Reassessing our knowledge about LGBTQ+ mental health and practice

Dr. Shanéa Thomas, Training Specialist and Assistant Clinical Professor, argues that trainers are the key to inclusion in mental health and LGBTQ+ practice.

Many of us may still be reeling from the instability of the last three years, discovering the new landscape of need among the populations we serve, especially within mental health. Moving into a new year means taking the constructive lessons of the previous year and reimagining how our practices and skills can have a different impact in the future. One way has been for therapeutic practices to find ways to increase the reach of their services. A 2020 study found that audio and video telehealth services have increased 80 percent during the pandemic in the United States (Karimi et al., 2022). Globally, the need continues, as the World Health Organization (WHO, 2022) states that there has been a 25% increase in anxiety and depression. Looking specifically at LGBTQ+ people during the pandemic, “LGBTQ+ adults have been twice as likely to experience mental health problems compared to non-LGBTQ+ adults” (File & Marley, 2022). When working with these populations, the volume and specificity of service delivery requires professionals to find innovative ways to accommodate the need and variety of demographics, in person or online.

As training must be informative and skill-building for its audience, with organizational initiatives becoming more diverse and inclusive, we must also be affirmative in our practices. What sometimes keeps LGBTQ+ people away from treatment are the different levels of oppression, discrimination and micro and macro aggressions, experiences that increase what we call minority stress. This differential treatment causes this population to become even more isolated and feel disconnected from the health and community care they deserve, and they internalize these negative reactions as the truth, ultimately affecting their mental health. What are some ways that clinical and therapeutic trainers and educators can positively change the impact of their work? Here are three tips for bringing the intersections of mental health and LGBTQ+ practice to the fore in your work:

1. Examine your own biases about LGBTQ+ people and mental health

Becoming a trainer on this topic first requires us to examine what some of our own biases are and where they come from. For you, what was your education around LGBTQ+ people? What did you see in the media about this population? What were the conversations in your home about mental health?

Reactions to those questions are going to differ depending on who answers them. This affects our ability to translate the information we learned and witnessed to another person or group of people. Sometimes our own personal thoughts and experiences prevent us from being present in our practices. For those people who are also struggling with identity-related issues, they are also at risk of experiencing minority stress, which can affect their work emotionally as well. For anyone, finding support such as clinical supervision or a support group of colleagues can help navigate any feelings that arise to help our work remain unbiased by our own experiences.

2. Train from a place where we can all reach

When training on Diversity, Equity, and Inclusion practices, I have noticed that when it comes to race and ethnicity, there is always some level of debate about the relevance of history, struggle, and the right to exist when it comes to power and privilege. However, with issues related to sex, gender identity, gender expression, and sexual orientation, while we may not always agree on how a person appears, we can all agree that we all have a sex and gender. (even validating those who are agender). and asexual).

Although talking about sex and gender can be taboo in some quarters, the concept of inclusion also means that we are all affected by the gender binary no matter how we identify: it shows up in the insurance paperwork we sign, the bathrooms we provide, and the services. offered to customers. When coaching on LGBTQ+ and mental health issues, remember that since sex and gender are on a spectrum throughout life, we never know when there is a change in who we are as we all evolve over time. Use inclusive language and concepts in trainings to reach your current audience and who they might be in the future.

3. In training, the best practice is always to know our limits

Being an inclusive trainer means knowing our limitations in knowledge and practice. There is such a wide range of identities that it would be impossible to know them all, depending mainly on cultural traditions, geographic regions, language, etc. For example, when you think of men, who comes to mind? What problems do they face? What happens if the person appears to be male, but the anatomy is that of a person assigned a female gender at birth? Does this change your point of view about how you talk about the needs of those who identify as men? Understanding the limits of our knowledge in an ever-changing field allows us to assess for ourselves where we need to grow. Just as we cannot pour from an empty cup, neither can we teach new and inclusive methods from an ancient book. Training is not just about who we serve, but also about an opportunity to learn (and unlearn) ourselves. It is ethically responsible for trainers to know when we simply don’t have the resources to give to those we serve.

Also continue to invest in workshops, training or certification programs to improve your skills and receive new and updated vocabulary and research. I also recommend that trainers and educators update the language and culture information in training materials at least once a year. This may even be a staff, committee, or community effort to ensure ongoing awareness, practicality, and accountability. This way, you’ll always be one step ahead in the new year.


  1. Archive, T. & Marlay, M. (2022, June 16). Regardless of household type, LGBT adults struggle more with mental health than non-LGBT adults. Obtained from
  2. Karimi, M., Lee, EC, Couture, SJ, Gonzales, AB, Grigorescu, V., Smith, SR, De Lew, N., and Sommers, BD (February 2022). National trends in telehealth use in 2021: disparities in utilization and audio vs. video services. (Research Report No. HP-2022-04). Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services.
  3. World Health Organization (WHO). (2022, March 2). The COVID-19 pandemic triggers a 25% increase in the prevalence of anxiety and depression worldwide. Obtained from

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