“Adderall or Top Surgery”: How Our Mental Healthcare System is Failing the LGBTQ+ Community

Vienne Aberle

Every day that Simon goes to work at his part-time job, he intentionally leaves his nametag off. Each time a customer asks for his name, he feels his anxiety flare up. 


Simon is a transgender and nonbinary person whose experience with the anxiety of something as simple as introducing themselves is not an isolated one. Everywhere, from the biggest cities in the country to Boise, queer people face constant fear and anxiety related to how their identities are received by the public. According to the American Psychological Association, LGBTQ individuals are more likely to be victims of violence compared with their heterosexual peers. Despite the increased violence and discrimination queer people face, there has been little focus on the trauma these experiences cause, and the mental health impacts these individuals face because of the barriers to getting help that they must leap over. In a time where hate and prejudice are running high in our country, and mental health has become a global topic amplified by the pandemic, it is important to include minority groups into the conversation. 


To best understand the ways in which queer identity and mental health are so closely related, as well as the roadblocks they face in accessing mental healthcare in Boise and broadly, I brought together Simon, along with James, a 19-year-old college student who is transgender and gay. Both have struggled for a long time with mental health issues and have faced barriers in obtaining care because of their queer identities. Often, the first issues begin at home. Having an unaccepting family can lead to denial and self-hatred, and because of this, oftentimes young people can’t reach out for the help they need. 


Simon began struggling with gender dysphoria at a young age but was forced into denial because of his unaccepting parents. He was in denial for years and tried to force himself to be hyperfeminine. When he realized he was trans, he avoided telling his parents because they would have told them that it wasn’t something to see a therapist for. Because Simon’s parents were dismissive and unaccepting, Simon was forced to use his depression as a way to convince his parents to get him a therapist. 


James grew up with conservative parents that were incredibly open about how much they despised gay and transgender people, and James internalized this homophobia and transphobia. That, paired with neglect and abuse from his parents, took a significant toll on his wellbeing and mental health. 


“My family was completely against it. And I hated that other people could express themselves and be happy with themselves in that way and I couldn’t,” James says. “You hate yourself; you don’t really know why, and then once you realize that other people are starting to like themselves, but you’re not allowed to, you’re not allowed to be content with yourself and explore your identity, it crushes your soul in like every way.”


Simon and James’ stories are not unlike the experiences shared by the greater LGBTQ community. Support from a community and family as a younger person makes a huge difference in a person’s overall mental health, and especially for transgender children, who experience higher rates of suicide when they don’t have a supportive family. However, according to the Human Rights Campaign, studies have found that transgender children whose families affirmed their gender identity were as psychologically healthy as their non-transgender peers. This demonstrates that having a solid support system plays a major role. “You feel undeserving of any love and any attention and it leads to self-harm, suicidal ideation, and suicide attempts,” says James. 


In addition to fearing the reactions of family and close friends, queer people face an incredulous amount of societal backlash that leaves many anxious and on edge. Being afraid for their safety and their lives, the anxiety that comes with simply existing in a heteronormative world with little protection has a severe impact on the mental wellbeing of LGBTQ individuals. 


James stressed the impact of anxiety and the racing thoughts he feels when in a new situation in which he might be outed, saying, “You never know how they’re going to react, and that seriously exacerbates anxiety and related disorders to the point where it’s crippling.”


Simon agreed, as did I. “I have to worry about if somebody is going to physically harm me, murder me, and then get away with it, you know? Because they can,” James adds. This fear is legitimate and warranted, as the FBI reports climbing rates of hate-based crimes against LGBTQ people since 2019. The rise is nearly a 20% increase, and because local authorities are not required to report hate based crimes as such in reports to higher levels such as the FBI, this is only a small fraction of how many hate crimes against the LGBTQ community really take place each year. 


Having to face constant fear and anxiety publicly and in their private lives, it is unsurprising that queer people suffer disproportionately from mental health issues. According to an article by Health Partners, “A recent study found 61% of LGBTQ individuals have depression, 45% have PTSD and 36% have an anxiety disorder. Additionally, 40 percent of transgender individuals have attempted suicide in their lifetime.” That percentage is over nine times the national average. With so many people struggling, one could expect that safe mental health resources are within reach for LGBTQ individuals, but the reality is much different. When looking toward gender affirming and mental health care, a mountain of roadblocks stands in the way.


Most people are taught to trust doctors, but queer people learn that they must remain incredibly cautious. According to the American Psychological Association, many LGBTQ folks report experiencing discrimination when attempting to access health services, causing delays or denial of necessary treatments. In fact, 22% of transgender people say that they avoid health care providers out of fear of discrimination. When transgender people do not have access to physical healthcare, they may struggle with excessive body dysphoria that is harmful to their mental health, as are chronic conditions and general health concerns that lead to stress and anxiety. 


When Simon was first looking for a therapist, he purposefully researched therapists that were listed as LGBTQ friendly. After searching, he finally found someone, or so he thought. It quickly became clear that this therapist wasn’t outright transphobic but was very narrow minded with affirming his identity. Simon’s therapist told him that he wasn’t trans, and he explained that this seems to be a common theme for other queer people seeking therapy or gender affirming care. “Their therapist convinced them that they’re not trans, unless they meet this very specific idea of what a trans person is.” A survey by the American Psychological Association shows that over half of LGBTQ respondents report that they have faced providers that use harmful language, deny them care overall, or blame their identities for being the reason for illnesses. 


In addition to the discrimination, Simon and James explained that therapists and healthcare providers are often only willing to focus on one problem at a time. This can be incredibly harmful for queer individuals who may seek affirmative care while also needing to treat mental health issues. Simon’s experience with this forced him to put transitioning on hold because his doctors made him decide on treating his ADHD or pursuing gender affirming care. “It definitely delays transitioning because you can only focus on one thing at a time, either mental health or transitioning,” James adds.


“Exactly,” Simon says, “It’s like..which do you want, Adderall or top surgery?”


The stress of all those things only amplifies mental health issues, and with the lack of resources, queer people are left feeling isolated and struggling. I then asked the two about the resources they’ve found in Boise. James explained that although it may seem like there are resources, that really isn’t the case. He explains, “On the surface it looks like there are, like the Gender Equity Center or Planned Parenthood, but those are…two things.” More so, looking into the resources available at the Gender Equity Center at Boise State University, the website links mostly external resources such as hotlines and a document of supposed LGBTQ friendly counselors and therapists in the area. And, as Simon explained earlier, often times therapists list LGBTQ friendly on their profiles, but are not actually experienced in dealing with queer issues and problems that have stemmed from the experiences of being gay or transgender. 


Simon adds, “I haven’t sought any gender affirming care in Boise because first of all, I had other things I wanted to address, like dealing with my mental health,” again reaffirming the common experience of only being able to face one issue at a time. “But I also didn’t know how I wanted to transition,” he says, “I feel like if there had been adequate resources available, I might have known by now.”


To wrap up my conversation with Simon and James, I asked what the ideal situation in regard to resources looks like to them. “Teaching about consent, boundaries and personal identity at a young age, and allowing kids to be more open trying to express gender nonconforming traits and allow them to grow out of prescribed gender roles,” James says. James explains that seeing support for his identity as a kid would have prevented him from much of the pain – both physical and mental – that he has endured in his life up to this point. Now that he is on to the chapter of his adult life, other responsibilities take the front seat in his mind and the added struggle of identity, fear, and mental illness create a heavy burden to carry each day. “I think that addressing it when you’re young is so much healthier than addressing it when you’re an adult and expected to do everything on your own,” James explains.


As for Simon, the ideal situation is a bit simpler, and one that highlights the mentality many LGBTQ individuals have. “It’s gotten to the point where it’s difficult to imagine what an ideal situation would look like because me just disclosing to my doctor that I’m transgender would be the most ideal option, and not being afraid of that. It’s the bare minimum.”


The links between LGBTQ people and mental health issues and the gaps in access to the proper mental healthcare that these two individuals face represents a broader issue, one that goes beyond Boise, beyond Idaho, and beyond the entire country. The lack of acceptance and support, the fear of discrimination and violence, and an overall sense of exhaustion from trying to find help and coming up empty is the experience that the majority of queer people can attest to, including myself. Many find comfort in the familiar, gravitating to those who help them create a sense of community and safety. Others, like me, demand more. Nobody is asking for a pride parade for the mentally ill gays every day of the week; we want accessibility, safety, change. The very experience of being queer can cause trauma and mental health issues, and when that combines with genetic disposition and familial abuse, it’s a cocktail perfect for a minority group disproportionately affected by mental illnesses. 


Something that can be done is to create legitimately queer friendly spaces. We can also work to support and pass legislation that actually protects LGBTQ individuals. As a community we should work together to foster understanding at an early age and create environments of exploration. We can also create and support those working to create mental health resources that are tailored to helping LGBTQ people--something more than just a hotline. It sounds like many steps, and maybe it is, but it’s the bare minimum for people who have been continuously underserved. Maybe, if people could feel safe enough to reach out to professionals for help without barriers, then, as James says, “We wouldn’t be so overwhelmingly desperate for anything that makes us want to live.”

Vienne Aberle is a writer and student at Boise State University. When she isn't studying and writing, she enjoys cooking, playing piano, and collecting an exorbitant amount of Squishmallows. She hopes to use her voice to write things that matter in her community and promote positive change.

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