Happy Pride
Happy Pride. June is Pride Month and has been recognized as such since 1999 when it was first officially designated under President Bill Clinton. The first Pride march was held on June 28, 1970, one year after the Stonewall Uprising, which sparked the modern LGBTQ+ rights movement.
It has been 57 years since Stonewall and over 25 years since Pride Month was officially recognized, and yet individuals within the LGBTQ+ community still face significant stigma and stark disparities in healthcare and mental health outcomes.
Mental Health Classification and the Weight of History
All major professional mental health organizations now affirm that identifying as other than heterosexual is not a mental health disorder. Identifying as transgender, nonbinary, or genderfluid is not a mental illness. Being part of the LGBTQ+ community does not imply impairment or pathology.
However, history matters. These identities were once - and in many systems, still are - treated as disorders, and that legacy continues to impact care today.
The American Psychiatric Association (APA) did not remove homosexuality from the DSM until 1973/1975 updates, and the World Health Organization (WHO) did not declassify it until 1990. We are still working to undo the stigma that those classifications helped create.
Mental Health and Substance Use Disparities
Statistics across multiple sources consistently show significant disparities:
- LGBTQ+ individuals are more than twice as likely as heterosexual individuals to experience a mental health disorder in their lifetime.
- They are approximately 2.5 times more likely to experience depression, anxiety, and substance use disorders.
- Suicide attempt rates:
- 2.3% heterosexual individuals
- 4.4% gay/lesbian individuals
- 7.4% bisexual individuals
- Up to 65% of transgender individuals
- 31% of LGBTQ+ older adults report depressive symptoms, with 39% reporting serious thoughts of suicide.
- 8% of bisexual women report heavy alcohol use compared to 4.4% of heterosexual women.
- Approximately 25% of LGBTQ+ individuals report alcohol misuse, compared to 5–10% of the general population.
- Substance use disorders affect an estimated 20–30% of LGBTQ+ individuals, compared to about 9% in the general population.
These numbers are not about identity itself; they reflect the impact of chronic stress, discrimination, and lack of access to affirming care.
Healthcare Disparities and Barriers to Care
Healthcare disparities among LGBTQ+ individuals remain widespread. Many delay or avoid treatment altogether due to prior experiences of stigma, discrimination, or feeling unsafe in healthcare settings.
Additional contributing factors include:
- Limited social support, especially in non-affirming environments
- Family rejection and isolation
- Stigma even within parts of the LGBTQ+ community (including experiences often reported by bisexual individuals)
- Higher exposure to violence and trauma, often unaddressed due to barriers in accessing care
According to Human Rights Watch, LGBTQ+ individuals also report difficulty accessing HIV prevention and treatment, hormone replacement therapy, and primary care. There are still documented cases of patients being refused care or subjected to discriminatory or abusive language in medical settings.
What Affirming Care Looks Like in Practice
When possible, specialized or LGBTQ+-affirming programs are preferred because they reduce fear of judgment and allow individuals to be seen in community with others who share similar lived experience. These environments can help address issues like social isolation, family rejection, discrimination, and trauma.
But even when specialty programs aren’t available, all providers can take meaningful steps to create affirming care.
Practical, Accessible Steps for Providers
- Ensure clients are matched with affirming clinicians whenever possible
- Use appropriate self-disclosure when clinically relevant (including identity and lived experience as a form of therapeutic transparency when appropriate)
- Identify as LGBTQ+ ally or affirming provider in visible ways (flags, pins, signage)
- Include pronouns in email signatures, intake forms, and documentation
- Ask open-ended questions about name, pronouns, sexual orientation, and gender identity at intake
- Use gender-neutral language until identity is clarified
- Build intake and documentation systems that reflect inclusive practice
Beyond the Clinical Room
There are also broader responsibilities within healthcare systems:
- Advocate for inclusive policy at local, state, and federal levels
- Engage in ongoing cultural humility and competency training
- Improve how sexual orientation and gender identity data are collected in healthcare systems
Closing
Pride Month is both a celebration and a reminder. A celebration of resilience, identity, and community—and a reminder that stigma and disparity are still present in very real ways.
As providers, we cannot separate clinical care from context. Affirming care is not an “add-on” - it is part of ethical, competent practice. The way we show up in our language, systems, and spaces directly impacts whether people feel safe enough to seek and stay in care.
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