Young people accessing your service for the first time can feel nervous, and LGBTIQ+ young people may have feelings and experiences that compound this further.
They may feel disempowered under the care of caregivers, school and the health system. Young people impacted by intersecting experiences of oppression may also have added stressors when entering new spaces of support.
To feel safer in a healthcare setting, there are many ways that LGBTIQ+ clients undertake unseen effort including:
Consider how these experiences impact your LGBTIQ+ clients, and how to respond as part of affirming clinical practice.
Emotional labour
Emotional labour is unpaid, unacknowledged or unbalanced interpersonal work someone does to maintain harmony or safety in a relational dynamic. An LGBTIQ+ client is likely to perform emotional labour to increase your understanding of their experience, and to keep themselves safe.
This could include:
- feeling like they need to ‘come out’ to clinicians and explain their gender and sexuality experience
- needing to explain who in their family can know about their chosen name or pronouns and who it is not safe to be ‘out’ to
- feeling the need to disclose lived experience of an intersex variation and then explain this experience
- needing to explain how to safely discuss their lived experience of intersex variations with family, health services and other spaces, if necessary
- suppressing their anger or resistance to homophobia, transphobia and endosexism in appropriate ways so they are not pathologised or punished for their negative responses.
Responding to emotional labour
- Thank the client for their labour and generosity in explaining their experience to you.
- Clarify whether there are people in the client’s life who they don’t want to know about their identity and experience, and how to approach consent and confidentiality.
- Ask if you can share what they’ve explained to other members of the treating team (or external stakeholders) to limit their need to perform further labour.
- Don’t apologise profusely for not knowing, as this puts further labour on the client to console you.
- Don’t distance yourself from the client’s experiences, which can make them feel isolated and as if it is a learning experience, e.g: “I have never met a trans femme person before, so I don’t know how you’d like to be treated."
- Don’t be defensive when you don't know the appropriate response.
- Don’t share information with the client’s treating team, family or other stakeholders without their consent or consideration for their safety.
Moral panic
Moral panic is an irrational widespread fear that someone or something is a threat to the values, safety and interests of a community or society at large.1 It encourages discrimination against minorities, contributing to an environment where they are affected by minority stress and need to perform significant emotional labour to survive.
The LGBTIQ+ population has experienced ongoing moral panics throughout Australia’s history. These panics by mainstream Western culture are reinforced by media and legislation that influence and perpetuate negative community attitudes. Some examples of anti-LGBTIQ+ moral panic include:
- the fear that gay people will dismantle the nuclear family
- fear of queer adults ‘grooming’ children
- stigma related to human immunodeficiency virus (HIV)
- opposition to gay marriage
- widespread transphobia and fear that athletes with XY chromosome variation are competing unfairly in women’s sport.2
The impact of moral panic on clients can include:
- distrust in adults and health systems
- high levels of minority stress
- apprehension about accessing mental health services and low engagement with services, due to a belief that society in general is against them
- being suspicious and untrusting of support and care from family, friends and the community.
Responding to the impact of moral panic
- Be curious and work to notice your own biases, where they may come from and how you think they might influence your practice.
- Be an ally to LGBTIQ+ clients, acknowledging what you don’t know and commit to learning more.
- Acknowledge that moral panic towards people with intersex variations may or may not relate to LGBTQ+ experience. Affirm the unique stigma they experience.
- Talk to colleagues about the negative cultural biases your team might have about LGBTIQ+ people, e.g. reframe the idea that LGBTIQ+ clients are mentally unwell and acknowledge they are surviving as best they can in a world that is oppressive to them.
- Advocate with other services and supports to reframe their fear about working with LGBTIQ+ clients.
- Explore the issue of risk, where clinicians may avoid working with minority populations because it’s more difficult. This feeds into moral panic narratives and has further negative health outcomes for LGBTIQ+ populations.
- Seek guidance from LGBTIQ+ organisations, explore resources and speak about these issues in clinical supervision.
- Don’t transfer your apprehension or fear about LGBTIQ+ issues onto the client, e.g. making them feel untreatable by referring them out immediately to a specialised service, or failing to address discrimination-based mental health issues that causes a client to self-blame and pathologise.
- Don’t ignore stigmatising language or actions from others because they are out of your control. It’s everyone’s responsibility to challenge these and work towards equitable health rights.
Minority stress
Minority stress is the experience of stress because of direct or perceived stigma and discrimination based on being a minority within society. Internalising these prejudices and attitudes can impact mental health. Clients can experience minority stress due to situations including:
- not disclosing their preferred name due to fear of rejection or dismissal of culture
- not seeing their own experience of sexuality or gender on an intake form
- feeling anxious entering a mental health space, knowing that LGBTIQ+ people are stigmatised, and that their identity or sexuality may be pathologised or merged with mental health issues.
- being unable to access a toilet due to a lack of inclusive and accessible bathrooms
- inaccurate and tokenistic inclusion of people with intersex variations on intake forms, such as including intersex as a gender or sex option (when it's not a gender or a third sex)
- erasure of people with intersex variations from demographic data collection
- needing to explain their experience as a person with an intersex variation to clinicians who don’t know about their variation, or understand the stigma, discrimination and medical trauma they face.
Responding to minority stress
- Acknowledge the existence of minority stress as a part of your client’s life and that you will work to minimise this in your interactions with them, e.g: “I know there are many ways society and the health system can make you feel unwelcome or unable to be cared for. I don’t want to add to that, and I will speak up for you if it happens while you’re being supported by CAMHS".
- Keep checking in with the client about their experience and if there’s any ways you can support them.
- Consider the therapeutic and health frameworks you work in (such as ecosystems theory, narrative therapy, internal family systems and dialectical behaviour therapy), which already address how a client’s mental health is impacted by internalising outside environments and cultures.
- Take into account minority stress caused by LGBTIQ+ identity or other intersecting experiences of discrimination when assessing a client’s mental health. For example:
- consider the way that homophobic bullying at school would contribute to social anxiety
- ask curious questions about a client’s experience of disordered eating, and the potential link to their gender diversity
- consider the impact of endosexist body shaming or invasive questions towards a client with an intersex variation.
- Acknowledge the legacy of danger and hostility that the health system and its spaces represent to LGBTIQ+ people, rather than seeing a client’s negative responses to the system as their own responsibility.
- Consider the likelihood of medical trauma, objectification and medical curiosity experienced by a client with an intersex variation throughout their lives.
References
- Cohen S. Folk devils and moral panics: the creation of the Mods and Rockers. London: MacGibbon & Kee; 1972.
- InterAction. Sports discrimination. Sydney, Australia: Intersex Human Rights Australia; Aug 2024 [cited Sept 2024].