Every year, the month of March is recognized as Social Work Month. Social Work Month is a time to not only honor the past achievements and successes in the field but also to serve as a call to action for the work ahead of us still left to do. The 2023 theme for Social Work Month is “Social Work Breaks Barriers”. Every day, social workers, and our allied health professional colleagues, help to break down barriers that prevent people from living more enriched, fulfilling lives. In addition to the direct services we provide to individuals, families, couples, and groups, we also work to advocate at a systems level to ensure that laws and policies are adopted so everyone can live safely and to their fullest potential. This year’s Social Work Month theme recognizes that there continue to be barriers of all shapes and sizes that prevent people and communities from thriving. A prime example of these barriers is seen within the lack of cultural competency for providers working with LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Agender/Asexual, and other members of the community who identify with a sexual orientation or gender identity that isn’t included within the LGBTQIA acronym) clients and the socio-political environment surrounding transgender and non-binary individuals, especially youth, in our country.

Cultural competency is a critical aspect of providing effective services to LGBTQIA+ clients. When service providers are culturally competent, they are better able to understand and meet the nuanced health care needs of their LGBTQIA+ clients. This includes understanding the unique challenges and experiences that LGBTQIA+ individuals face, as well as having the knowledge and skills to provide culturally responsive services. As clinicians, we have an obligation to not only meet our clients where they are but also advance our areas of competency when we are presented with client needs beyond our existing comfort zones or areas of expertise. Far too often, I have seen LGBTQIA+ clients referred out to other providers by very well-intentioned clinicians who question whether they have the skill set needed to effectively treat the presenting concerns of LGBTQIA+ individuals.  The reality is, in 2022, 60% of LGBTQIA+ youth who wanted mental health services said that they had been unable to access care due to a variety of barriers, including wait lists, parent/guardian support, costs, and the inability to find competent providers¹. As behavioral health providers, we no longer have the luxury, if it even existed at all, to simply pass our LGBTQIA+ clients to the known “out” providers in the community and hope for the best. The current realities of the behavioral health crisis in our country require clinicians to develop enhanced competencies, and comfort, themselves in order to serve their existing, and even newly referred, clients who happen to identify somewhere along the LGBTQIA+ continuum.

There are a number of additional reasons why cultural competency is important for LGBTQIA+ clients. First, LGBTQIA+ individuals often experience discrimination and exclusion from mainstream society. They may feel that they do not have a safe place to turn for help, and they may be reluctant to seek services from providers who do not understand their culture or who do not have comfort working with LGBTQIA+ clients. The lack of provider cultural competency can in fact be detrimental to the clients we are sworn to “do no harm” to. Nearly one in 4 transgender individuals say that they have avoided seeking health care when injured or sick due to fear of discrimination and mistreatment at their provider’s office because of their gender identity². The needs of some members of the LGBTQIA+ community require us as providers to do better. In 2022, 45% of LGBTQIA+ youth across the United States said that they had “seriously considered” suicide in the past year while 14% had made at least 1 attempt during this time¹.  Nearly one in 5 transgender and nonbinary youth reported at least one suicide attempt in the past year¹. Over 40% of transgender adults report at least one suicide attempt in their lifetime².

Second, the LGBTQIA+ community is diverse, and each individual has their own unique experiences and needs. Service providers who are culturally competent will be able to better assess each client's needs and provide the appropriate services in a more inclusive and affirming (AKA - effective) way. They will also be able to create a safe and welcoming environment for their LGBTQIA+ clients. Developing enhanced competencies doesn’t require significant flexing of our clinical muscles either. The simple act of respecting our client’s personal pronouns and affirming the name the transgender or non-binary client wishes to use for themselves is, in fact, one of the simplest forms of suicide prevention available to behavioral health clinicians. Transgender and nonbinary youth who reported having their pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those whose pronouns were disregarded¹. Respecting an individual’s personal pronouns IS a form of LGBTQIA+ competent suicide prevention.

Finally, cultural competency can help to reduce the stigma that LGBTQIA+ individuals often face. When service providers are knowledgeable and sensitive to the needs of their LGBTQIA+ clients, it sends a message that these individuals are valued and respected. This can help to improve the mental health and well-being of LGBTQIA+ individuals. LGBTQIA+ youth who live in a community that is accepting and affirming of LGBTQIA+ people report a significantly lower rate of suicide attempt¹. Yet, only a few months into the 2023 legislative session, the Human Rights Campaign (HRC) has identified more than 340 anti-equality bills have been introduced or proposed in state legislatures across our country.  Over 150 of these bills specifically target the transgender community, many geared towards youth. The HRC reports, “From bans on gender-affirming healthcare, sports and books to forced outing, anti-drag and curriculum censorship bills, this onslaught is unprecedented and deeply disturbing.” From the recent stories of such harmful bills being passed in states like South Dakota, Idaho, Oklahoma, Tennessee, Kentucky, Montana, and North Dakota, it’s clear that there are still many barriers that must be smashed in order to support the health and safety of LGBTQIA+ individuals of all ages here in the United States. Social workers and our clinical colleagues are called to action in the face of such barriers. There is work to be done.

As you celebrate Social Work Month 2023, challenge yourself to not only celebrate those barriers that our field has already overcome but also to face and address any of the current barriers in our field that still exist. Cultural competency is essential for providing effective services to LGBTQIA+ clients. By understanding the unique challenges that these individuals face, service providers can create a safe and welcoming environment that meets their needs. And developing some basic cultural competencies in our work with LGBTQIA+ clients can be a much lighter lift when compared with trying to find the “out” therapist in your area with openings on their caseload for new clients. It Is also the right thing to do for your existing LGBTQIA+ clients who need us to challenge our own biases and comfort zones and grow as providers. As Martin Luther King, Jr. said in 1957, “Life’s most urgent question is: What are you doing for others?”.

Sources:

1. The Trevor Project 2022 National Survey on LGBTQ Youth Mental Health 
2. The 2015 U.S. Transgender Survey, Executive Summary

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We welcome guest columnist Christopher McLaughlin, MSW, LCSW.  Chris is the instructor of TCI's LGBTQIA+ Certificate Program, a two-part online self-study program that offers in-depth information for behavioral health clinicians on the fundamentals of working with and the inclusion in healthcare of LGBTQIA+ clients.

About Christopher McLaughlin:

Chris McLaughlin, MSW, LCSW (he/him/his), is the Executive Director of the Maine Chapter of the National Association of Social Workers (NASW) and owner of Inspired Consulting Group, LLC. He obtained his BA in Psychology and his MSW from the University of Maine. Chris has spent more than 20+ years as a provider and a leader in behavioral health services for youth and families across a variety of clinical settings. Chris is an adjunct faculty member at the University of Maine and Husson University in Bangor.

Additionally, Chris served for four years on the Maine Board of Social Work Licensing and is a member of both the NASW and the Society for Social Work Leadership in Health Care (SSWLHC), where he is the current Maine Chapter President, and he is a member of the National Board. Chris holds additional certifications from Cornell University. Nationally, he was SSWLHC’s 2019 recipient of the Eleanor Clark Award and was named Health Care Social Worker of the Year in 2019 by the Maine Hospital Association and the Maine Chapter of the SSWLHC. In 2020, Chris was awarded the Alumni of the Year distinction from the University of Maine School of Social Work.

For organizations seeking further guidance on LGBTQ+ issues, Chris offers a consultation service to walk organizations through essential competencies that move them closer toward being LGBTQ+ affirming providers. You can learn more about Chris’ professional background and interests here.