June 19, 2024

Serene Nest

taking care of your health, Our Mission

Healthcare Initiatives And Policies For LGBTQ+ Inclusivity

5 min read

Written by Jorge R. Petit, MD

In the past year, nearly two-thirds of LGBTQ+ adults have experienced some form of discrimination or unfair treatment in their daily life, as reported by KFF. This can come in many forms, such as incorrect assumptions, or threatening or harassing actions. It is in part, due to such treatment, that LGBTQ+ people have higher rates of mental health conditions than non-LGBTQ+, especially those that are younger, lower income, women, or report chronic illness or disability. This form of discrimination has profound effects on many aspects of an individual’s life, and specifically can impact the healthcare they receive. Too often, LGBTQ+ individuals, in order to minimize these negative experiences, will likely avoid care, which often results in negative clinical outcomes.

Mental Health Disparities in LGBTQ+

Disparities in mental health issues, such as depression, anxiety, and substance use disorders, are particularly pronounced among LGBTQ+ youth, who are frequently subjected to bullying, harassment, and rejection from their families and communities. The COVID-19 pandemic and recent social and political unrest have exacerbated these challenges, highlighting the urgent need for supportive environments in schools, families, and healthcare settings.

A recent survey1 underscored the significant barriers LGBTQ+ individuals face in accessing healthcare. Over half of the respondents reported experiences where healthcare providers denied them care, used harsh language, or blamed their sexual orientation or gender identity for their health issues. Such discriminatory practices deter LGBTQ+ individuals from seeking necessary care, leading to delayed or inadequate treatment for mental health and substance use issues. The lack of culturally competent providers and fear of discrimination further complicate access to appropriate healthcare services.

Effective interventions are available and have been shown to benefit LGBTQ+ individuals. These include LGBTQ-Affirmative Therapy, Cognitive-Behavioral Therapy (CBT), support groups, family therapy, LGBTQ+ community centers, and mental health education and awareness programs. The success of these interventions, however, hinges on their implementation in respectful, welcoming, and inclusive settings by health professionals with specific training and experience in working with LGBTQ+ populations.

Tools for LGBTQ-Affirming Care

The Centers for Medicare and Medicaid Services’ (CMS) Office of Minority Health (OMH) plays a crucial role in improving healthcare for LGBTQ+ individuals. Last June, OMH released a statement highlighting resources such as the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Excellence in LGBTQ+ Behavioral Health, toolkits for equitable care, and telehealth resources specifically tailored for LGBTQ+ patients. These resources are essential for increasing visibility, promoting acceptance, and providing supportive networks that can greatly enhance the mental well-being of LGBTQ+ individuals.

I want to specifically call out a recent initiative that I think can be transformative in NYS and hopefully far wider: NYS OASAS Part 830 LGBTQ-Affirming Program Endorsement Standards and Guidance. This set of standards and guidance have the unique opportunity to truly transform how LGBTQ+ affirming services must be structured, delivered and fostered in an ambulatory setting as well as addressing the workforce training and competence issues needed. I encourage everyone to check out the standards set forth and make an effort to apply for this program endorsement (for those programs that this applies to) or review and adopt these to whatever setting you are in, because it is critical that we address the serious health inequities that LGBTQ+ individuals face.

We must start to address the behavioral health impacts on LGBTQ+ individuals. This will require a multifaceted approach and involves:

● Creating inclusive and accepting settings and communities that foster a sense of welcoming and belonging,

● Educating healthcare providers on LGBTQ+ cultural competency, and

● Increasing access to LGBTQ-affirming mental health services.

Identifying the opportunities within each organization to train the workforce and measure the results can accelerate adoption of this initiative. Technology like Emotivo, which analyzes quality of care in each behavioral health encounter, can begin to incorporate such visibility into your workflow at scale. Without visibility, the impact of the training can be lost, and then devalued.

Building Inclusive Work Culture

Creating longevity of such initiatives, to become more than lip service, requires fostering an inclusive work culture. Embody those values in the treatment of patients as well as the staff. From a leadership perspective, setting an example is paramount. In the spirit of LGBTQ+ Pride, I want to reflect on the powerful connection between leadership, visibility, and the celebration of diverse identities. After years of executive healthcare leadership roles, I am convinced that leadership is not about the title you have or confined to a singular mold; it thrives when as individuals we embrace our authentic selves, proudly own our LGBTQ+ identity, and cultivate an environment of belonging, inclusion and visibility.

Authentic leadership starts with embracing one’s true self, including one’s LGBTQ+ identity. The journey towards self-acceptance and coming out can be transformative, providing a profound understanding of one’s authentic self. As a proud and visible LGBTQ+ leader, I lead from a place of self-acceptance and pride and inspire others to do the same. By sharing my story, challenges, and triumphs, I create supportive environments that celebrate diversity, enabling others to bring their whole selves to the table.

Authentic leadership drives positive change, breaking down barriers, and creating spaces where everyone can thrive. Let us continue to celebrate and uplift LGBTQ+ leaders who pave the way for a more inclusive and accepting future. For your organization, ask yourself how you can bring more of your authentic self to the work environment to empower the rest of the team to do the same?

Dr. Petit is a board-certified Adult, Community and Public psychiatrist and healthcare executive leader with over 30 years of focused attention on innovation and healthcare transformation for those most in need and vulnerable. He has been at the helm of many organizations, including Services for the UnderServed (S:US), Coordinated Behavioral Care (CBC), Beacon Health Options, as well as former Associate Commissioner for the Division of Mental Hygiene in NYC Dept. of Health and Mental Hygiene. Dr. Petit is an active member of SAMHSA’s Center of Substance Abuse Treatment (CSAT) National Advisory Council and on many committees and boards in government and non-profits, promoting social justice action-oriented approaches to increase access to health, behavioral health, and social needs. He is founder and CEO of Quality Healthcare Solutions providing expert consulting, advisory and technical assistance services ranging from strategic planning, capacity building, cross-cultural competence and DEIBA organizational readiness. He is clinical advisor to Emotivo Health, a technology startup in behavioral health.

1 Choi KR, Wisk LE, Zima BT. Availability of LGBTQ Mental Health Services for US Youth, 2014 to 2020. JAMA Pediatr. 2023 Aug 1;177(8):865-867. doi: 10.1001/jamapediatrics.2023.1473. PMID: 37273225; PMCID: PMC10242505.


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