Finding Queer Affirming Mental Health Care

Before Kris Grafing began his hormone therapy in 2006, he had socially transitioned and was passing as male. Medical challenges had prevented him from transitioning using hormones, but once those issues were resolved he was ready to begin the hormone treatments that would complete his transition. Before he could do so, however, he had to attend mandatory one-on-one sessions with a psychiatrist. 

The Medical University of South Carolina was the only place in his home state that had doctors who would work with him. Before hormone therapy could begin, he had to undergo a series of sessions where he would be questioned about his aspirations until the psychiatrist gave the go-ahead to begin hormone therapy, or stopped the process before it started. The whole system felt rife with gate-keeping, and left Grafing feeling helpless. 

“I was angry about it, but I didn’t feel like I had any recourse, so I went along with it. I was under the impression that if I didn’t meet all of his checkboxes that I wouldn’t be given permission to start hormones,” Grafing told me.

“I felt brushed off and pegged as mentally ill, and not mature enough––not capable enough to make my own decisions [...]”

The queerness-as-illness line is an old one, and persists today, even in modern mental health systems. If you want proof, note that conversion therapy is still practiced across North America, under many different guises.

After completing his hormone treatments, Grafing did eventually find a psychotherapist who was a good fit for him. He managed by reaching out to his personal connections in the LGBTQ+ community in Charleston, but he wishes therapy had felt like an option for him earlier. As a questioning queer youth, he had chalked his attraction to girls up to being a lesbian. Only through his own research later in life did he learn about trans identities, hormone treatments, and transitioning, and realized that was an option for him. “As far as transitioning, I wish I had had that kind of counselling when I was much younger. I wish I had spoken up. It would have been more beneficial to me when I was fifteen years old.”

Not only do queer, questioning, and trans folk need to navigate where their identities fit into their families and communities, they often need to find ways to accept themselves, to deal with current and/or past trauma, and how to come out to a world filled with judgement, rejection, and hate. Finding the right mental health practitioner can be a life changing experience. Sadly, for a queer or trans person, being able to find a competent therapist to support them through their unique challenges can be difficult.

A Safe Place for Us

“Queer and trans people experience higher rates of mental health issues such as suicidality, depression, anxiety and also substance use issues when compared to their cis-gendered and straight counterparts,” explains James Young, a researcher at Simon Fraser University (SFU) who is studying how to eliminate barriers to mental health support for queer and trans folk. 

“A lot of queer and trans people have unresolved trauma, and this can lead to these higher rates of mental health issues. I think because of that, it’s important to try to increase accessibility to these services, because of the disproportionate experiences and issues that these populations face.”

With the endless choices, and a vast sea of options for mental health therapies these days, finding the right therapist can be difficult. When you’re queer-identifying or questioning, it’s even harder. The wrong therapist, or even the not-so-right one, can be downright damaging. Just ask any of the 50,000 people who have been exposed to conversion therapy in Canada alone, and who have suffered from depression, anxiety, self-doubt and self-hatred as a result.

Therapy doesn’t need to be conversion therapy to be damaging. Travis Salway Ph.d. explains, even subtly unsupportive or negative therapy can have exponentially negative effects on a queer person’s mental health and general success.

Salway is studying how LGBTQ+ people experience mental health systems. He explains, “we do know that in Canada, from national surveys, that lesbian, gay and bisexual people are more likely to report unmet mental health care needs.”

In addition to more overt discrimination like bullying and exclusion, there are more subtle prejudices and stresses that LGBTQ+ (as well as other minorities) suffer with. This “minority stress” can manifest in any number of ways, such as a queer person avoiding family gatherings for fear of interactions with unsupportive, and even homophobic relatives. 

Negative or subtly insensitive interactions with less-than-knowledgeable, or untrained mental health providers can have disastrous affects for a queer or trans person entering their offices.

“We wouldn’t see the same kind of lasting stress, and anxiety and self doubt and hatred that is associated with conversion therapy, but we might see that that person avoids opening up or even going to see another health care provider,” says Salway. “They’re deterred from coming back to the clinic, or worse, they’re deterred from coming back to any clinic.”

Know the Signs 

Doing some homework before committing to a mental health worker can really help. Queer affirming mental health care acknowledges and celebrates queer identities, but how do you know if a therapist you are considering is queer affirmative? With so many online options available now, how do you identify the ones that have the training and the sensitivity not to support you?

According to their research, there are some signs, explains Natasha Vitkin, SFU researcher also working with queer and trans barriers to mental health care.

For example, take a close look at the language on a practitioner’s website. Does it use inclusive language? Does the practitioner describe their practice as “queer/trans affirming”, or is LGBTQ+ listed along with other “problems” to be solved? This is an important to take note of, says Vitkin, because such phrasing could be a subtle indication of insensitivity around a queer or trans person’s needs.

“When we think of the history of mental health care, for a long time queer identities were pathologized and thought of as something that needs to be fixed or addressed,” says Vitkin. 

Also, look at how the practitioner identifies themselves on their site. Do they disclose their own gender or sexual identity? This can be a signal that a practitioner will be competent and able to administer support from a place of lived experience and understanding. A simple rainbow or trans symbol can also be something to look for on a site. 

While you can’t always count on a website or profile to tell you how well you’ll match with a mental health practitioner in-person, it can at least give you an indication of where they are coming from and where their interests lie. 

Where’s Your Access?

Accessing care is the second hurdle that queer and trans folk face when seeking mental health support. The first is knowing where, and how to look. For Jason Sober-Blodgett, a queer affirming counsellor was non-negotiable; it was imperative he find a therapist who could not only speak his language, but understand it as well. Sober-Blodgett admits he’s lucky to live in the West End of Vancouver, B.C., where the LGBTQ+ community is strong and there is a comprehensive pool of resources from which to draw. He was given a list of queer-affirming mental health practitioners through his GP.

“I think a lot of the things I was needing a counselor for had nothing to do with the gay experience, but being a gay man, it’s hard to separate those things a lot of times. Despite whether or not it really has anything to do with the gay experience, it is who I am.

“I’m also in a committed, married, polyamorous relationship. I’ve expanded in my viewpoints, and my husband has expanded in his viewpoints over the past two to three years as we have experienced more. Being able to go to someone who I can talk to comfortably about polyamorous relationships, especially polyamorous relationships in the gay community, that was important. Even if that is not necessarily the focus of what we’re talking about, it seeps into conversation because it is part of who I am.”

COVID-19 means that a lot of mental health services have been shifted to the online space, which frequently solves accessibility issues for people who aren’t as lucky to live in an urban area that has a large LGBTQ+ community, such as those who may live in remote areas or who otherwise face mobility problems. For other minorities it presents a whole new challenge, as considerations around access to privacy and tangible resources like computers or phones may be an issue.

Don’t Stop at Queer Affirmative

If you’re queer or trans, it’s important to find a queer affirmative mental health provider, but don’t stop there. After looking for weeks, months or even longer for a counsellor or therapist who fits the bill, you might be desperate to make it work, because you’re so relieved to finally have someone to talk to. 

Being queer, or queer affirmative doesn’t mean that a therapist is going to be the right fit for you. The bottom line is that they work for you, and you are more than one fact about yourself. It’s important that you feel comfortable communicating your needs. The relationship between you and your mental health practitioner should be one where you feel comfortable being you, and that may mean that a therapist who is simply LGBTQ+ competent may not be enough.  

Many mental health professionals will offer free consultations. Take advantage of that, says clinical counsellor Collette Mrazek. “Do a consult. You need to feel good with that person,” she told me. “It’s worth waiting for.”

Mrazek explains many people wait until the breaking point before they seek help. Once they reach that point they’re desperate, so they feel like they aren’t able to wait on a list for an appropriate practitioner. This is frequently when people settle for what’s available, and maybe that’s a practitioner who hasn’t had the right training, personality, or experience for them. 

Mrazek emphasizes “It doesn’t go well, and then you never go back to therapy. I think waiting for someone you feel good with is worth it, even if that’s four months.” 

Cost

For many queer, trans, and marginalized populations, the cost of mental health services is prohibitive. There are practitioners who offer therapy on a sliding scale, and occasionally free services, but wait lists for public practitioners who offer this service, or non-profit programs who do so, are frequently overbooked and over-burdened with lengthy wait-lists. It is best to leave these services to those in critical need if that is an option.

As with most minorities, those who identify as LGBTQ+ are more likely to suffer from poverty than cis-gendered or straight people. According to the BC Poverty Reduction Coalition (BCPRC), trans and non-gender conforming people have twice the unemployment rate as the general population. 

It’s these sorts of numbers that keep LGBTQ+ people alienated from the healthcare system that should support them, and what makes independent services a good choice for those who are able to afford them. Salway and other research teams are working to improve access. Salway says, “If someone is in distress and they’re not sure where to start, they should at least call someone. The first step is just to connect to a warm body. If they don’t connect them to the perfect service, at least they get the ball rolling.” 

If you are a queer, trans, or questioning person, you don’t need to be alone. Just start with a phone call, or the click of a button. 

Which Doctor has service providers who offer sliding scale services, and a free clinic. Which Doctor members receive a 20% discount on services scheduled through the site.

Which Doctor neither condones nor permits anyone practicing conversion therapy to use their resources. Should you find a practitioner on the site who does practice conversion therapy, please alert us immediately, and we will investigate the problem immediately.