Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face unique mental health challenges that social workers and case managers often overlook. LGBTQ+ mental health struggles range from anxiety and depression to trauma and severe social exclusion.
Addressing these types of cases requires a sensitive, culturally competent approach that acknowledges LGBTQ+ individuals’ concerns and greatest mental health risks.
Key Mental Health Challenges Facing LGBTQ+ Populations
Mental health is just as important as physical health, despite being so often overlooked. LGBTQ+ individuals are 2.5 times more likely to experience depression, anxiety, and other mental health concerns than heterosexual, cisgender individuals, and the reasons behind it vary significantly.
Some of the most common mental health challenges experienced by LGBTQ+ individuals include:
- Anxiety disorders
- Depression
- Post-traumatic stress disorder (PTSD)
- Minority stress
- Substance abuse
- Bipolar disorder
- Eating disorders
- Suicidal ideation
Risk Factors Tied to Discrimination and Stigma
According to reports by individuals, families, and friends, roughly 57% of LGBTQ+ individuals have been threatened or harassed, and 51% have experienced sexual harassment and violence due to their gender identity or sexual orientation. Harassment, discrimination, rejection, and cultural stigmas significantly increase someone’s vulnerability to mental health and wellness issues among LGBTQ+ people. This is especially true among transgender and nonbinary individuals, who are more frequently targeted by slurs, threats, and violence.
Discrimination, rejection, and similar negative experiences can lead to serious mental health challenges and an impaired quality of life. Children are particularly vulnerable, as discrimination and isolation can limit healthy brain development, leaving a lifelong impact. Traumatic experiences, such as violence and harassment, can also cause individuals to develop PTSD, which can make them feel even more scared or anxious in uncomfortable situations.
LGBTQ+ individuals also experience various types of discrimination outside of direct conflicts, such as unfair treatment in the workplace. Nearly 60% of LGBTQ+ people have reported that they feel they have fewer employment opportunities, while 50% believe they are paid less due to their gender or sexuality.
The Impact of Social Isolation and Rejection
Rejection from families, communities, and social opportunities can create severe emotional distress and long-term mental health risks. Social isolation, in particular, directly contributes to physical and mental health challenges, as many people felt around the world during the COVID-19 pandemic.
Many LGBTQ+ individuals experience disenfranchised grief, which often describes the feeling of loss after someone becomes estranged from their family, relationships, and social norms. Disenfranchised grief is just as real as any other type of grief. Various LGBTQ+ people who willingly separated from their parents experience similar symptoms of depression and grief to individuals whose parents have died. Nevertheless, most workplaces and institutions don’t offer bereavement support for this type of grief, which can make it challenging for those facing it to get the mental health care they need.
Unfortunately, many people fail to consider the full picture when addressing LGBTQ+ individuals who are estranged from their families or friends, especially when they severed the relationships themselves. As discussed above, being met with stigmas and abuse in any type of relationship can hurt your mental health and contribute to suicidal ideation, making removing yourself from the relationship the only healthy option.
Despite this, most LGBTQ+ individuals who cut ties with their family are often thoroughly questioned on why they “would ever do such a thing.” These conversations regularly lead to harmful statements that inadvertently try to make LGBTQ+ individuals feel guilty for protecting their mental health. This stresses the importance of approaching LGBTQ+ mental health with empathy and competency.
Why Culturally Competent Support Matters in Case Management
Cultural competency is essential for any type of case management, even non-clinical, especially when you’re working with clients who are prone to discrimination and stigma. This healthcare approach requires you to consider each client’s cultural background, values, and beliefs. When working with LGBTQ+ mental health cases, you must use affirming language, such as the client’s preferred pronouns, and maintain a safe environment.
A crucial aspect of cultural competency for LGBTQ+ clients is understanding the diverse risk factors each individual may encounter.
“LGBTQ+” is an umbrella term that covers various identities, including:
- Gay
- Lesbian
- Bisexual
- Pansexual
- Omnisexual
- Asexual
- Demisexual
- Transgender
- Non-binary
- Gender queer
- Gender fluid
- Agender
- Bigender
- Intersex
Despite the significant overlap, discrimination based on sexual orientation often looks different than discrimination based on gender identity, so the solutions that helped a gay man overcome his fears of socialization may not work for a transgender woman. Researching exactly how discrimination impacts different members of the LGBTQ+ community will help you approach each individual client with more empathy and understanding.
Trauma-Informed Strategies That Build Trust
A trauma-informed approach requires you to acknowledge and be sensitive to the impact of trauma and PTSD on LGBTQ+ individuals. Even if someone doesn’t outright disclose their trauma, you should still provide support under the assumption that they experience some sort of trauma related to their gender or sexual orientation.
Understanding the relationships between LGBTQ+ identities and mental health will help you establish trust and a safe space where they can talk about their feelings. This doesn’t mean you must act like you’re walking on eggshells, as that can make clients feel uncomfortable. Instead, you should be aware of the words, questions, and triggers that may upset LGBTQ+ individuals and focus on empathizing with what your client is saying.
Barriers to Accessing Mental Health Services
LGBTQ+ people face various obstacles and challenges in obtaining the mental health resources they need. Many LGBTQ+ individuals experience discrimination and bias from their healthcare providers, with some providers blaming patients’ gender identities and sexuality for their illnesses.
Many transgender people in the U.S. are actively losing access to healthcare due to limited insurance coverage and changing laws. As of early 2025, 25 states have implemented blanket bans on various types of gender-affirming care, resulting in many trans individuals losing their healthcare mid-treatment.
Meanwhile, a 2024 class-action lawsuit against New York City’s health insurance plan claims that male couples are excluded from equal healthcare access. Furthermore, despite laws aimed to protect them, some same-sex couples still struggle to maintain equitable insurance coverage for both partners. Some spouses and partners are also unlawfully refused access to or decision-making power for their loved ones at hospitals.
How Caseworkers and Programs Can Deliver Inclusive Support
LGBTQ+ mental health services should be tailored to clients’ unique needs. This requires you to consider various types of solutions, such as referrals to affirming services, access to housing or job training, and ongoing check-ins.
The minority stress model can be a powerful tool when you’re addressing LGBTQ+ cases. This visual model charts how transphobia, homophobia, prejudice, and other forms of discrimination negatively impact physical and mental health. Consulting this chart can help you learn more about your clients’ situations when you still have limited information to approach each case with care and respect.
Partnering With LGBTQ+ Centers and Providers
Working with other case managers, providers, and specialists through cross-agency collaboration is an effective way to home in on clients’ unique mental health risks. For example, Black trans women are statistically discriminated against more than most other demographics, resulting in significant health concerns.
A single agent may not have the resources to understand this unique intersection between racial and LGBTQ+ discrimination. However, consulting with other social workers and mental health experts may help you handle the case with better sensitivity and care.
Tracking Outcomes With Client-Centered Data
Addressing LGBTQ+ mental health struggles leaves you with much to consider, from the client’s background to the ongoing threats against LGBTQ+ healthcare. This can make it challenging to actually focus on the client and the case at hand.
Casebook and other case management tools can simplify your job by documenting clients’ progress and ensuring continuity across mental health services. This way, you can review previous notes to remind yourself of the client’s triggers, concerns, and healthcare goals. Casebook also helps you identify care gaps so that all clients receive comprehensive and equitable care, regardless of their gender identity or orientation.
How Casebook Supports Inclusive, Collaborative Case Management
Casebook’s simplified platform supports LGBTQ+ clients by letting you easily coordinate care between providers. Real-time updates encourage you to take immediate action as soon as a client’s paperwork goes through, so they can receive the care they need as soon as it’s possible. Data tracking and progress monitoring also enable you to oversee the client’s care over the long-term.
These types of tools are especially crucial when you’re working with multiple providers. Seeing the client’s full healthcare journey rather than the sporadic updates you get in follow-up sessions will help you identify successes and setbacks and immediately respond to their mental health concerns.
Improving LGBTQ+ Client Outcomes Starts With Better Systems
From changing laws to PTSD caused by violent assaults, key LGBTQ+ mental health struggles and concerns are shifting day by day. Keeping yourself informed and understanding the importance of relationships and mental health for LGBTQ+ clients will help you address their needs while maintaining their trust and safety.
Find out how Casebook can simplify case management so you can stop focusing on the paperwork and instead focus on your clients’ real-life issues.
