Reducing Stigma and Creating an LGBT Affirmative Environment on Inpatient Psychiatric Units: Process Models, Case Studies, and Interventions

Despite significant advancement in the quality and availability of mental health services for lesbian, gay, bisexual, and transgender persons in recent decades; much remains to be done. One area where appropriate services for LGBTs are considerably lacking is on inpatient psychiatric units. The rationale for establishing LGBT friendly environments on inpatient psychiatric units is multifaceted and includes: the high likelihood of non-heterosexual individuals being present among the patient population; the higher probability of early onset psychiatric difficulty and trauma related disorders in LGBT individuals; the lack of resources and support within the LGBT community for individuals with serious mental illnesses; and the special needs which LGBT individuals may have during the course of their hospitalization due to their status as sexual minorities. The lack of such an environment can be harmful to LGBT patients in that it may exacerbate, rather than alleviate, the symptoms of psychiatric illnesses. This doctoral project seeks to provide a foundation for creating LGBT affirmative environments on inpatient psychiatric units by: (a) presenting a review of the literature related to factors that contribute to sub-standard care for non-heterosexual patients, specifically the lack of training received by medical personnel about this population and the prejudice against both non-heterosexuality and mental illness which exists in both individuals and the healthcare system as a whole; (b) illustrating the ways in which stigma creates vulnerability to psychiatric illness in LGBTs using process models drawn from the literature; and (c) presenting and applying concepts drawn from the literature review to a case study involving three critical incidents that occurred on an actual psychiatric unit in a didactic format to facilitate increased sensitivity toward LGBT patients and to provide practical suggestions for clinicians addressing similar situations. Both systemic and individual perspectives and approaches are utilized.