June is Pride Month, and EHN Canada’s most recent webinar centred on mental health and substance abuse in the 2SLGBTQ community. Pride is celebrated around the world this month to recognize the 1969 Stonewall Uprising, a pivotal moment for the gay liberation movement.
But what does sexuality or gender identity have to do with mental health or addiction?
It’s complicated, but we can begin by considering some history: The 2SLGBTQ community has faced systemic oppression dating back to European colonization of Canada. In the 1700s, settlers brought with them traditional Christian ideals of sexuality, and forced Indigenous children at residential schools to recognize only two genders.
Centuries later, discrimination and stigma continued to shape the lives of queer, trans, and gender non-binary folks on both an individual and societal level. For example, same-sex attraction was criminalized until the late 60s, and was categorized as a mental illness until 1973. Until recently, trans identity was pathologized and categorized as a mental health disorder.
While strides have been made toward equality, LGBT-identified people continue to experience harm and violence, as well as marginalization from governments and other institutions — including within the healthcare system. For some, this has bred a distrust of care providers, and continues to create disparities and barriers to potentially lifesaving mental health services.
To provide the best care, mental healthcare workers have to consider the unique challenges the community has faced throughout history, and acknowledge the stigma they continue to face today. On June 5, Ryan Slobodian, a registered clinical counsellor at Edgewood Treatment Centre in British Columbia, sat down with Toronto-based drag queen and entertainer Juiceboxx (you might recognize her from the first-ever season of Canada’s Drag Race), who shared how she struggled with alcohol use back in the early days of her career in the city’s club scene.
She reflected on struggles with anxiety and panic, sobriety during COVID-19, her favourite non-alcoholic beverages, and why she decided to ditch alcohol following years of heavy drinking at her performances.
EHN has a LGBTQ+ focused treatment program —Why?
Ryan is the program lead of Edgewood’s ALLIANCE program, which is dedicated to supporting 2SLGBTQ patients throughout treatment. “We have to honour and appreciate the different experiences that minorities experience in terms of their trauma history,” he said.
The program is modelled after the work of Dr. Shelley Craig at the University of Toronto, and is rooted in Cognitive Behavioural Therapy. Central to Dr. Craig’s AFFIRM model is that persistent discrimination and stigma is traumatic for members of minority groups, and can contribute to mental health and addiction issues. EHN clinicians look into how the discrimination and stigma processes affect the individual.
People who do not identify as straight or cisgendered are no strangers to stigma and discrimination. Historically, this has included bullying, harassment, violence, or misgendering on the individual level, to broader, systemic oppression, like marriage inequality for gay couples, barriers to or denial of adequate healthcare for trans folks, and social exclusion.
And, as Ryan points out, hearing consistent, negative messaging about one’s own sexuality or gender identity (i.e., experiencing homophobia or transphobia) can create a skewed, negative self-perception and contribute to mental illness or addiction. These experiences can be traumatic, and they must be unpacked in a safe and inclusive treatment environment. Intersectionality — the way race, gender, disability and other characteristics create overlapping systems of oppression — is also an important factor to consider during the therapeutic process.
EHN contributing writer Andrew Brudz explores trauma and the LGBTQ+ community in more detail, and shares how addiction has touched his life, in a recent blog post.
According to the Canadian Mental Health Association, three significant determinants of positive mental health and wellbeing are social inclusion, freedom from discrimination and violence, and access to economic resources. With that, let’s consider some facts:
- Many 2SLGBTQ adults and older adults have experienced discrimination from governments and other institutions, including being confined to psychiatric institutions due to their sexual orientation or gender identity
- 2SLGBTQ youth face approximately 14 times the risk of suicide and substance abuse than heterosexual peers
- Some research suggests that use of alcohol, tobacco and other substances may be 2 to 4 times higher among 2SLGBTQ people than heterosexual people
- Rates of unemployment and underemployment are high in trans populations
- There are very disproportionate rates of 2SLGBTQ–identified youth among homeless and street-involved youth
- Prejudice or lack of knowledge of 2SLGBTQ -specific needs among healthcare providers results in underuse of health services among LGBT2SQ people, and, consequently, worse health indicators.
- Lesbian, Gay, Bisexual, Trans and Queer-Identified People and Mental Health (The Canadian Mental Health Association
- Providing Trans Affirming Care to Sexual Assault Survivors (Trans Link Network)
- Trans hate crimes are on the rise, even in Canada (The Conversation)
- Health in Focus: LGBTQ+ Seniors (Rainbow Health Ontario)
- Eating Disorders in LGBTSQ Adults and Adolescents (Rainbow Health Ontario)
- Health Equity Impact Assessment: LGBT2SQ Populations (Rainbow Health Ontario, the Government of Ontario)
- Celebrating Indigenous History Month and Pride Month in the Faculty of Health Sciences (McMaster University)
- Report: Health and Healthcare Access for Trans and Non-Binary people in Canada (Trans Pulse Canada)
Chandler, L. (2020, July 2). What is intersectionality, and what does it have to do with me? YW Boston. https://www.ywboston.org/2017/03/what-is-intersectionality-and-what-does-it-have-to-do-with-me/
Curlew, A. (2019, August 20). Transgender hate crimes are on the rise even in Canada. The Conversation. https://theconversation.com/transgender-hate-crimes-are-on-the-rise-even-in-canada-121541
Jones, A. M. (2020, March 13). Trans and non-binary people still face health-care barriers in Canada: study. CTV News. https://www.ctvnews.ca/health/trans-and-non-binary-people-still-face-health-care-barriers-in-canada-study-1.4852486
Lesbian, Gay, Bisexual, Trans & Queer identified People and Mental Health. (2020). Canadian Mental Health Association. https://ontario.cmha.ca/documents/lesbian-gay-bisexual-trans-queer-identified-people-and-mental-health/
Resource Library. (2020). Rainbow Health Ontario. https://www.rainbowhealthontario.ca/lgbt2sq-health/resource-library/
Trans PULSE Canada. (2021, April 26). Health and health care access for trans and non-binary people in Canada. https://transpulsecanada.ca/results/report-1/