Mental Health Challenges of LGBT Forced Migrants

Article excerpt

Many LGBT forced migrants have significant and sometimes incapacitating psychological scars. Mental health providers can assist in documenting the psychological impact of antiLGBT persecution and its impact on the ability to secure refugee status.

Lesbian, gay, bisexual and transgender (LGBT) forced migrants around the world report a history of multiple traumatic events across their lifespan. The range of events includes verbal, emotional, physical and sexual abuse and assault, harassment, shunning, spitting, discrimination in housing and employment, destruction of property, blackmail, forced prostitution, forced heterosexual marriage, 'corrective rape'1 and coerced sexual orientation conversion interventions. Those who from a young age are perceived by others as behaving in gender non-conforming ways are targeted starting in childhood.2

LGBT persons who are victims of sexual orientation and gender identity (SOGI)based violence seldom find comfort in their families, either because they are not 'ouf to their families or because their families join in their persecution. LGBT forced migrants are distinct from other persecuted groups in that their families of origin often contribute to the abuse. Many LGBT forced migrants report emotional, verbal, physical and sexual violence at the hands of their family. A Peruvian woman who was non-gender conforming was, from an early age, emotionally and physically abused by her family; she was not allowed to eat with the rest of the family and, unlike her siblings, was not given a bed to sleep in. A Colombian woman reported feeling sad, angry and isolated when, after an anti-LGBT assault by the police, she could not go to her family for help and emotional support as that would have necessitated coming out to her family.

Psychological consequences

Many suffer from significant mental health consequences as a result of a lifetime of cumulative trauma. Common diagnoses are recurrent depression, dissociative disorders, panic disorder, generalised anxiety disorder, social anxiety, traumatic brain injury and substance abuse. LGBT forced migrants may also suffer from two types of Post-Traumatic Stress Disorder: PTSD and complex PTSD. PTSD includes the symptom triad of re-experiencing traumatic events, numbing and avoidance of thinking about these events, and hyper-arousal. Those who have a history of cumulative trauma may suffer from the symptoms not only of PTSD but also of complex PTSD which include selfdestructive behaviour, amnesia, intense shame, difficulties with intimacy, experiencing bodily pains in response to psychological distress, and despair about finding loving relationships.

Adjudicators expect coherent, consistent and sequential accounts of persecution. But a person's survival of persecution sometimes necessitates amnesia and denial of the impact and severity of traumatic events. Memories of trauma may be stored as fragments - images, sounds, smells and physical sensations - rather than as a verbal narrative, and this poses challenges to recounting a history of persecution. Furthermore, repeated retelling of a history of persecution can be re-traumatising for the forced migrant and cause secondary trauma to advocates and adjudicators. When a mental health provider is available they can utilise techniques that may minimise the level of re-traumatisation.3

Assessing SOGI

In the absence of a safe environment, many LGBT individuals are not able to work through the internal processes necessary to allow them to integrate the multiple aspects of their sexuality. Instead, these processes may slow down or become 'frozen' until they reach the relative safety of a new host country. Because the coming-out process may only begin to unfreeze many years after arrival in the host country, some individuals may have difficulty convindng adjudicators that they are LGBT. To document the developmental changes that LGBT forced migrants may experience in their sexual orientation and gender identity before and after migration, it is helpful to shift expert testimony away from a focus on any one aspect of SOGI to documenting shifts over time in a broad range of SOGI features: sexual feelings; sexual fantasy; crushes and falling in love; romantic relationships; self-labelling; disclosure of self-labelling to LGBT persons; disclosure of self-labelling to heterosexual persons; forming relationships with other LGBT persons; and sexual behaviour. …