In 2011, the United States Military repealed its “Don’t Ask, Don’t Tell” policy that prevented gay, lesbian, and bisexual service members from disclosing their sexual orientation. Current estimates indicate that more than 1 million veterans identify as gay, lesbian, or bisexual (GLB). Now, a University of Missouri researcher says these service members and veterans often are marginalized and may benefit from mental health professionals, including social workers, who are informed about the needs of individuals who identify as GLB.
Although his findings do not generalize to each individual (meaning that each person has their own interpretation of their personal experience—and it’s important to honor that), the research shows that many people who identify as GLB experience higher levels of mental health symptoms, such as anxiety and depression, in response to environmental stressors that are associated with identifying as a sexual minority. Researcher Michael Pelts, from the MU College of Human Environmental Sciences, refers to this as “minority stress.” Pelts says this can manifest in any environment where GLB individuals do not have equal access, are treated differently, or are at risk of being treated differently because of either real or perceived sexual orientation.
Pelts gives one very real example: Think of serving in the military prior to 2011, when Don’t Ask, Don’t Tell (DADT) was still law. Between 1995 and 2010, almost 14,000 GLB military members were discharged due to sexual orientation, who are now military veterans. When they were in the service they could be discharged because of their sexual orientation. Whether actually discharged or always under threat, by law, their entire career would end if they disclosed, intentionally or not, their sexual orientation.
“Identifying as GLB and serving in the military can provide a distinct set of experiences and challenges for individuals,” Pelts says. “Within the U.S., identifying as a service member or veteran can marginalize individuals. This is also true for people who identify as GLB. The impact may be compounding. For example, suicide has a high occurrence rate among veterans and even more so among veterans who identify as GLB.”
In attempts to explain this phenomenon:
The truth is, regardless of sexual orientation, societal response to veterans has been different at different times in history. Society does not always value veterans. Pelts cites reports that show this was especially noticeable after the Vietnam War when returning soldiers were not always held in high regard. Reactions to combat experiences and stigma expressed as negative attitudes toward service can have negative effects for some veterans. The impact may manifest in many ways. For example, compared to non-veterans, veterans experience higher rates of homelessness. Additionally, service members and veterans of recent wars experience significantly higher rates of suicidal ideation and suicide when compared to non-veterans. Adding in sexuality as a factor, non-veteran GLB people also experience significantly higher rates of suicidal ideation and suicide than heterosexual counterparts. If an individual identifies as both veteran and GLB the impacts of marginalization can be compounded: GLB veterans experience even higher rates of suicidal ideation and suicide.
With such powerful statistical information, why then are GLB veterans seeking mental health care services outside of Veterans Affairs? Many veterans, in general, seek and receive their care for both physical and mental health needs outside of the VA Healthcare system. According to Pelts, some reports show that as many as 75% of veterans receive their care outside of VA. One of the primary reasons for this is limited VA capacity. As a result, it is likely that every provider of mental health services will, at some point, encounter veterans in their practice, whether that be a private or public practice. It is also likely that a number of those veterans will identify as GLB.
“Social workers in the public and private sectors make up the largest group of mental health service providers to veterans and their families,” Pelts says. “It is likely that social workers will continue to see current and new generations of veterans struggling with their sexual identity and with the impact of internal and societal stigmas related to identifying as GLB. Therefore, mental health professionals need to be equipped to care for members of this population.”
In order to better equip themselves, Pelts says that social workers and other mental health providers should challenge their cultural assumptions when treating clients who are veterans or service members. “It’s not ethically sound practice to assume that all service members and veterans are heterosexual. Assuming individuals are heterosexual can compound stress for GLB individuals and make them less likely to share information, which can make it more difficult for health professionals and mental health providers to provide adequate care.”
Pelts said health providers should adopt practices to be more inclusive to veterans who identify as GLB. Part of increasing inclusivity includes simple changes such as modifying medical history forms and in-take documents. By going about the simple task of using more inclusive terminology, individuals who identify as GLB may feel less alienated.
Pelts cites previous research that shows GLB people use the services of mental health providers at rates higher than non-GLB people. Reports also show that one of the primary reasons GLB people seek the assistance of a mental health provider is in response to societal stigma related to identifying as a sexual minority. Reaching those individuals in service delivery can be facilitated by practicing in a manner that does not assume all patients are heterosexual. Referred to as “affirming practice,” a practice that does not assume heterosexuality and is informed about the needs of GLB clients can extend beyond the individual client. Pelts gives the example that now military members can serve openly and the military recognizes marriages of same-sex couples. An affirming practice may reach the child of a same-sex couple who wishes to discuss the parents’ sexual orientation. An affirming practice may also reach family members and friends of GLB veterans who do not understand minority sexual orientation.
“It is essential for mental health professionals to create culturally competent practice approaches,” Pelts said. “Social workers have a tremendous opportunity, if not ethical responsibility, to be leaders in the provision of mental health services for GLB service members, veterans and their families.”
However, Pelts says that the future needs of mental health for GLB service members and veterans is somewhat unknown at this time. With the repeal of DADT, GLB service members are able to be open about their sexuality, and the needs of of veterans who have been closeted their entire military career could likely be different than those who can serve openly. Pelts says, “The repeal of DADT went into effect in 2011, so this issue has not been explored yet. This is an issue that we will look at more closely as more service members and veterans serve openly over time.”
Further research also needs to be done regarding transgender individuals, Pelts says, urging that understanding the experiences of transgender military members and veterans is also important. “The repeal of DADT allows GLB service members to serve openly; however, the same protections have not been extended to transgender people,” he says. “The experiences of sexual orientation and gender identity are separate constructs that warrant separate research. Using the same data, we are currently looking at the same information related to transgender individuals and will be sharing that soon.”
Michael Pelts is the author of “Veterans Mental Health: Implication for Services With Gay Men and Lesbians Who Have Served,” published in Social Work in Mental Health.