Mental Health Issues for LGBTQ+ Veterans #MHM #MHAM

When it comes to LGBTQ+ Veterans, the VA separates lesbian, gay, and bisexual (LGB) Veterans and transgender/intersex Veterans. The differentiation is not discriminatory; it is necessary because the VA recognizes that LGB and transgender/intersex Veterans face different health issues.

Mental health for LGBTQ+ Veterans is multilayered due to the progress of military equality starting with the repeal of the “Don’t Ask, Don’t Tell” (DADT) policy in 2011. When DADT was implemented, it was essentially a path for LGB servicemembers to either begin to serve or continue to serve so long as they did not disclose their sexual orientation in the application process or anytime during service. It was progress for sure; however, the stress of having to serve in silence for years may have taken its toll. Mental health issues may exist for those who served before DADT was put into place and this is where we tend to see the harsher treatment of LGB servicemembers.

Before DADT, LGB servicemembers were not allowed to serve really at all and the military made certain that a servicemember who was caught would be marked for life. In the years preceding DADT, those discharged for homosexuality were likely given “other than honorable” or “dishonorable” discharges along with the designation of being called “undesirable” on discharge papers. A servicemember may have received an honorable discharge but would have had a caveat attached making some remark to being booted for being gay. It was perhaps a no-win situation.

When one takes into account the stresses of silence and the stresses of military service, there can be no doubt that any LGBTQ+ servicemember affected by the military’s policies would carry with them mental health issues when they entered Veteran status.

Look back at the issues listed for LGBTQ+ people and overlay them with the issues of Veterans, they remain the same but also take on important distintion

  • Coming out in the military could have had positive consequences but also have negative ones because of existing military policies and the environment of one’s unit. Coming out before and during DADT would’ve been difficult if the servicemember did not have some form of support. Coming out after getting out could be difficult because of the stresses of silent service.
  • Rejection within the military and within the community are factors. Despite the repeal of DADT and the lifting of the transgender ban, there are still areas in the military that may be less supportive of one’s coming out. Additionally, the communities surrounding military bases and communities where LGBTQ+ Veterans end up settling in after service may not be so supportive.
  • Trauma, like the last post, is also a factor for LGBTQ+ Veterans because of homo/bi/transphobia, bullying, and identity-based shame. As much as we may like to believe that the military is progressing because of new LGBTQ-friendly actions, discrimination still exists. Unfortunately, LGBTQ acceptance in the military may be subjective from one unit to another. Because of this, an LGBTQ+ servicemember may not report discrimination, harassment, or assault to his/her/their command. Trauma in the service can then lead to mental health issues when the servicemembers becomes a Veteran if left untreated.
  • Substance misuse or overuse to deal with LGBTQ and/or military-related issues may occur. LGBTQ+ Veterans might use alcohol or drugs to try to cope with rejection, trauma, discrimination, and/or assault, as well as military-related issues like exposure to combat and/or traumatic brain injury (TBI).
  • Homelessness can result from lingering effects of post-traumatic stress disorder (PTSD) and substance abuse compounded with a lack of family and social support networks.
  • Suicide is a major concern as LGBTQ+ Veterans are at higher risk for suicide; transgender Veterans are even more at risk with a rate 20x higher than that of non-transgender Veterans.
  • Inadequate mental health care is still an issue even if an LGBTQ+ Veteran is receiving care from the VA. Depending on the robustness of the VA health care system’s LGBT Veteran Care program, a Veteran may run into a provider who is not fully aware of the services for and issues pertaining to LGBTQ+ Veterans. This may result in misgendering, microaggressions, and refusal of care.

Mental Health Issues & Disparities

Lesbian, Gay, Bisexual and Transgender (LGBT) Veterans experience discrimination and living with that discrimination can lead to or aggravate the following mental health issues. In some cases, mental health issues come to light after leaving the military:

According to the VA’s Office of Health Equity, sexual and gender minority Veterans face stigma and discrimination that affects their mental health. In fact, LGB Veterans are twice as likely to receive a diagnosis of an alcohol use disorder and fives times as likely to receive a PTSD diagnosis.

PopulationAlcohol use disorderptsd
Gay & Bisexual Males10.20%53%
VA Males6%16.80%
Lesbian & Bisexual Females5%67%
VA Females1.20%5%
From Cochran, B., et al (2013)

Additionally, transgender Veterans have significantly higher rates of serious mental illness, suicidal ideation, PTSD, and major depression than non-identifying transgender Veterans.

PopulationMajor DepressionPTSDsuicide ideation/attemptserious mental illness
Transgender Veterans46.38%50%48.55%53.62%
Non-Identifying Transgender Veterans29.79%35.11%23.94%28.72%
From Ramirez, Heliana. 17 May 2019, VA Palo Alto Health Care System.

What Can You Do

If you are enrolled and using VA health care, you can schedule a mental health appointment through the following means:

The VA offers a variety of tools and resources as options to the above methods:

Suppose you are seeking mental health care outside the VA, the National Alliance on Mental Illness (NAMI) offers the following important considerations when seeking LGBTQ-competent care.

  1. Think about what you’re looking for in a provider.
  2. Gather referrals from online directories, your insurance provider, local LGBTQ+ community centers, health centers, and community groups. Even affirming places of worship.
  3. Make the call, you may want to ask the provider if they have previous experience with LGBTQ+ patients or if they are comfortable working with LGBTQ+ patients. If you are reluctant to call, you can ask a friend or family member to do so for you.
  4. Ask questions in your first visit, your new provider may welcome the inquiries. Below are some things to ask:
    • My identify is __________. What experience do you have working with people with that identity?
    • What experience do you have with the LGBTQI community?
    • Do you have any specific training or certifications that relate to working with LGBTQI clients?
    • Do you provide conversion therapy or reparative therapy? How do you feel about those specific practices?
  5. Build a relationship once you have found the right provider for you. Be patient, it may take time and several calls. In your search, keep in mind that you’re looking for someone to help you improve your mental health. If the provider you select doesn’t feel right, you can move on to the next provider and keep searching.