Common experiences

LGBTIQ+ young people experience health and social challenges that impact their mental health and act as barriers to healthcare.

By understanding some of the more common challenges your clients experience, you will be better equipped to support them in your clinical practice.

Alcohol and other drug use

One-third (33%) of LGBTQ+ young people aged 12 to 17 years surveyed for the Writing Themselves In 4: NSW report said they had used recreational drugs in the past six months, compared with 18% of their cis heterosexual peers.¹

LGBTIQ+ young people may engage in alcohol and other drug (AOD) use for different reasons to their heterosexual peers. As a clinician, it’s helpful to understand both your client's individual reasons, and the context of AOD use in LGBTIQ+ culture.

Often the intersection of LGBTIQ+ stigma and discrimination is not considered when supporting young clients who engage in problematic AOD use. This can mean that their reasons for use are not acknowledged, their shame about use and LGBTIQ+ experience is increased, and they are blamed as an individual.

LGBTIQ+ clients may use AOD because:

• it is often seen as an element of connection in LGBTIQ+ community
• parties and festive spaces, where AOD use is common, are among the few safe spaces for LGBTIQ+ people to express identity and connection
• it helps to lessen inhibitions and overcome internalised shame about identity, creating space to explore gender expression, sexual intimacy and social connections
• they are self-medicating for mental health distress in the context of stigma and discrimination, and managing internalised shame about LGBTIQ+ identity.

Housing and homelessness

The Writing Themselves In 4 report found that 23.6% of LGBTQ+ young people aged 14 to 24 had experienced at least one form of homelessness.¹ Safe, secure and stable housing is a key social determinant of health, and the impacts of insecure housing are long lasting and compound mental health issues.² In addition, LGBTIQ+ people often experience homelessness at a younger age than the general population due to homophobia at home.

The report does not include young people with intersex variations, and the impact on this group of homelessness due to stigma and discrimination is not clear due to a lack of data.

When working with clients experiencing housing instability, be aware of:

• potential for greater reliance on chosen family, friends and community for housing and social support
• the impact of housing insecurity on attendance at school and appointments, as well as alcohol and other drug use
• the strain that housing insecurity can put on community and intimate relationships, including power and control dynamics
• rough sleeping may feel like the only option available to them – use a person-led approach to support what is best for the client while advocating for safe and affirming housing options
• the impact of homophobia or transphobia when accessing housing services or supports – it's common for trans young people to be denied single-gendered housing options due to their identity, and advocacy may be needed for them to access appropriate housing.

Eating disorders and body image

For LGBTIQ+ young people, the causes of eating disorders and support for these issues can be more complex than in the general population. Consider the following social, psychological and identity-related factors that may affect LGBTIQ+ clients.

• Homophobia, transphobia and the need to fit in and conform to societal standards can lead to significant emotional distress.
• Discrimination, alienation or rejection of LGBTQ+ clients by family or friends can cause feelings of isolation. For clients with intersex variations, discrimination and stigma about their bodies can cause feelings of isolation. This may heighten stress and exacerbate pre-existing vulnerabilities related to body image and eating behaviours.
• For trans, non-binary and gender diverse clients, gender dysphoria can lead to eating disorders as they try to modify their bodies to align more closely with their gender identity.
• Trans and gender diverse people may feel pressure to meet societal beauty and body image standards, such as 'passing' so their gender identity is validated.
• Narrow cultural representation of LGBTIQ+ people in media and culture can mean a client doesn't see themselves reflected in a positive or diverse manner. This may exacerbate feelings of inadequacy or pressure to conform to certain body image standards.
• There is a gap in appropriate and affirming healthcare services for LGBTIQ+ individuals, including those dealing with eating disorders which are predominantly geared towards cisgender endosex women.

Family, domestic and sexual violence

Both national and international research indicates that LGBTQ+ people experience sexual, family of origin and intimate partner violence at rates comparable with, or higher than, those reported by women in the general population. However, there is limited research specifically addressing the violence experienced by LGBTQ+ people, and no reliable research into the experiences of people with intersex variations in Australia.

InterAction describes the risk of domestic, family and intimate partner violence for for people with intersex variations:

“Intersex people have innate sex characteristics that don’t fit medical and social norms for female or male bodies, and that creates risks or experiences of stigma, discrimination and harm. Those experiences of stigma and harm can occur in domestic, family and other intimate situations.”

As a CAMHS clinician, you will be familiar with supporting young people experiencing family, domestic and sexual violence (see the NSW Government’s Domestic and Family Violence Framework for Reform).

Below are some of the experiences and barriers to support that are specific to LGBTIQ+ clients.

• Family of origin violence
• Intimate partner violence
• Sexual assault

Neurodiverse experience

There is high prevalence of intersecting experience of neurodiversity in the LGBTIQ+ population. In the survey of young people conducted for this project, 22 out of 26 respondents identified as neurodiverse, with the most common diagnoses being autism and ADHD (sometimes referred to together as AuDHD).

The correlation between neurodiversity and trans and gender diversity is also high. A 2018 Australian study found that up to 22.5% of trans and gender diverse adolescents had a diagnosis of autism, compared with 2.5% of all Australians,^3,4 and 70% of the autistic community have been found to identify as non-heterosexual.⁵

Autigender and gendervague are terms specific to neurodiverse LGBTIQ+ gender identity. Autigender is a person whose understanding of gender is fundamentally altered or influenced by their autism. Gendervague refers to a person who cannot separate their gender identity from their neurodivergence.⁶

Being autistic doesn't cause my gender identity, but it is inextricably related to how I understand and experience gender.

When working with neurodivergent LGBTIQ+ clients:

• support their access to CAMHS care with consideration of their neurodiverse experience, where possible
• be aware they may be fidgety, uncomfortable with eye contact or physical closeness, need questions to be rephrased and take time to answer – this is not necessarily an indication they don’t want to engage
• be aware of environmental stimuli like bright lighting, loud or constant noise and strong scents
• create a sensory-responsive clinical setting they feel comfortable in, and include sensory supports, such as fidget toys and colouring books
• support their self-advocacy in social, health and community settings by building their communication skills, navigating health and social systems, and conveying their sensory and communication needs.

References

1. La Trobe University. Writing Themselves In 4: NSW report. Melbourne, Vic: La Trobe University; 2021 [cited Sept 2024].
2. NSW Ministry of Health. Social determinants of health. St Leonards, NSW; 2022 [cited Sept 2024].
3. Strang JF, Janssen A, et al. Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. J Am Acad Child Adolesc Psychiatry. 2018:885-887. DOI: 10.1016/j.jaac.2018.04.023.
4. Gratton FV. Supporting transgender autistic youth and adults: a guide for professionals and families. London: Jessica Kingsley Publishers; 2020.
5. George R, Stokes MA. A quantitative analysis of mental health among sexual and gender minority groups in ASD. J Autism Dev Disord. 2018;48(6):2052-63. DOI: 10.1007/s10803-018-3469-1.
6. Stimpunks Foundation. Autigender. Littleton, CO: 2022 [cited Sept 2024].