ARQ2: Question A4 - Relationship between sexual orientation/gender identity and substance use and/or mental health

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Is your reason for getting help (substance use, mental health concerns) related to any issues around your sexual orientation or gender identity? not at all a little somewhat a lot unsure prefer not to answer

Relevance/intent

LGBTTTIQ people have specific life factors that relate to substance use and mental health.

Sexual orientation and gender identity are not inherently related to increased susceptibility to substance use problems or mental health problems. However, any stress, worry or uncertainty related to sexual orientation or gender identity may be related to a client’s use of substances, self-harm or suicidal behaviour.

Stress, prejudice and discrimination related to sexual orientation or gender identity create a stressful social environment that can lead to mental health problems for LGBTTTIQ people (Meyer, 2003).

Historically, the psychiatric system has linked homosexuality and gender identity issues with mental illness, which may trouble clients. Clinicians must be careful not to pathologize, or imply a pathological connection between, clients’ mental health/substance use concerns and their identity

Client perceptions

“When it comes to the mental health system and trans people, the idea is that as soon as you’ve transitioned, you won’t be depressed anymore. But if you transition and you are depressed, there is the fear that medical professionals will assume that transitioning was a bad thing and that you made a mistake. But I say that there’s stigma in society as a result of being trans, as a result of not passing, as a result of being seen as a freak. Are we not supposed to experience that oppression? Are we somehow supposed to just let it fall off our shoulders and not be affected by it? Some doctors see this only as a medical transition issue. They don’t understand at all the social implications of what we experience and how it affects us.”

“It’s like you have to deal with two things instead of just one. You’re dealing with a mental illness and you are struggling with your sexual orientation. It seems doubly hard.”

Therapist/counsellor perceptions

“Oppression is bad for people’s health.”

“How a client’s identity is integrated affects other problems: depression, self-esteem, substance use.”

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Asking the Right Questions 2

• Acknowledgments
• Introduction
• Using the manual
• Background information:
  • Part A — Client Questionnaire
    • A1: Significant relationships
    • A2: Sexual orientation
    • A3: Gender identity
    • A4: Relationship between sexual orientation/gender identity and substance use and/or mental health concerns
  • Part B — Conversation Guide
• Counsellor competence
• Resources
• References
• Appendix

• Print Bookmark