Lesbian, gay, bisexual and transgender patients can easily fall through the cracks in any health system.
But LGBT veterans often face unique struggles that may keep them from accessing care, said Jillian Shipherd, clinical psychologist and co-director of the LGBT Health Program at the Veterans Health Administration.
That is why the Department of Veterans Affairs has been building up several programs aimed at bringing these veterans into its health system in what Shipherd said is a crucial step for providers, because having a minority sexual orientation or gender identity can significantly affect health.
“Sexual orientation and gender identity are social determinants of health,” Shipherd said.
Lesbian, gay, bisexual and transgender veterans often face unique struggles and are in a “double closet,” said Shipherd—meaning they don’t talk about their veteran status when in the LGBT community and hide that they’re LGBT from fellow veterans.
Relatively few seek care in the VA system and are likely to present to non-VA facilities, too, said Shipherd, who was one of several speakers at a web event on how the VA cares for LGBT patients. The event was hosted this week by the Substance Abuse and Mental Services Administration and the Health Resources and Services Administration.
Though there may be specific considerations for veterans, LGBT patients of all kinds have reported negative experiences when seeking care. Shipherd said systems are “not designed to be welcoming” to LGBT patients, and many providers lack training to address their specific needs.
Kristin Potterbusch, director of HIV and behavioral health integration at the SAMHSA-HRSA Center for Integrated Care Solutions, said that while treatment may be of equal quality, LGBT patients routinely experience harassment or disrespect when seeking care.
For example, a significant majority (70%) of transgender patients who responded to a 2010 Lambda Legal survey reported at least one of these experiences, she said:
- They were refused needed care because they are transgender.
- Healthcare professionals refused to touch them or used “excessive” safety precautions.
- Healthcare professionals spoke with them using harsh or abusive language.
- They were blamed for their own health status.
- Healthcare professionals were physically rough with them or even abusive.
“This means that 70% of individuals are not only not being fully cared for by health systems but are potentially and really, truly experiencing a level of harm and traumatization for seeking care,” Potterbusch said.
Shipherd said there are several characteristics that should be built into any program for LGBT patients: a welcoming environment, staff sensitivity and respectful and inclusive language. Patients should be assessed for gender and sexual identity at intake, and that information should be kept up-to-date should those identities change, she said.
Providers also need greater education on the health disparities LGBT patients face—and should not expect patients to be the source of that training, Shipherd said.
The VA’s plan is built on these principles and includes developing systemwide policies, including anti-discrimination and clinical policies, educating staff members and push for greater assessment through support tools and informing and engaging LGBT patients about the services available to them.
One clinical support resource, for example, is a national e-consultation program for transgender patients that is built into the electronic health record. The clinician can request a consult through the EHR, with the patient’s permission, and those questions will be routed to an interdisciplinary team that can assist with transgender care.
Engagement efforts don’t have to be complicated, either, said Michael Kauth, Ph.D., a psychiatry professor at Baylor College of Medicine and co-director of the VA’s LGBT health program. A simple step: Clinicians can wear rainbow lanyards or pins, which can create a more welcoming atmosphere.
“Generic environments are great for the majority because the majority are welcome in most environments,” Kauth said. “But minority folks are not so welcome in those environments, and they look for signs and signals that show that they’re expected and that they’re welcome there.”