Young and idealistic, I took on an internship in a psychiatric hospital expecting the world of mental health to be the most sensitive, open-minded, and forward-thinking branch of medicine. I was rudely awakened when the doctor I worked for told me of a resident who greatly deviated from my ideal. The young resident was interviewing a lesbian patient suffering depression who related her extreme difficulty coming out as a lesbian and the lack of family and social support she received. The resident, however, did not further engage the patient in conversation about her sexual identity or social environment. Rather, he dismissively relied entirely on the tried-and-true symptomatic review questions from the DSM (e.g., “Have you lost any interest in activities you once enjoyed?”).When I insisted to the doctor I worked for that this resident must have been an extreme case, she told me that this scenario was not uncommon: Many of the medical interns and residents she worked with had inadequate training in discussing issues around sexual identity and in providing specific care and resources to sexual minority patients.
Unfortunately, this situation is not unique. According to an article in the Windy City Times, a survey conducted by the Gay & Lesbian Medical Association (GLMA) found that 40% of physicians had no formal training in working with LGBT patients, while 56% of those who received formal training said that it was not at all helpful. The article also mentioned a study published in the Journal of the American Medical Association (JAMA) that found that a third of contacted U.S. and Canadian medical schools offered no training on LGBT health; schools that did offered an average of 7 hours of LGBT health training (Roehr, 2011).
Other studies, old and new, have reached similar conclusions: across both disciplines and patient age groups, education specific to sexual and gender minority patients is lacking (Coleman, et al., 2013; Lena, Wiebe, Ingram, & Jabbour, 2002). While culturally sensitive and knowledgeable doctors are crucial to the delivery of competent sexual and physical health care to LGBTQ patients, this is arguably even more important in the provision of mental health services. In a population that is marginalized and thus faces a greater proportion of mental health problems than their heterosexual peers (Hatzenbuehler, 2011; Eisenberg & Resnick, 2006), LGBTQ individuals have a significant need for psychiatrists who are sensitive to and comfortable discussing the unique range of issues faced by LGBTQ patients.
Study after study and summit after summit have shown that many physicians are not comfortable acknowledging and discussing patients’ sexual identity, despite the salience of sexuality in their patients’ lives. For psychiatrists, the avoidance of a salient aspect of patients’ identities and lives could be particularly detrimental to their mental health. More research must be done on the discrepancy of LGBTQ mental health issues education for physicians broadly and psychiatrists specifically. We need to tackle the area of psychiatric residency training and find out where the weak points in curriculum are, in order to come up with a standardized way of training psychiatrists in sexual identity sensitivity and healthcare. Seven hours of training is not going to cut it. Sexual identity education should be an ongoing process, like anything else in medicine.
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References
American Medical Association. (1995-2014). LGBT Resources. Retrieved June 26, 2014, from AMA: http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources.page?
Coleman, E., Elders, J., Satcher, D., Shindel, A., Parish, S., Kenagy, G., et al. (2013). Summit on Medical School Education in Sexual Health: Report of an Expert Consultation. The Journal of Sexual Medicine, 924-938.
Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among Gay, Lesbian and Bisexual Youth: The Role of Protective Factors. Journal of Adolescent Health, 662-668.
Hatzenbuehler, M. L. (2011). The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth. Pediatrics, 896-903.
Lena, S. M., Wiebe, T., Ingram, S., & Jabbour, M. (2002). Pediatric residents’ knowledge, perceptions, and attitudes towards homosexually oriented youth. Annals of the Royal College of Physicians & Surgeons of Canada, 401-405.
Roehr, B. (2011, September 28). Survey: Med schools teach little about LGBT issues. Windy City Times, p. 5.
The Trevor Project. (2012, June 6). Warning Signs of Suicide. Retrieved from The Trevor Project: http://www.thetrevorproject.org/suicide-resources/warning-signs
Blog of the University of Michigan Center for Sexuality and Health Disparities 