It wasn’t until 1973 that the American Psychiatric Association voted to remove homosexuality as a mental disorder. The recency of that decision still affects the LGBT community today. It opens the door to discrimination. Discrimination contributes to higher rates of depression, substance abuse, and suicide. Dr. James Dilley of the Alliance Health Project discusses its effects, and the impact that a continued shift toward acceptance can have.

James Dilley: You know, it wasn’t until 1973 that the American Psychiatric Association, after a fairly lengthy period of debate, discussion, and advocacy, voted to remove homosexuality as a mental disorder. Discrimination, you know, comes in, of course, in many forms. And the psychological and the social implications of those are, you know, they’re not insignificant. So if you do surveys of physicians and health care providers about their attitudes towards LGBT people, 20 to 30 percent say, you know, “I’m really not comfortable providing this kind of care.” Does one come out on an application to college or to medical school or to law school or, you name it. These are questions that people struggle with even to this very day — 90 percent or so of LGBT kids definitely say that they’ve experienced this kind of thing on, kind of on a daily basis. Whether it’s being told or being called “faggot” or whatever, made to feel badly because they’re different. These kinds of things over time, sort of add up.

Discrimination, actual and perceived, then this expectation that develops for those events, results in lower self-esteem, difficulty with relationships, difficulty with one’s own, feeling happy about one’s own life. There is probably a two-and-a-half or so times likelihood of mental health disorders or problems among LGBT folks. Depression, anxiety, substance use in particular. In particular for women, actually, about three-and-a-half times rate of substance use disorders among lesbians and bisexual women. There are higher rates of, certainly attempted suicide among LGBT communities. Exactly how many of those are completed is harder to know. But I could certainly say just from our clinical work over the years, it’s certainly not an uncommon kind of scenario, unfortunately. There’s just no question that today is just 180 degrees different than the way it was when I was growing up in small towns in the Midwest. As a middle-aged man, suddenly I was able to fight in the armed services when DOMA went down in the '90s. Now, today, I can actually be married in all 50 states. The fact that that has happened over this period of, what, 50 years or so is really quite remarkable. As those negative attitudes lessen, I can’t help but think that there’s going to be lesser mental health problems among LGBT folks.