Bisexual patients face hurdles in getting culturally competent mental health care

This Bisexual Health Awareness Month, providers should hold themselves to higher standards.

credit: getty images
credit: getty images

Last fall, I made an appointment with a new psychiatrist, hoping to explore my options for more effective treatment for my lifelong struggle with depression and anxiety. Life under the Trump regime has taken a harsh toll on me as an openly queer/bisexual woman, and like so many of my friends and fellow advocates from various social justice movements and marginalized communities, my regular regimen of antidepressants and self-care simply isn’t cutting it anymore.

Having been to this rodeo before, I made sure to ask the receptionist for a doctor in the practice who was culturally competent and experienced working with LGBTQ patients, a reasonable request given that I live in the South’s most LGBTQ-friendly city, Atlanta. She assured me that Dr. D. was both. At the start of my appointment, I was optimistic, trusting the receptionist’s assurances, and knowing that the health care system I was patronizing had an explicitly stated commitment to LGBTQIA cultural competency listed on their website.

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When I sat down in his office, Dr. D. began the usual new patient intake questions. What brings you here today? I told him I was struggling with severe depression, and that simple tasks like going to work and being out in public were triggering intense anxiety. What is going on in your life that you find particularly difficult? I told him that I am bisexual, that I’m dating a straight cisgender black man, and that I feel unsafe and unwelcome to be myself at work, in my community, and in LGBTQ spaces.

“It’s difficult and scary to be the person I am and love who I love in America today,” I told him.

His response was a blank stare, no hint of empathy or understanding, followed by a request for further explanation and a passing comment about the local area’s “large homosexual population.” I asked him if he was aware of the mental health disparities bisexual people face, or if he was familiar with the concept of minority stress and its role in mental illness. Again, nothing.

As I explained to my doctor, numerous studies have shown that bisexual women suffer significantly higher rates of depression, anxiety, suicidal ideation, and substance abuse compared to our straight and lesbian peers. We are also more likely to have experienced abusive relationships that can leave us with lingering trauma-induced mental illness. A 2010 study from the Centers for Disease Control and Prevention (CDC) found that 61 percent of bisexual women will experience rape, physical violence, and/or stalking by an intimate partner, compared to 44 percent of lesbian women and 35 percent of heterosexual women.

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In health care settings, we often face stigmatizing comments and assumptions from those tasked with caring for us. Bisexual women are three times more likely than lesbians to be closeted to our healthcare providers, which means that our specific needs and the societal stresses that cause them are not being adequately addressed.

“Providing high quality mental healthcare to bisexual patients requires specific education and training,” Dr. Lauren Beach, bisexual advocate and postdoctoral research fellow within Northwestern’s Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) told ThinkProgress. “While bisexual patients may experience similar stressors as gay, lesbian, and other monosexual patients, it has also been shown that bisexual people experience bisexual-specific minority stress. Mental health professionals need to be aware that even within LGBTQIA community spaces, bisexuals can face rejection and a lack of social support. Therapists and other mental health providers should seek specific training for how to provide tailored, bisexual affirming, culturally competent care.”

While I was relieved that Dr. D. was receptive and interested in learning more, my appointment quickly devolved into him asking me questions that required me not only to educate him on my community and our mental health struggles, but also to recount numerous traumatic personal experiences related to my identity as a bisexual woman.

As a bisexual community advocate, I am in a unique position to have developed the knowledge and confidence to turn our exchange into a teachable moment. As a patient, however, it should never be incumbent upon me to educate my medical providers on the most basic and publicly available information about my community’s health needs, particularly when they claim a commitment to LGBTQ cultural competency.

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Even still, I am tremendously lucky compared to many other members of the bisexual community who face major barriers to accessing healthcare. In addition to the higher rates of poverty among bisexual people compared to gays and lesbians, a 2017 study from the Center for American Progress (CAP) showed that even with the Affordable Care Act in place, 19 percent of bisexual people lack medical insurance, compared to only 6 percent of gay men and 4 percent of lesbians. (ThinkProgress is editorially independent of CAP.)

As our national leaders blame “mental illness” for mass shootings that are predominantly carried out by straight cisgender white men, bisexual people are silently facing some of the most formidable barriers to mental health care of any group in the nation, disparities that are compounded for those in our community who are also people of color, transgender, and have disabilities. When we are able to access care, daring to hope for some relief from the daily burdens of living in a world that denies our existence and erases our identities, we are forced to educate the very people we are paying to act as experts in our care.

While there are nascent policy efforts in places like Washington, D.C. to require LGBTQ cultural competence on the part of health care providers, those policies are not enough to ensure that the unique needs of bisexual people are met.

“Future health policy advocacy efforts designed to improve the cultural competency of healthcare providers should ensure that providers are required to receive specialized training in serving not only generally ‘LGBTQ’ but also specifically bisexual patient populations,” Beach said.

As we observe Bisexual Health Awareness Month, it is incumbent upon mental health providers to take more initiative and hold themselves and their colleagues to higher standards of cultural competency, by seeking out resources and engaging with the growing body of peer-reviewed research on the specific needs of bisexual people and other sexual and gender minority groups. Bisexual people need the help and advocacy –– our very lives depend on it.

Beth Sherouse is a writer and activist based in Atlanta.