LGBT-parented families and behavioral healthcare

Throughout 2011 and 2012 I interviewed families headed by LGBT parents in preparation for the book Family Pride: What LGBT Families Should Know About Navigating Home, School, and Safety in Their Neighborhoods (Beacon Pres: 2013).  Access to behavioral health care was a recurrent concern. To begin though I need to present some surprising demographics regarding these families.

·      Twelve to twenty percent of LGBT couples are raising children; other estimates are that one third to one half of lesbian and bisexual women and approximately twenty percent of gay and bisexual men have a child.[i]

·      Same-sex parents in the U.S. have fewer financial resources to support their children than married opposite-sex parents. The median household income of same-sex couples with children is 23% lower than that of opposite-sex married parents.[ii]  Poverty rates increase when same-sex parents live in rural areas and/or are people of color.[iii]  

·      Same-sex couples of color are more likely than their white counterparts to be raising children.  As one example, a 2007 study by the Our Family Coalition found that in California more than half of all African American, Asian Pacific Islanders, and Latino/a same-gender couples between the ages of 25-55 years were raising children of their own (43%, 45%, and 62%, respectively), while only 18% of white same-gender couples were raising children.[iv]

·      Gay men and lesbians raising children are more likely to be living in southern and/or rural states.[v]

We also know that the behavioral healthcare needs of LGBT families are not adequately being met. After all, Lambda Legal’s 2010 release “When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV” found that 56 percent of respondents had experienced some form of mistreatment when accessing services and that its report likely understated the barriers to health care experienced by LGBT people.[vi] 

Similarly, The Human Rights Campaign’s 2011 report “Healthcare Equality Index 2011” concluded that many LGBT people often decline to seek healthcare in times of need out of fear of discrimination and poor treatment by healthcare professionals.[vii]  Danese, a lesbian mother, for example, quickly recognized that the inpatient substance treatment facility in which her daughter had entered was not necessarily LGBT-affirmative:  “When filling out the forms with the intake person she asked about our daughter’s father; when I told her she had same-sex parents she seemed baffled and unsure what to do.  She hesitatingly smiled and crossed off “name of father” from the application and wrote “name of second mother” instead . . .  Our daughter was allowed one phone call a day, and she told me that the structure of her family was never discussed.  What infuriated me the most though was that during the first week of treatment a “family day” was held in order to introduce parents and siblings to the essentials of recovery, and the lecturer never once mentioned same-sex parents.  She did mention divorced, widowed, and single parents in additional to the traditional two-parent model, but same-sex parents were left untouched.”

Also consider Jessica.  She admitted with shame that she had conspired with her fourteen-year-old daughter Michelle to keep their family composition a secret from a counselor:  “It was mortifying to listen to this counselor telling us about the impact of family dynamics on Michelle’s drug problem, yet the entire time we’re sitting there we’re lying to him….I’m pretending to be a single mom instead of talking about Jody [her girlfriend] and her own ongoing alcohol abuse in our home.”  Jessica and her family live in a small town in West Virginia (Jessica called it a “hamlet.”) and they had to drive more than an hour to even obtain treatment services.  Even more intimidating, the facility was evangelical and not going to necessarily look upon her family with respect.  Jessica summarized her dilemma with a barely discernable shrug: “What could I do?”

In Families Like Mine author Abigail Garner proposes, “LGBT families should be allowed to be just as wacky, troubled, or complex as any other American family.”[viii]  Unfortunately this privilege is not granted to LGBT families.  Traditional families coping with domestic violence, substance abuse, molestation, and mental illness receive societal support; additionally, neighbors, family, teachers, medical professions, and politicians don’t blame these problems on parents’ sexuality.  However, when a LGBT family experiences the same problems, parent sexuality or gender identity is perceived as the pivotal factor on which all these problems build.

Behavioral health treatment providers are increasingly working with LGBT families, and it may be parents or their children who are the identified substance abusers. While our understanding of the treatment needs of LGBT families is in its infancy, we must do what we can to prevent the insensitive and misinformed clinical encounters experienced by Danese, Jessica, and other LGBT parents and their children.