Empowering LGBTQIA+ migrants, asylum seekers and refugees through destigmatization: reflections on mental health care in Europe

Mental health remains a stigmatized subject across societies, cultures and political systems. The stigma surrounding mental health spreads through different channels, such as public stigma, self-stigma, community and family-based stigma or a combination of the above. These different forms of stigma are often built upon stereotypes and discrimination but also stem from a lack of understanding and awareness regarding mental health and the struggles and challenges associated with it.

For marginalized groups such as the LGBTQIA+ community, mental health is a particularly pressing topic, as homo- and transphobia, societal exclusion, derogatory narratives, hate crimes and abuse may lead to a variety of mental health issues. The 2015 U.S. Transgender Survey report revealed that 39% of the respondents experienced serious psychological distress in the month prior to completing the survey, while 40% have attempted suicide in their lifetime. Moreover, 33% of the respondents were exposed to mistreatment when seeking healthcare in the year prior to completing the survey, including being verbally harassed or refused treatment because of their gender identity (James et al., 2016:5). The report substantiates the well-documented link between experiences of discrimination and marginalization and poor mental health outcomes for the LGBTQIA+ community (idem:103).

LGBTQIA+ migrants, asylum seekers and refugees in particular are especially vulnerable to mental health issues and mental illness. More often than not, their experiences are based on a history of traumatic events, including verbal, emotional, physical and sexual abuse, assault, harassment, shunning, discrimination in housing and employment, forced prostitution, corrective rape, conversion therapy and destruction of property. As victims of systematic persecution and discrimination, they rarely find support within their family circle or, even worse, experience abuse from precisely those connections (Shidlo and Ahola, 2013:9), which contributes to their mental health issues and often results in deep psychological and physical trauma. Many suffer from complex Post-Traumatic Stress Disorder (PTSD), which involves self-destructive behavior, amnesia, intense shame and difficulties with intimacy. Depression, dissociative disorders, panic disorder and generalized anxiety disorder are also common diagnoses among the LGBTQIA+ migrant, asylum seeker and refugee community (ibid). LGBTQIA+ forced migrants who flee to the EU also face prolonged transit periods. During transit, LGBTQIA+ forced migrants are, compared to general migrant populations, at higher risk of abuse and discrimination due to their sexual orientation and gender identity, which is only exacerbated by the general lack of access to mental health care and services in transit spaces (Yarwood et al., 2022:2). Within the post-migration context, hormone therapy and the necessary medicine for treatments may be difficult to access (idem:15), which in return further deteriorates their mental health. A study of the post-migration experiences of LGBTQ+ refugees in Germany found that the participants’ mental health decreased as they navigated daily experiences of intersectional discrimination and violence in their new host society and developed feelings of being unable to avoid discrimination as a whole, even in environments deemed “safe”. They subsequently struggle with rejection expectation, minority stress and identity concealment (Golembe et al., 2021:1055-1056).

While the length and the complexity of the migration journey of LGBTQIA+ forced migrants increases the likelihood of being survivor of traumatic incidents, many encounter anti-LGBTQIA+ violence and victimization by European immigration officials after arriving in Europe. After arrival, they continue to hide their sexual orientation and/or gender identity and often lack information on how to access support services, which plays a significant role in the high rates of hopelessness and suicidality among affected groups (Alessi et al., 2018:813). Structural violence inflicted by immigration/asylum determination procedures in European countries, including restricted access to health care and the possibility of deportation, only add to the mental health issues LGBTQIA+ forced migrants experience in the post-migration scenario. The populist, anti-immigration and right-wing political climate in Europe does little to make Sexual Orientation and Gender Identity (SOGI) claimants feel safe in their host societies and may lead to them being unable to process their experiences of trauma and violence, as additional threats and new hostile agents emerge. Furthermore, repeatedly retelling their history of abuse and persecution, as an integral phase of the asylum case assessment procedure in Europe, can also re-traumatize LGBTQIA+ forced migrants. Alternative methods which instead aim at minimizing the re-traumatization of LGBTQIA+ forced migrants need to be integrated into the overall asylum process in Europe and beyond.

Most importantly, mental health care/services in host societies need to be specifically tailored to the individual mental health related needs of LGBTQIA+ forced migrants, while housing and integration programs provided for them should similarly be responsive to such needs. Mental health services must also acknowledge the intersection between mental health and minority status, including race, ethnicity, gender and sexuality, in order to design appropriate and sensitive care. Mental health professionals should also be aware of their cultural biases (especially those of cis- and heteronormative nature) and should familiarize themselves with diverse expressions of sexuality and gender identity across societies and cultures. The destigmatization of mental illness and mental health in Europe needs to occur in private and public environments with the help of accessible, comprehensive and inclusive policies, open debate on a societal-institutional level and via support groups/organizations within civil society. Mental health services and professionals, community-based initiatives and support groups may also encourage and help LGBTQIA+ migrants, asylum seekers and refugees to reduce self-stigma and to take pride in and to celebrate their mental health journey. Moreover, awareness-building via educational channels, tailored training for health care professionals and NGO/other organization staff, advocacy initiatives and peer support are necessary for combatting stigma and discrimination across European societies in relation to the mental health of LGBTQIA+ migrants, asylum seekers and refugees. Mental health is a universal human right.