What LGBTQIA+ Patients Wish Their Mental Health Providers Understood

As psychiatric clinicians, we’re trained to assess symptoms and offer care based on what we hear. Yet, when it comes to LGBTQIA+ patients, many providers miss critical parts of the story, not out of malice, but due to a lack of training and awareness.

This isn’t about shame; it’s about growth. LGBTQIA+ patients face unique stressors, health disparities, and systemic barriers that impact their mental health. When providers aren’t affirming, patients notice. They may disengage, minimize their experiences, or not return at all.

If you’re a provider aiming to offer better care and if you’re reading this, here’s what your LGBTQIA+ patients wish you understood.

Identity Isn’t the Problem, But How It’s Treated Often Is

Being queer, trans, or nonbinary isn’t inherently distressing. The distress often stems from stigma, isolation, discrimination, and erasure. This is known as minority stress; the chronic toll of navigating a world that invalidates or targets one’s identity.

Research supports this. A study published in Scientific Reports found that proximal factors of minority stress, such as self-stigma and expectations of rejection, significantly impact psychological well-being among queer individuals.

Furthermore, the Minority Stress Theory posits that LGBTQIA+ individuals experience unique, chronic stressors related to their stigmatized identities, leading to adverse mental health outcomes.

Clinical takeaway: Avoid pathologizing identity. Instead, ask, “What has your experience been like navigating your mental health and your identity?” and genuinely listen to the response.

Safety Isn’t Assumed, It’s Built

Many LGBTQIA+ patients enter healthcare settings bracing for harm, not healing. Past experiences of discrimination or invalidation in medical environments contribute to this apprehension.

A study by the Center for American Progress reported that nearly one-third of transgender individuals said a doctor or other health care provider refused to see them because of their actual or perceived gender identity.

Moreover, 22% of transgender people reported avoiding or postponing needed medical care due to disrespect or discrimination from health care staff.

Clinical takeaway: Actively create a safe environment. This includes using inclusive intake forms, displaying visible signals of support (like a small Pride flag), and addressing microaggressions promptly.

Your Curiosity is Not More Important Than Their Consent

It’s natural to have questions about unfamiliar identities or experiences. However, LGBTQIA+ patients are not responsible for educating you during their sessions.

Unwarranted probing can feel intrusive and may retraumatize individuals who have faced discrimination or invalidation. It’s essential to recognize that the therapeutic space should prioritize the patient’s needs and comfort.

Clinical takeaway: Prioritize consent and relevance. Before asking questions, consider, “Do I need to ask this to provide effective care, or am I seeking to satisfy my curiosity?” Seek education outside of patient sessions.

Pronouns Are Not Optional. Language Is Clinical.

Using correct pronouns and respectful language is essential. Misgendering a patient, even unintentionally, can damage trust and rapport.

The American Psychiatric Association emphasizes that affirming a patient’s gender identity, including using correct pronouns, is a fundamental aspect of respectful care.

Additionally, a study found that transgender and nonbinary youths who reported that all the people they live with respect their pronouns reported lower rates of attempting suicide.

Clinical takeaway: Use accurate, respectful language. For example, say “name used” instead of “preferred name,” and “assigned female at birth” rather than “biologically female.”

Mental Health Diagnoses Can Be Weaponized

LGBTQIA+ individuals are disproportionately misdiagnosed with certain mental health conditions, often due to biased interpretations of their experiences.

A study in JAMA Network Open found that sexual and gender minority groups exhibited higher odds of multiple diagnosed mental health conditions compared with their cisgender, heterosexual counterparts.

This diagnostic bias has real consequences: incorrect treatment, stigma within the medical system, and long-term harm to self-trust.

Clinical takeaway: Approach diagnosis with humility. Consider the context of systemic oppression and trauma, and avoid attributing distress solely to identity.

What Actually Feels Affirming? Patients Say:

“When I don’t have to explain my pronouns because they’re already on the form.”
“When my therapist talks about joy and not just survival.”
“When someone asks about my partner without assuming gender.”
“When I’m treated as a whole person, not just a category.”

Affirming care isn’t about perfection; it’s about presence. Being a provider who listens, reflects, and adapts can make a significant difference in a patient’s mental health journey.

Want to be an affirming clinician? Start here:

Update intake forms to include gender identity, pronouns, and chosen name.
Educate yourself on minority stress theory and queer-affirming therapy models.
Follow LGBTQIA+ mental health professionals and educators for ongoing learning.
Practice accountability when mistakes occur: apologize, correct, and move forward without centering yourself.
Create space in sessions to discuss identity, not just symptoms.
Audit your waiting-room materials to ensure inclusive imagery.
Schedule quarterly LGBTQIA-specific CME or webinars to keep skills current.

Your patients don’t need you to know everything. But they do need you to try.

Putting Affirmation Into Practice

Affirming care is not a one-time certification; it is a daily practice built on curiosity, consistency, and humility. Here are three concrete ways to keep your momentum towards affirming care:

Audit one touchpoint each week. Start with your intake paperwork, then move on to email templates, voicemail greetings, and EMR macros. Ask, “Does this language signal respect for every identity that might walk through my door?”
Schedule structured reflection. Block fifteen minutes after your last session every Friday to note what felt affirming, what did not, and what you will do differently on Monday. Small, deliberate adjustments compound into measurable change.
Stay in conversation. Join a peer consultation group focused on LGBTQIA+ mental health or follow clinicians who publish practice updates on platforms like PubMed Clinical Updates or professional listservs. Learning in community accelerates growth and prevents isolation.

The first time a patient’s shoulders relax because they feel understood, you will know the effort is working. Keep refining, keep listening, and keep choosing language and actions that communicate safety. Your willingness to evolve is the most powerful clinical tool you possess and it is one that every LGBTQIA+ patient deserves.