Dr. Kristopher Wells University of Alberta - Supporting Mental Health in LGBT Children and Adolescents

January 6, 2015

Supporting Mental Health in LGBT Children and
                Adolescents

            Dr. Kristopher Wells
            University of Alberta
            kwells@ualberta.ca

Session Goals
— Understand the lived and learned realities of
   sexual and gender minority (LGBTQ)
   individuals
— Identify barriers and inclusive strategies for
   creating welcoming and safe environments for
   sexual and gender minority (LGBTQ) clients
— Share evidence-based professional resources for
   support

300 Kids is 300 too Many

    http://www.youtube.com/watch?v=Wh1jNAZHKIw

World Health Organization: 1 Million

Canada: 4,000 Completions

Alberta: 5,000+ attempts
2010: 524 Completions (395M/129F)    91 < 24yrs
2011: 498 Completions (377M/121F)    70 < 24yrs
2012: 509 Completions (385M/124F)   103 < 24yrs
2013: 537 Completions (396M/141F)    75 < 24yrs
2014*: 347 Completions (271M/76F)    70 < 24yrs

BC Coroner’s Report (2008)

Current Outlook on SGM Youth in Canada
“Generally speaking, Canadian youth and young adults are healthy
and highly resilient, and most are successfully making the transition
to adulthood. But not everyone is flourishing. … Sexual [and
gender] minority youth are at a much higher risk of experiencing
harassment, victimization and physical or sexual violence, both in
school and in the community. … Lesbian, gay, bisexual,
transgender or questioning (LGBTQ) youth and young adults are
also more likely to commit suicide. … More [research and
advocacy] work needs to be done to provide appropriate programs
and services.”

- from The Chief Public Health Officer’s Report on the State of
Public Health in Canada 2011: Youth and Young Adults – Life in
Transition

Sexual and gender minorities (LGBTQ), in addition to
having the same basic health care needs as the general
population, experience significant health and health care
disparities and have specific health care needs related to
their sexual orientation and gender identity. These
disparities include:

   • Chronic (and often stress-related) disease
   • Compromised adult and adolescent mental health
   • Unhealthy relationships (e.g., Intimate partner
     violence)
   • More pronounced gender identity concerns
   • Increased STI/HIV risk factors
                                          - Obedin-Maliver, et al., 2011

While access to medical care/
   treatment may be equal in
Canada, the quality of health care
 provided to sexual and gender
     minorities often isn’t.

             WHY?

WHY?
 • Sexual and gender minorities are more likely to face
   barriers in accessing appropriate medical care, which can
   exacerbate health disparities.

 • Heterosexual and gender normative bias

 • Fear of stigmatization

 • Internalized homophobia/transphobia

 • Attitudes of health care providers (personal morals v.
   professional conduct)

What is LGBTTTIQQPAA?
— Lesbian, Gay, Bisexual, Transgender,
  Transsexual, Two-Spirited, Intersexual,
  Queer, Questioning, Pansexual, Asexual,
  Allied
— Sexual and gender minorities

— Invisible minority

— Disproportionate targets for violence and
  victimization
— Coming out at younger ages

Generation
  Queer

Sexual Orientation

— An individuals enduring sexual,
 psychological, and emotional
 feelings of attraction towards
 another person

— Operates on a continuum

Gender Identity
— A persons internal sense or feeling of being
   masculine or feminine
— Sex and gender are distinct categories
— Gender variance exists on a continuum          (i.e.
   none, low, high intensity)
— Gender identity/transition is a relatively new
   social phenomena, which schools/service
   agencies are only beginning to become aware of
   and address

What are the (potential) barriers to
        inclusive service?

A 2007 survey of over 700 Californian physicians
found that 18.3% were “sometimes” or “often”
uncomfortable in providing care to gay patients.
Demonstrated need for:
• Training on knowledge, skills, and attitudes necessary to
  provide excellent, comprehensive care for sexual and
  gender minority patients

• LGBTQ-specific training (knowledge content) in pre-
  clinical and clinical settings

• Training in communication skills with patients and
  colleagues around sexual orientation and gender identity
  issues

Minority Stress
                       Sexism      White Privilege

               Heterosexism                 Colonization
           Racism                 Ageism

             Aboriginal                           LGBTQ
                                  Youth
             Community                          Community

            Homophobia            Poverty             Classism
                    Transphobia             Ableism
                       Mainstream Culture

Ethnocultural/Aboriginal LGBTQ Youth &
Challenges to Identity Formation:
   • Negotiate 3 distinct cultures
   • Prioritize or suppress different aspects of identity
   • Ethnocultural/Aboriginal and sexual identities are
   stigmatized
   • Minority within a minority (double/triple minority
   status)
         The unique stressors of managing multiple levels of stigma, including
         race, ethnicity, gender, sexual orientation, and gender identity
         require additional sensitivity and knowledge of appropriate
         community resources. - Ryan & Futterman, 1998

Two-Spirit
— Pre-colonization

— Multiple gender roles

— Often received special recognition &
 ceremonial roles

— Reclaim traditional roles and identity

Health, Mental Health, and Safety
  Consequences for LGBTQ Youth
—   truancy or dropping out

—   drug and alcohol abuse

—   increased peer victimization

—   withdrawal from social and school activities

—   more experiences of dating violence

—   higher rates of pregnancy involvement

— significantly higher rates of bullying, physical assaults/
   violence, sexual harassment, and sexual abuse

— running away from home

— turning to prostitution and/or living on the streets

— depression, eating disorders, post-traumatic stress, self-
   harm

— increased suicide ideation or suicide attempts

(Bagley & Tremblay, 1997; Grace & Wells, 2001, 2004, & 2005; McCreary Centre Society, 1999;
   Ryan & Futterman, 1998; Saewyc, 2011; Wells & Tsutsumi, 2005; Wells, 2006; Williams,
   Connolly, Pepler, & Craig, 2003 & 2005 )

Homophobia, Transphobia, & Heterosexism:
                 Risks
— Mental, Emotional and Physical Health
  — Anxiety, Depression, Fear, Suicidality, Internalized
   Homophobia, Negative Self-Concept, Emotional abuse, Eating
   disorders
— Personal
  — Physical, verbal, & cyber bullying, Isolation and withdrawal
   from activities, Truancy, Sexual Risk Taking, Drug & Alcohol
   Abuse
— Environmental
  — Stigmatization, Harassment, Lack of Role Models, Family
   Rejection, Gay Bashing, Marginalization, Familial rejection &
   street involvement, Lack of health information

Youth comment about “hiding oneself”

o It makes me even more angry, and since I cant express that
  anger, it turns inward.
o It requires energy that should be available for other things.

o It can crush people on the inside.You eventually fade as a
  person as it changes you, rots you.
o I think it absolutely kills my self-esteem and confidence.

o Its emotionally draining to always pretend that I am
  someone Im not.

What Can I Do?
 (1) Create an inclusive environment
   • An invisible minority

   • Challenge heterosexual presumption/
     bias

   • Provide universal gender-inclusive
     restroom

• Examine your surroundings
   • Safe space posters

  • Clearly identified non-discrimination
    statements

  • Information materials about LGBTQ
    health issues

  • LGBTQ community magazines/
    resources

• Develop an LGBTQ referral network/
  program

• Remember families of choice, not
  necessarily families of biology

• Acknowledge and mark significant days
  •   Oct 11 – International Coming Out Day
  •   Nov 20 – Transgender Day of Remembrance
  •   Feb 25 – Pink Shirt Day
  •   May 17 – International Day Against Homo/Transphobia
  •   June/Sept – LGBTQ Pride Month

(2) Guidelines for Patient Discussions/Forms
   • Are your intake forms inclusive?
      • Male, Female, Transgender, Other:
        ______________

   • Utilize open-ended questions

   • Ensure for a non-judgmental and professional
     approach to service by all staff

   • Use gender neutral language (e.g., “partner,”
     “significant other,” “spouse”)

• Model back language (e.g., “Queer,” “Dyke”)

• Do not make assumptions about health or
  behaviours based simply on bodies or
  appearance.

• Be open and willing to let your patients
  educate you!

(3) Confidentiality
   • Promote open conversation; reinforce
     confidentiality (e.g., youth coming out)

   • Specify what information will be kept in a
     patient’s medical record and who has access to it
     (e.g., Fear of outing)

   • Disclosure of one’s sexual or gender identity
     should be the right of the client

(4) Conduct Violence Screening
  • Hate crimes in Canada disproportionately impact
    sexual and gender minorities (fear of re-
    victimization)

  • Ask questions in a gender neutral way
     • “Are you being/have you ever been hurt
       (physically, sexually, emotionally) by someone
       close to you, involved with you, or by a
       stranger? (post-traumatic stress disorder)
     • “Have you ever experienced violence or abuse?”
     • “Have you ever been sexually assaulted?”
     • Constant level of hyper-vigilance

(5) Language
  • Listen to how your clients describe their sexual
    orientation and gender identity (e.g., transgender,
    transsexual, panssexual, gender fluid, gender
    variant, gender creative, gender smoothie)

  • If in doubt, ask clients to explain or for a word or
    phrase they prefer to use

  • Use preferred names and pronouns (Indicate
    preference somewhere on their medical/client file,
    so it can be consistently used)

(6) Staff Sensitivity/Training
   • Support hiring openly visible LGBTQ staff

   • Openly visible LGBTQ staff and patients can be a
     strong indication of a welcoming, safe, and inclusive
     environment

   • Avoid ghettoization by asking LGBTQ staff to
     educate others on sexual orientation and gender
     identity issues

• Train front line staff as first point of contact
   • Gender-neutral language
   • Avoid heterosexual presumption

• Support ongoing professional development

• Connect with and link to LGBTQ community
  agencies and groups for referrals

Let’s Recap: What we can do
— Engage in personal and professional reflection
— Use inclusive language
— Normalize sexual and gender minority realities
— Display affirming symbols and images
— Establish Safe Therapeutic or Educational Spaces
— Advocacy
  — Address homophobic/transphobic language & bullying; Use
    preferred name & pronouns use
— Be familiar with LGBTQ resources
— Educate yourself: Attend workshops, read books, ask questions

Public Health Agency of Canada

iSMSS Studies
— Academic studies and research
— Graduate students
— NEW Undergrad & Graduate Courses
— Monthly Speakers’ Series

iSMSS Services
— Camp fYrefly: www.CampfYrefly.ca
— fYrefly in Schools – peer-to-peer education program
— Family Resilience Project – Free Counselling
— Gay-Straight Alliance support for schools (Provincial Conference)
— UofA Safe Spaces Initiative/Report
— Educational Outreach/PD Workshops
— University of Alberta Pride Week

                         www.ismss.ualberta.ca