Self-harm is a serious and sensitive topic. Trigger Warning for discussion of self-harm. If you are thinking of harming yourself, call the US suicide hotline at 988. If you have harmed yourself or are in immediate danger, call 911.

As a survivor of self-harm behavior, I deeply understand the pain and suffering that it brings. Unfortunately, the behavior is prevalent amongst LGBTQIA+ people who are mentally ill. That is why today I will briefly cover why that is and what we can do to lessen its prevalence.

Why Is It So Prevalent?

By prevalent, I am referring to the rates of self-harm in the LGBTQIA+ population compared to the heterosexual/cisgender population. One study in 2019 found that up to 53% of LGB people engaged in self-injury behaviors. In non-LGB+ people, it was up to 20%.

The reason for this inequality is the same as the reason for the general mental health inequalities that LGBTQIA+ individuals face. Stigma, discrimination, and misinformation can cause extreme psychological stress. This stress can manifest into severe mental health disorders such as PTSD, depression, eating disorders, and anxiety.

Self-harm does not typically stand on its own. It is normally a symptom of an untreated (or poorly treated) mental illness. It’s similar to how a fever is not a disease, but rather a symptom of infection. So, it makes sense that if mental illness is more often seen in LGBTQIA+ people than non-LGBTQIA+ people, the same can be said for self-harm.

This logic carries over into the increased rates of suicide in the community. You can learn more about the topic of LGBTQIA+ suicide and how to prevent it here. Now we know why it’s a greater issue for LGBTQ+ people than others. But why does anyone self-harm in the first place? The reason varies by person, but the core of the problem can almost always be traced back to one or more of the following:

• The need for control.

• The inability to manage or express one’s emotions healthily.

• The need to ground yourself.

• The desire to influence other people.

I want to focus on that last part for a second. The desire to influence other people can be interpreted to mean attention-seeking. There is a stigma that people who self-harm are attention seekers and that nothing is truly wrong with them. In reality, it is not the attention itself that drives people to self-harm; it is the product of the attention, which often comes in the form of assistance. If the person’s goal was to cry for help, they achieve it by getting your attention. If their goal was for society to notice them instead of shunning them, your attention achieves that.

If you want someone to notice you, be outspoken and upfront. I know these solutions can seem scary to those who struggle with self-preservation or communication skills, but a moment of discomfort to ask for help is better than the lifetime of discomfort that self-harm brings. Speaking of overcoming self-harm, let’s dive into what we can do to lessen its prevalence.

Preventatives

Different approaches work differently for each individual. That is why it can be hard to lump the LGBTQIA+ community together and form a catch-all solution. As such, the solutions, preventatives, and alternatives should be as broad as the community itself.

In this sense, broad does not mean vague: it means expansive and inclusive. Some measures we can take that fit this description are offering individualized LGBTQIA+ mental health care at more practices, hospitals, and community centers.

Many organizations offer LGBTQ+ mental health services, but they tend to be concentrated in progressive cities such as Tampa, LA, and San Francisco. Even if you’re in a city, some states do not have any LGBTQIA+ care centers. A 2017 UCLA study published in the Public Library of Science (PLOS) found that eleven states, not including Hawaii or Alaska, had no qualifying LGBT community health centers.

NOTE: The states that have LGBT community health centers offering transgender services are in red. The ones that do not are in white and the states without sufficient data are in grey.

By including these services in all states and practices, we can decrease the rates of self-harm and mental illness for LGBTQIA+ people all over the United States. Mental health providers can also take extra care to watch for signs of self-harm in their LGBTQIA+ patients.

Screening tools and inclusive forms can give providers insight into what a patient might be at a greater risk for. If all practices used inclusive forms, providers could better help their patients, patients can feel accepted at the practice, and organizations can use the data to create better treatments.

For those outside the medical field, such as parents and friends of LGBTQIA+ people, you can be aware of the signs and how to get your loved one help. Our resource page has a diverse set of education and treatment information. We encourage you to familiarize yourself with this topic to help prevent or recognize self-harm behaviors.

Use the survey below to discover your knowledge of self-harm red flags.

Advocacy is another huge preventative for self-harm. Advocacy leads to public awareness and direct action. It also shows those who are struggling that people care and will fight for them, which can improve their outlook on life.

You can get involved in this solution by telling your story, volunteering at LGBTQ+ mental health organizations, and supporting legislation to end mental health inequality.

Do you know any measures to prevent self-harm and lessen its prevalence? Drop your suggestions or resources in the comments!

Sources:

https://www.thetrevorproject.org/resources/article/support-for-self-harm-recovery/

https://www.webmd.com/parenting/news/20190603/lesbian-gay-youth-at-higher-risk-for-self-harm

https://www.valleybehavioral.com/disorders/self-harm/signs-symptoms-causes/

Figure 1: Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape, Martos AJ, Wilson PA, Meyer IH (2017) Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape. PLOS ONE 12(7): e0180544. https://doi.org/10.1371/journal.pone.0180544

Figure 2: Richard Liu, Ph.D., assistant professor, department of psychiatry and human behavior, Alpert Medical School of Brown University, Bradley Hospital, East Providence, R.I.; Bridget Hughes, senior director, youth services, Hetrick-Martin Institute, New York City; June 3, 2019, JAMA Pediatrics, online