Homosexuality was removed from the Diagnostic and Statistical Manual, the Bible for mental health diagnoses, in 1973. Some of the harms of anti-LGBTQ discrimination remain. Recently, advocates reflected on how to better treat and represent the LGBTQ community.

Dan Leonard was struggling in the spring of 1966.

He had recently come out as gay, and he was in the midst of a difficult academic program at the University of North Carolina at Chapel Hill School of Medicine. Eventually, he was dismissed from the medical school.

The sting of the dismissal was only heightened by an exit interview he had with the school psychiatrist a precaution the university took after a student died by suicide one year previously.

In the process of our conversation, he told me in no uncertain terms that homosexuals cannot be doctors, Leonard said.

Fast forward to today, LGBTQ Pride Month, an annual celebration that dates back to the early 70s, has become commercialized by big businesses sporting rainbow flags and popular retailers selling Pride merchandise. Nonetheless members of the LGBTQ community still continue to struggle against discrimination, the vestiges of which still remain in institutions, such as mental health fields.

The American Psychiatric Association (APA) only removed homosexuality from the Diagnostic and Statistical Manual (DSM) in 1973.

This is just one example of a historic trauma put on the community, said Trey Roberts, the manager of community engagement at the Dorothea Dix Park Conservancy and co-founder of Raleigh Pride, at a showing of the documentary CURED the conservancy hosted with the National Alliance on Mental Illness (NAMI) North Carolina and NAMI Wake County.

The documentary, aired at the newly restored Chapel at Dorothea Dix Park last week, followed the journey of the LGBTQ activists and psychologists who fought to change the DSMs classification of homosexuality as a mental illness in the late 1960s and early 1970s.

Before that time, members of the LGBTQ community were subject to different forms of conversion therapy meant to change their sexual orientation or gender identity. Those purported therapies at times included genital shock therapy and even lobotomies to treat what was previously considered an illness.

The Dorothea Dix Park Conservancy does not know whether those practices also occurred at the late Dorothea Dix Hospital, Roberts said, since it does not have enough resources.

Were a small staff and we have a group of volunteers who are determined to collect as much as they can, Roberts said. We are very interested in finding more resources to do this work because this kind of history wasnt that long ago.

Even after homosexuality was removed from the DSM, it was replaced by a new category: Sexual Orientation Disturbance, in which homosexuality was considered an illness if a person who was homosexual wanted to change. This allowed certain doctors to continue practices such as conversion therapy.

The classification was then changed to Ego Dystonic Homosexuality and finally removed altogether from the DSM in 1987.

Despite the APAs previous statements that homosexuality is not a mental disorder that should or needs to be changed, the University of California at Los Angeles Williams Institute found that 698,000 LGBTQ adults in the U.S. have received conversion therapy. Furthermore, the study found that 16,000 LGBTQ youth will receive conversation therapy annually in the 32 states where it is still permitted.

North Carolina is one of those states, despite a 2019 poll that found that 80 percent of respondents in the state said the practice should be banned for kids under the age of 18.

LGBTQ youth whose parents attempted to change their sexual orientation attempted suicide at more than twice the rate of youth whose parents did not, according to a 2018 study by The Family Acceptance Project.

Gov. Roy Cooper banned the use of state funding for conversion therapy for minors in 2019, making North Carolina the first Southern state to do so. There are 20 states that ban the practice for minors, according to the Human Rights Campaign.

Coopers executive order was not an outright ban on the practice, but Kody Kinsley, chief deputy secretary for health at the North Carolina Department of Health and Human Services, said it was a good first step to ending the practice, which he called quack science at a panel following the documentary.

Weve instituted that ban around the state dollars that we have in our Medicaid program, our state-funding program, Kinsley said, which its important to remember is one of the primary sources of behavioral health services in North Carolina.

Over a million people dont have health insurance in North Carolina, which means that most folks are reliant on state-funded services.

After his ignominious departure from medical school, Leonard later became a research technician at the medical school and eventually, a nurse. He was often the first or perhaps only openly gay person the people he worked with knew. But Leonard persevered with the help of his guardian angel professor William Huffines.

My first research job in the med school just happened to be in the lab next to his lab, Leonard said. And all the people in that end of the hall had been told that a gay man was coming there to work, and they were to be nice to me.

Leonard never imagined a future where gay marriage would be legal, a topic he says now is almost passe, but that doesnt mean that members of the LGBTQ community do not still face discrimination.

Weve come far from where we were before, Roberts said, but theres still a lot more work that needs to be done Theres still a lot of things we dont talk about and need to address. Such as body image and pronouns and sexuality, identity.

Mental health professionals also need to learn how to treat members of the LGBTQ community, since many LGBTQ may not feel comfortable with certain therapists, Roberts said at the panel.

I know for myself, like coming out was like second adolescence, Roberts said, You went through so much of your life as this one person or pretending to be this one person that when youre finally able to be yourself its almost like you have to really learn a lot of things relearning and loving yourself and loving someone else and finding yourself.

Transgender people, and especially transgender women of color, still face discrimination, or worse, such as increased rates of violence. Roberts said it is harder for those people to find stable employment and thus health care because of the discrimination they face.

At least 29 transgender or gender non-conforming people have been killed in the U.S. in 2021, according to the Human Rights Campaign.

Dana Cea, an online therapist from Wilson, North Carolina, who identifies as queer, said the field must learn to be culturally humble, learning more from the client perspective instead of assuming that were the expert and we know everything, at the panel.

I think we have strived from fixing the wrongs that have happened into competence and thats really not enough, Cea said, because no one can be 100 percent competent at anything.Its really being able to take a step back and be humble and say, I dont know everything.

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Reflecting on LGBTQ mental health discrimination in NC - North Carolina Health News