First, Do No Harm: Reducing Disparities for Lesbian, Gay, Bisexual, Transgender, Queer and Questioning Populations in California The California LGBTQ Reducing Mental Health Disparities Population Report First, Do No Harm: Reducing Disparities for Lesbian, Gay, Bisexual, Transgender, Queer and Questioning Populations in California The California LGBTQ Reducing Mental Health Disparities Population Report Table of Contents Acknowledgements .. 4 Executive Summary .. 11 Part 1: Introduction and Background Information . 18 What We Know, What We Don’t Know and What We Need to Know About LGBTQ . 20 Research Issues: Who Counts, What Counts, How to Count . 20 History - The Sexologists . ...................22 The Diagnostic and Statistical Manual of Mental Disorders . .............25 Gender Identity Disorder (GID) . ...............27 Etiology: The “Choice” Debate . ....................32 The Many Forms of Stigma . ................35 Minority Stress . .......................37 Majority Rules - Anti-LGBTQ Initiatives .. ..................39 Coming Out / Staying In . .................44 HIV and AIDS .. ......................45 Alcohol and Other Drugs (AOD) . ..............46 Domestic Violence .................................... ........................47 Suicide ............................................ ..........................52 Resiliency ......................................... ..........................52 Mental Health Services: The Good, the Bad, and the Harmful . .............54 First Do No Harm . ......................56 Lack of Training . .....................58 Seeking Cultural Competence .. ..................60 Intersecting Identities . ............................64 Lesbians .......................................... ..........................64 Gay Men ............................................ ........................67 Bisexual Individuals . ...................70 Transgender Individuals . ................77 People of Color Who Are LGBTQ . ...............83 $VLDQ$PHULFDQ1DWLYH+DZDLLDQVDQG3DFL¿F,VODQGHUV ..............................84 Black/African American/African Descent . ...................87 Latino/Hispanic/Mexican American/Chicano .. .....................92 Native American—Two-Spirit . .......................95 Couples .............................................. 101 Parents, Children and Families . 103 Youth . 106 Older Adults ......................................... 124 Part 2: Research Methodology .. .128 Community Engagement . 128 Information Gathering: A Multi Method Approach . 128 Strategic Planning Workgroup . 128 Community Dialogue Meetings . 130 Advisory Groups . 131 Community and Provider Surveys . 132 Data Analysis and Preparation of Findings .. 134 Study Limitations . 136 Part 3: Findings and Recommendations . 139 Community Survey . 139 General Demographics . 140 Sexual Orientation . 145 Gender Identity . 147 Intersex ............................................ 148 Mental Health and Minority Stressors . 149 Social Supports - Rejection and Outness . 152 6HUYLFH3URYLGHUV2XWQHVV5HMHFWLRQDQG'LI¿FXOWWR)LQG ...........................156 Access to Services .. 157 Mental Health Services - Barriers, Problems and Satisfaction . 159 Provider Survey . 162 Workplace Environment . 163 'LVSDULWLHVIRU/*%74,GHQWL¿HG3URYLGHUV .......................................163 Barriers to Providing Services . 164 Comfort Matters . 165 Training Matters . 167 Summary ............................................ 169 Recommendations .. 171 Focus 1: Data Collection, Research and Evaluation . 172 Focus 2: Policy . 173 Focus 3: Workforce Training . 176 Focus 4: Funding and Services . 178 Part 4: Community Defined & Promising Practices . 181 Index By Practice Focus . 182 Description of Practices . 185 Glossary . 206 References . 210 $SSHQGL[$$GGLWLRQDO3RSXODWLRQ 6XEMHFW6SHFL¿F5HFRPPHQGDWLRQV . 237 Policy . 237 Workforce Training . 237 Funding and Services . 238 Appendix B: Additional Resources .. 240 Acknowledgements Writers Pasha Mikalson, MSW Seth Pardo, PhD Jamison Green, PhD Project Staff Pasha “Poshi” Mikalson, MSW Project Director Mental Health America of Northern California Nicole Scanlan Project Coordinator Mental Health America of Northern California Seth Pardo, PhD Data Analyst Executive Director, Professional Education & Research Consulting Daniel Gould, LCSW* LGBT Health and Human Services Network Deputy Director Equality California Institute * Former Staff Member Laurie Hasencamp Interim Executive Director Equality California Institute Susan Gallagher, MMPA Executive Director Mental Health American of Northern California Contributors $VLDQ$PHULFDQ 1DWLYH+DZDLLDQ3DFL¿F,VODQGHUVHFWLRQ R. Anthony Sanders-Pfeifer, PhD—Alameda County Behavioral Health Services and Contra Costa County Behavioral Health Services Black/African American/African Ancestry section Gil Gerald, President/CFO—Gil Gerald and Associates, Inc. Parents, Children and Families section Judy Appel, JD—Executive Director, Our Family Coalition Renata Moreira, MA—Our Family Coalition 4 Domestic Violence section Susan Holt, PsyD, CCDVC—LA Gay and Lesbian Center HIV and.