I was asked by a friend recently to give a lecture to students studying psychiatry about treating LGBTQ youth. I decided I wanted to make a list of “Do’s and Don’ts” as part of the presentation. I started asking my clients their experiences with healthcare providers: the good, the bad, and the ugly.

I took away a few things from these discussions. I did not have one client on my caseload who had not in some way experienced discrimination in the form of micro aggression from healthcare providers. I also did not have one client who was absolutely horrified by their experience. They all relayed to me stories very easily and with flat affects about these awful experiences. They only became somewhat upset about it when I reflected to them how terribly they had been treated in those moments. Overall they had a calm acceptance of how they had been treated and discriminated against.

All of these clients who had been shamed, questioned, and put down by healthcare providers who they were supposed to be able to trust, were under the age of twenty-two.

Some of these clients I knew for awhile. These small moments of discrimination had never been shared before I asked. Thank God I asked. Why hadn’t I asked before? I had asked all of them at some point about discrimination they faced. But I never specifically asked about that discrimination being within healthcare.

Micro-aggression is an amazing term. It captures the daily put-downs and small discriminatory acts that cause the break down of people’s souls.

In the “What not to say” list one of my clients said to tell people “Never ask if it’s a phase.”

It’s not a phase.

By the time a person comes out to a healthcare provider they know it’s not a phase. They’ve likely been tortured by thoughts and feelings for years and over time developed language of their own to name themselves as gay or lesbian or queer or transgender or whatever.

It has never crossed my mind to ask clients if this is a phase. Because even if their sexual attraction or gender identity changes and develops over time I would not demean their narrative down to a “phase”. It’s not the role of any healthcare provider to question a person’s self-definition in a demeaning manner.

Healthcare providers are in a unique position. We are a necessity for people because our human bodies are fragile so every one in the LGBTQ community will have at least one experience in their lifetime with some sort of provider. If an individual presents for mental health services they didn’t just decide to come in for services. They have been thinking and thinking and picking up to call and hanging up and canceling the intake, and rescheduling, so when they finally make it through the door to be asked if it’s a phase just made that entire struggle worthless. They walked through the door looking for a safe space and instead found more ignorance and intolerance.

Microaggression is defined as “a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority.” per Google Dictionary.

It’s calling your transgender son “her, she” or “daughter” for the thousandth time even though they’ve been out as a male for a year. It’s a question of the validity of your belief that you identify as gay or lesbian or bisexual. It’s an assumption that because you’re a gay male you have HIV or you’re a slut or you want to be my bestie and go to the mall with me. It’s the assumption that your lesbian daughter’s girlfriend made your daughter this way. It’s the displacement of blame for something that should not be seen as a problem in the first place. It’s outing your child to people they are not ready to be out to. It’s seeing headlines in the news every day of transgender people being murdered and reading the comments from people who feel this was an act of justice. It’s living next to neighbors who you’re not sure are LGBTQ friendly. It’s being on edge everywhere you go and in every interaction you have with every person in a 24 hour period.

It’s so many little things that happen daily in the lives of LGBTQ youths that scrape away their self worth that leads to the high rates of depression and the high suicide rate.

Suicide rate is such a pretty term for young people killing themselves.

This is a message to all my fellow healthcare providers in whatever capacity you interact with LGBTQ individuals do it with compassion and validation because kids are dying. Don’t let your own beliefs interfere with the implicit oath you take by working in healthcare that you will provide quality care to all individuals. All providers should be safe spaces for all minorities.

Don’t ask if it’s a phase. It’s not.

Don’t tell them their sexual orientation or gender identity isn’t important to the care you are providing. It is.

Do ask if they feel depressed. Do ask if they have thoughts about dying.

Don’t screw up the potentially one and only contact with healthcare a person has before they die because of ignorance and hate.