empowers someone to make medical decisions for another person if that person becomes unable to make these decisions for him- or herself. A few states have created advance directive registries. In these states, an adult can register his or her desires regarding end-of-life treatment and name a health-care proxy. This information in kept in an Internet database accessible by health-care agencies. Each state has its own protocol for validating health-care proxies, and LGBT parents are strongly advised to secure this information.
LGBTs are also advised to complete a visitation authorization, a document allowing a person to designate who will be able to visit him or her in the hospital if that person is no longer able to communicate. The presidential memorandum of April 15, 2010, summed up the plight succinctly: “Every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides—whether in a sudden medical emergency or a prolonged hospital stay… [U]niquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives—unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.”43 This memorandum, sent by President Obama to the secretary of Health and Human Services, called for new guidelines regarding hospitals’ compliance with existing regulations to guarantee that all patients’ advance health-care directives are respected and that hospitals participating in Medicare and Medicaid programs cannot deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. These regulations went into effect in 2011.
Finally, for LGBT parents, a consent for treatment allows a partner to consent to emergency medical treatment for a child if a biological parent is not available. The National Center for Lesbian Rights suggests that even if both partners are recognized as legal parents, it is advisable to execute this document in case they are traveling in a state that refuses to recognize their relationship or parental status.44
New regulations and guidelines, along with the growing acceptance of LGBT individuals and their families, are certain to lead to progress in their health care. However, this is a process. Some organizations will be more successful sooner than others.
When more than 50 percent of LGBTs report mistreatment by medical and mental-health-care providers, it is easy to understand their anxiety and even dread regarding accessing these services. In fact, many of the individuals I spoke to took a “guilty until proven innocent” approach; providers were assumed to be less than welcoming until they evinced proof to the contrary. Maris told me that her neighbor—a true straight ally if there ever was one—recommended her own children’s pediatrician as the ideal doctor to work with her family. Maris, however, experienced unexpected blatant hostility from this small practice and did not at all feel welcome, respected, or even safe. Maris’s neighbor was shocked at this report and indignantly contacted the provider, “gave him hell,” and, from that point on, refused to work with him any longer.
If all LGBT families had neighbors like Maris’s, their community experiences would surely be less turbulent. Unfortunately, they do not. Some families lie about their status, particularly designating one person to the “official” parent to shuttle a child to routine medical appointments while the identity of the other is elided or fabricated. Others carefully scrutinize the available options and select providers who are known to be LGBT affirmative even if the distance is far greater than closer local services. Many simply hope that no critical incident necessitates health-care proxies and visitation authorizations that might jeopardize their “secret.”
Lambda Legal urges families to fight back when discrimination occurs by contacting Lambda Legal, other legal and advocacy organizations, or a local attorney. But for low-income families and those living in the closet in their local communities, these options are not realistic, at least at the present stage in the progress of LGBT rights. It is thus recommended that families create active support systems, including straight allies, who can and will fight on their behalf.
Beginning in 2010, the expectations and guidelines for medical providers and mental health regarding LGBTs have evolved at an astounding rate, with some advocates claiming the changes occurring during the two years following equal the importance of the American Psychiatric Association’s 1973 decision to remove homosexuality from its manual of mental illnesses. Still, setbacks can occur. For example, Emilia Lombardi, a professor at the University of Pittsburgh, expressed concern that the Health of Lesbian, Gay, Bisexual and Transgender People report could have a similar fate to earlier efforts, such as the 2001 US Department of Health and Human Services’ Strategic Plan on Addressing Health Disparities Related to Sexual Orientation, a document commissioned during the Clinton administration but disregarded by George W. Bush and his cabinet. According to Lombardi, “There are people in politics who don’t have a good view of science overall.”45 Bradley Jacklin of the National Gay and Lesbian Task Force agrees: “Elections do matter. There’s a risk of this becoming a doorstop if administrations change.”46 All of us—LGBTs and allies—must continue to advocate for continued improvements in laws and policies and fight efforts to roll back these gains.