Healthy Life, Healthy Body, Healthy Mind: Social Determinants of Health in LGBTQ+ Newcomers

Research points service providers toward concrete actions that can make a real difference. While some LGBTQ+ newcomers may also benefit from professional mental health treatment, you can always make a difference with strategies that address these social determinants, building community, stability, and agency. The following approaches, organized by key areas of support, can be adapted based on each person’s changing needs and priorities.  

Opportunities for community acceptance, involvement, contribution, and support:  

• Help LGBTQ+ newcomers feel a sense of belonging, and share mutual support with others, by demonstrating your own acceptance, introducing them to LGBTQ+ community organizations and support groups, and organizing social gatherings. Note that not all LGBTQ+ community organizations (see: the CenterLink directory) will offer services that are culturally or linguistically competent, or will understand migration; you can help them increase those capacities. 

Stability and safety: 

• Remain attentive to discrimination, and help clients understand and access support. Ensure that clients feel comfortable discussing instances of discrimination, which they may experience on the street, in their jobs, at home, or in service settings. Help them understand the legal protections available, which vary by location. In some cases, your help may be limited to problem-solving conversations. Other situations may call for mediation or the involvement of a lawyer or the police. 

• Make sure their legal and immigration needs are addressed. LGBTQ+ newcomers have distinctive needs related to confidentiality, health information, identity documentation, and family relationships. In addition, they may fall into immigration categories that expose them to risk (e.g., asylum seeker, undocumented), particularly if they lack legal information and representation. (See: Safeguarding Identity and Addressing the Legal Needs of LGBTQ+ Newcomers.) 

Access to necessary services: 

• In some cases (e.g., health care) LGBTQ+ newcomers may need practitioners with special skills. In other contexts, they may feel unsafe or unwelcome. Provide specialized services and referrals as needed—for example, by referring to the InReach directory. Provide staff, volunteers, and partners with training to ensure their professional behavior. Provide all clients with information about diversity in the U.S. and make alternative service arrangements if necessary. 

Self-determination: 

• Use individuals’ chosen vocabulary for self-identification. Make it a standard practice to ask clients for their name and pronouns in case these differ from their biodata or case files, and model this by sharing your own name and pronouns. In the case where a “deadname” (a formerly used name) or incorrect pronouns must be used for documentation or service access, communicate to the client when and why. 

• Enable clients to present themselves in ways that they choose, depending on context. “Coming out”—or being open about one’s sexual orientation or gender identity—can be empowering when freely chosen, but retraumatizing or dangerous when coerced.  This is also true of storytelling. Clients may want only certain people to know their personal information like pronouns, relationship status, or migration history. It is important to confirm this understanding with them, and to strictly respect their confidentiality. They may prefer to use certain names and pronouns in private, and others in public. 

Existential grounding: 

• Provide information about religious and spiritual options. Some LGBTQ+ newcomers have learned from experience to be suspicious of religion. Others are deeply invested in their religious communities. Inform clients about religious institutions that welcome LGBTQ+ people and encourage them to seek them out if they are interested. 

• Promote feelings of hope and purpose. LGBTQ+ newcomers often have a great deal of hope for the future, as shown by their determination to reach safety. The challenges they inevitably experience may lead to disillusionment; you can counter this by reminding them of the strength they have already proven, as well as by providing them with information about the opportunities that are available to them in their new country.