Why Now? The Mental Health Crisis Among Gay Men

It's not a secret, or if it is, it's an open one. Gay men are far more vulnerable to developing mental health issues than their straight counterparts. Research published last year by the American Journal of Men's Health found that the prevalence of depression in gay men is three times higher than in the general adult population. And because depression is a risk factor for suicide, suicidality occurs more frequently, too.

According to Dr. Matthew Oransky, whose clinical focus at the Mount Sinai Adolescent Health Center includes LGBTQ services, gay men also have a higher rate of anxiety and substance abuse. As we process the loss of Kate Spade and Anthony Bourdain and honor Men's Health Month, here is a look at why and how our community suffers as well as what can be done about it.

What Hurts
Gay men have long endured stigmatization, familial rejection, prejudice, isolation, discrimination and violence. The minority stress model, developed in 2003 with regard specifically to LGBTQ individuals, posits that these conditions create a "hostile and stressful social environment that causes mental health problems." According to this theory, it's the daily experience of living under minority stress that accounts for the high rates of suicide and mental illness in the queer community.

Unfortunately, as the Trump administration continues to erase LGBTQ-friendly policies (take a look at GLAAD's continually updated narrative), the level of what Oransky calls "distress" among gay men has increased.

"What I'm seeing in my patients is a sense of panic, anxiety and a feeling of invalidation by society at large," says Oransky. "One of my favorite studies among LGBT youth shows a relationship between living in a more politically conservative, less accepting environment, and rates of depression and suicide. It looked at different laws and people who had been elected, and it showed a relationship between conservatism and mental health problems amongst LGBT youth."

What Happens

Among other responses, chronic experiences of oppression can cause internalized homophobia, a particularly insidious condition. "I think it comes from things like bullying at school and from not being accepted within your own family," notes Giovanny Lopez, a licensed social worker who peer counsels LGBTQ people at Identity House in New York City.

"People with internalized homophobia have an inner conflict where they don't accept their own sexuality," says Lopez. "It can manifest in a lot of different ways, with low self-esteem, compulsive behavior, being closeted. There's often isolation because they are ashamed, so they don't feel comfortable connecting with other people."

Substance abuse is also a common problem in the LGBTQ community, with gay and bisexual men who abuse alcohol and illegal drugs like methamphetamines at a higher risk for contracting HIV and STDs.

Within the general population opioid abuse continues to wreak the most havoc, but according to Dr. Marc J. Romano, PsyD, Director of Medical Services at Delphi Behavioral Health, the gay community tends to favor "club drugs" like ecstasy, molly, GHB, crystal meth and ketamine. "People get impaired," he says, "and then they go out and engage in unsafe sex. But the other problem we see is that they're becoming heavily addicted to these drugs. That's impairing their ability to maintain their jobs, which affects their life and social relationships, and eventually, they need to go into treatment."

Getting Help
There is no shortcut to lowering the rates of mental illness in gay men or the LGBTQ community as a whole. Oransky would like to see a greater number of schools with gender and sexuality alliances, more mentoring programs and an increase in LGBTQ-affirming mental health and medical services. Lopez suggests people seek support from peer counselors and groups. Most importantly, those with suicidal thoughts should immediately seek help by calling The National Suicide Prevention Hotline at 1-800-273-8255.