Living As Our Whole Selves: Integrating Medical, Psychiatric and Social Care for LGBTQ+ People in Changing Legal Environments -- An LGBTQIA2S+ SIG-Sponsored Session

Abstract: The past decade has seen striking national developments for the health of LGBTQ+ people. Some of these have signaled major progress: the Supreme Court's overturning of bans on same-sex marriage; a marked increase in research focusing on LGBTQ+ health; and improved efforts by hospitals and other healthcare facilities to reduce institutional barriers. On the other hand, there have been developments which threaten the health and well-being of LGBTQ+ people across the country. In particular, laws have been introduced at state levels which limit access to medical care for people undergoing gender transition; criminalize the use of gender-appropriate facilities in numerous public environments; require child protective service abuse investigations of parents who allow children’s access to gender-affirming care; and restrict the recognition and discussion of LGBTQ+ people in educational and other public settings. Data show the impact of these adverse legal changes on LGBTQ+ people and their families has been enormous, with particularly detrimental effects on healthcare spanning experiences from the hospital setting to integrated healthcare clinics. As physicians in general medical settings with expertise in the biopsychosocial aspects of health outcomes, it is critical that C-L psychiatrists are equipped with a high-level understanding of the shifting social determinants and healthcare barriers faced by LGBTQ+ people. This LGBTQIA2S+ SIG-sponsored session will describe the barriers faced by LGBTQ+ people in healthcare systems, demonstrate their links to medical and psychiatric health outcomes, and provide C-L psychiatrists with the knowledge and skills to serve as expert consultants, advocates, and competent clinicians with the ability to ensure optimal outcomes for LGBTQ+ people in spite of systemic and structural barriers.



Dr. Mark Bradley will open the session by describing existing theory and research that link health outcomes for LGBTQ+ people to the social and legal environment in which they live, with particular attention to implications for care strategies in the general hospital and outpatient integrated care settings. Next, Dr. Ash Mehra, a Miami-based psychiatrist, will detail specific laws, policies, and data that illustrate the health effects of such conditions on the LGBTQ+ community. Ms. Heather Cherry, a clinical social worker and Veterans Care Coordinator for LGBTQ+ veterans in Miami, will then describe the impacts of Florida’s current socio-legal environment on patients and families encountered by clinicians, focusing on preparing C-L psychiatrists for similar challenges. Finally, Dr. Fi Fonseca will outline actionable strategies for C-L psychiatrists to ensure equitable treatment, provide optimal care in hospital and outpatient settings, and leverage community resources to build supportive care environments. Future directions for research and policy advocacy will be presented, aiming to close gaps in care and promote health equity for LGBTQ+ patients.

Learning Objectives:

• Analyze the impact of social determinants of health and current legal environments on the mental health outcomes of LGBTQ+ individuals, integrating the Minority Stress Model and recent research findings.
• Evaluate real-world effects of legal and social adversities on LGBTQ+ people in Florida through case studies and data, emphasizing the responses of patients, clinicians, and the local LGBTQ+ community.
• Identify and implement best practices for consultation-liaison psychiatrists to support LGBTQ+ equity and advocacy within general hospital and outpatient integrated care settings, fostering a holistic approach to patient care.