Caring for LGBTQ Individuals in Occupational Therapy

Occupational therapy encompasses a holistic approach to healthcare.

In 1973, a pivotal moment occurred in the history of mental health diagnosis: homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). This was a significant step forward in LGBTQ+ rights and recognition. However, despite this milestone, members of the LGBTQ+ community continue to face unique challenges in accessing healthcare services, including occupational therapy.

Recommended course: Caring for LGBTQ Individuals in Occupational Therapy

Barriers to healthcare

LGBTQ+ individuals with intersecting marginalized identities, such as race, ethnicity, disability, or immigration status, may face compounded barriers to healthcare access and experience greater disparities in health outcomes. Intersectional discrimination and systemic inequalities can further marginalize individuals within the LGBTQ+ community and limit their access to culturally competent and equitable care.

These barriers can include:

• Healthcare settings that are not inclusive or welcoming to LGBTQ+ individuals may deter individuals from seeking care or prevent them from disclosing their identity and health needs. 
• Economic barriers, including lack of health insurance coverage, financial constraints, and employment discrimination. 
• Healthcare providers may lack knowledge and understanding of LGBTQ+ health issues, including unique healthcare needs and concerns.
• Healthcare providers implicit biases towards LGBTQ+ individuals. 
• Legal barriers may limit access to certain healthcare services for LGBTQ+ individuals. 

Terms 

To provide more inclusive care, healthcare providers like occupational therapy practitioners (OTPs) need to understand terminology related to gender identity and expression.

• Cisgender: Describes a person whose gender identity aligns with the sex assigned to them at birth.  
• Gender dysphoria: Clinically significant distress caused when a person’s sex assigned at birth is not aligned with their gender identity.
• Gender identity: One’s innermost sense of self as male, female, a blend of both or neither. A person’s gender identity can be the same or different from the sex assigned at birth.
• Gender non-conforming (GNC): Describes a person who does not subscribe to society’s traditional expectations of gender expression or gender roles.
• Transgender: Describes people whose gender identity and/or gender expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation.

Pronouns

The American Psychological Association (APA) advocates for the singular “they” because it is inclusive of all people and helps writers avoid making assumptions about gender. The APA advocates for the singular “they” because it is inclusive of all people and helps writers avoid making assumptions about gender.

This advocacy reflects a broader commitment to avoiding assumptions about gender and embracing the diverse identities of all individuals. By respecting preferred names and pronouns, healthcare professionals, including occupational therapists, can create a more welcoming environment for LGBTQ+ patients.

Preferred names

A literature review found that using a preferred name can have a positive customer service benefit in allowing healthcare staff to address the patient in a manner they choose, whether or not they elect to provide a preferred name.

The use of preferred names for transgender patients has been identified as important in providing inclusion toward a class of patients who have historically been disenfranchised from the healthcare system. APA endorses the use of “they” as a singular third-person pronoun in the seventh edition of the Publication Manual of the American Psychological Association.

Activities of daily living

Occupational therapy encompasses a holistic approach to healthcare, focusing on enabling individuals to engage in meaningful activities of daily living (ADLs). For transgender individuals, navigating ADLs during the transition process can present unique challenges and considerations.

Jamie Kimelstein discusses in their thesis about gender as an ADL. Kimelstein explored the occupations of transgender people during the transition to better understand how transgender people carry out the occupation of gender.

OTPs play an important role in supporting individuals of the LGBTQ+ community.

• Tucking as an ADL involves concealing the genitalia to create a smoother pelvic contour. It may also involve using specialized undergarments, tape, or other methods to achieve the desired effect.
• Consideration of the way a person urinates. The way a person urinates can vary depending on factors such as gender identity, physical ability, and personal preference.
• Addressing same-sex intercourse refers to providing guidance about sexual activity between individuals of the same gender given the individual’s current health state.
• Binding as an ADL refers to the practice of flattening one’s breast tissue to create a flatter chest profile.

Equitable access to healthcare

Occupational therapy is about promoting occupational justice – the right of all individuals to meaningful and inclusive participation in society. For LGBTQ+ individuals, achieving occupational justice means having equitable access to healthcare services that affirm their identities and support their unique needs.