Let's talk about (un)safe spaces:
To start the discussion about mental health in the LGBT+ population, we must discuss safe spaces. And, to talk about safe spaces, we should ask ourselves if these are a response to unsafe spaces built over the decades in our society.
Firstly, it is essential to look at some figures. In Mexico, the National Survey on Sexual and Gender Diversity (ENDISEG), revealed that LGBT+ people are three times more likely to have suicidal thoughts and attempts than the rest of the population. Numbers from other countries of Latin America tell a similar story: in Colombia, half of the LGBT+ population has suicidal thoughts, and one in four has attempted it. Meanwhile, a non-binding study in Peru reported that more than half of those interviewed have mental health problems.
The latter are not isolated cases or just restricted to Latin America. In the United States, half of the gender-diverse adolescents between 13 and 17 years old have considered suicide, and 60% of people in the LGBT+ community who committed suicide, did it within the first five years after "coming out".
A study in the journal of the American Association of Public Health (AJPH) found a 'strong association' between discrimination and mental illness in gays and lesbian individuals. Similarly, an investigation in Mexico City found that discrimination and violence are not only linked to the mental conditions that the sexually diverse community experiences but that specific types of aggression are related to different problems. Verbal violence, for example, was connected with 'common mental disorders,' while physical violence was associated with alcoholism, suicidal ideation, and suicide attempts.
Likewise, violence and (re)victimization of trans people are related to mental health risks. On the other hand, respecting the pronouns with which the person identifies with (her, him, them) is associated with fewer symptoms of depression, suicidal ideation, and suicidal attempts.
"In general, there is a confusion around the idea that LGBT+ people, or those who belong to the gender diversity or are gender dissidents, have certain discomforts or certain difficulties just for being part of the community. However, it is important to reconsider the fact that it is not because we belong to the community (...) that we develop these discomforts or these needs, but because as part of this group, we are discriminated, we suffer violence; that forces us to hide, and those are the reason why we develop discomfort." explained Ricardo Ramirez, advisor in the 'Astronauta Emocional' organization.
Therefore, people of the gender-diverse community are not born with unusual problems, but they are instead victims of unusual prejudices that translate into discrimination. This generalized physical and verbal aggression leads them to develop mental health problems, as would happen with any other individual.
(Ab)normality as a paradigm
So far, the need for specialized spaces has no reason to exist. Sex-diverse people are more likely to have mental health problems, but the clinics accepting hetero cis people could also cover the demand of the LGBT+ community. At the same time, they could help to correct the problem that discrimination and violence have caused.
The problem is that clinics are often places where discrimination or violence exist, making these a much bigger obstacle to tackle. Mental health professionals, according to the 'Astronauta Emocional' proffesionals, have preconceived ideas of people who identify themselves as members of the LGBT+ community; in addition, just as in other instances, the idea that there's a correlation between HIV patients and their sexual orientation. In sum, it is also assumed that most queer individuals identify as such because of traumatic episodes, stigmatizing their identities.
What is happening? The root of the problem is that people assume something is wrong within them, instead of considering their context, their experiences and the violence they're victim of.
The edge of this issue is the Efforts to Correct Sexual Orientation and Gender Identity (ECOSIG by its acronym in Spanish) or the also miscalled "conversion therapies," that, as said by Ricardo, come from the idea that "everything out of the norm has to be corrected." These efforts are not related to health; they provoke substantial complications, such as increased suicidal ideation and attempts.
The basis of it all, as Ricardo explains, is the idea that gender-diverse people's identity is exclusively defined by their belonging to the LGBT+ community. “We have the same needs as everyone else, but just because we are deemed different, for not following the norm, pathologization occurs and health services assume that we are more likely to develop mental health issues. They only focus on who we are, not what we have gone through".
According to the psychologist, this leads to biased assumptions of depression, gender dysphoria, and consumption of psychoactive substances, among other forms of pathologization. The mix of all these factors causes clinics that are supposed to be safe places (and that are so for a significant part of the population) to turn into sites of revictimization where people prefer not to go because of fear or caution.
The (un)known community
An added problem is that even if people want to treat LGBT+ patients, they do not have enough training. Mental health professionals, says Ricardo, "should know how to accept and serve gender-diverse people; unfortunately, it is not like that."
Although homosexuality has not been considered a mental health illness since 1990 by the World Health Organization (WHO), the landing of this change is slow and gradual. Training for treating LGBT+ people is needed, and it should start with using the correct pronouns in the case of trans people through respect for the physical appearance of all patients.
A safe space "is not only one where they can receive us and accept us as we are, but also one where they can understand that we are vulnerable to certain needs or certain discriminations. They need to let us access those services just like any other person".
Safe spaces are nothing extraordinary, and the truth is that most of us unconsciously enjoy them. The debate is not whether safe places are or not exclusive but about if they can face external exclusion and prevent and cure its effects.
As has happened before with vulnerable communities, differential treatment is a response to the growing violence in our societies. We would not need to force visibility if an ongoing historic effort to make some communities invisible did not exist. It would not be necessary to have forced representation if forced exclusion did not exist. There would not be a need to address the psychological effects of "coming out" if the need for the closet had not been forced in the first place.
Safe spaces exist because we have been incapable of giving minimal standard attention to LGBT+ people. Some may call privilege the effort to equate what people outside the community have received for decades as part of an excluding normality. As members of this society, we all shall question: what are we doing to stop maintaining unsafe spaces?