Mental Health

June is a time for celebrating the diversity of Canada’s 2SLGBTQ+ communities. But it’s also a time to reflect on how we can nurture and support that diversity every day of the year.

The 2SLGBTQ+ community is disproportionately affected by mental health and addiction issues, and it prevents many of its members from living their best lives and reaching their full potential. For families, friends, and caregivers alike, changing the way we think about 2SLGBTQ mental health and addiction treatment and recovery can transform the outcomes.

Progress and challenges

There is much to celebrate during this year’s Pride Month. As of 2023, Canada is home to one million individuals who identify as 2SLGBTQ+, which represents 4% of the total population aged 15 and older. Three-quarters of Canadians support same-sex marriage, and 61% say they support LGBT people being open about their sexual orientation and gender identity with everyone. Just last year, the federal government unveiled a five-year, $100 million plan to support 2SLGBTQ+ communities across the country.

Yet in some ways, 2SLGBTQ+ visibility and acceptance have never felt more fragile as there is often backlash. Between 2019 and 2021, hate crimes based on sexual orientation rose nearly 60% to reach their highest level in five years.

More than ever, we need to make an effort to understand, celebrate, and make room for queer lives and identities, and that’s especially true when it comes to supporting 2SLGBTQ+ mental health and addiction treatment.

 The cost of being queer

In a perfect world, people of all genders and sexual orientations would be given equal opportunities to thrive. But the reality is that 2SLGBTQ+ Canadians still face multiple barriers to health, wealth, and wellbeing.

Many 2SLGBTQ+ Canadians live with the trauma caused by secrecy, stigma, discrimination, and fear. In addition to being the target of hate crimes, they are also more likely to experience financial distress, homelessness, and housing insecurity than heterosexual Canadians. Canadians who are 2SLGBTQ+ also have fewer job opportunities and earn significantly less than straight, male counterparts and experience frequent microaggressions at work. A lack of access to medical care, suboptimal healthcare experiences, and poorer health outcomes also diminish quality of life for queer people.

A mental health crisis

In the face of so many challenges, it’s unsurprising that the queer community sees a higher proportion of mental health and addiction issues.

Courtney Sullivan, Addiction and Mental Health Therapist and Support Coordinator at Homewood Health Centre, which is located in Guelph, Ontario and one of the largest mental health and addiction facilities in Canada, provides both outpatient and inpatient treatment for addiction and mental health. They work with clients who identify as queer, including individuals who may be experiencing homelessness, job loss, trauma, addiction, and a range of mental health issues.

“There is a lot of stigma towards the queer community,” they explained. “A lot of people have their families disown them or kick them out or withhold family support. A lot of queer youth, in particular, end up in the shelter system, which exposes them to trauma and substance use, and their mental health can get a lot more complex.”

Research shows that 2SLGBTQIA+ Canadians are seven times more likely to abuse drugs or other substances and five times more likely to have mental health issues. Sexual-minority Canadians are also approximately 25% more likely to contemplate suicide (40% vs. 15% for the general population) or have a mood or anxiety disorder (41% vs. 16%).

Treatment challenges

Not only do 2SLGBTQ+ have a higher likelihood of developing mental health issues and addictions, but their treatment journey is complicated by systemic ignorance and discrimination in the healthcare system.

According to a 2019 survey, 59% of nonbinary people were misgendered daily and only 47% felt comfortable discussing non-binary health concerns with their primary care provider. One in three said their primary healthcare provider had no knowledge about trans/non-binary health needs, and one in four did not have access to in-person spaces specific for non-binary people.

“There’s a large amount of queer people who don’t actually disclose their queerness to their health care providers,” said Sullivan. “The medical system doesn’t have the greatest history,” they continued, pointing out that as recently as the 1970s, homosexuality was classified as a mental disorder.

“People who do disclose to their doctors are often put in a position where they have to educate them about how healthcare should be delivered, which puts a huge burden on the queer community.”

It’s even more complicated for people with an intersectional identity that combines queerness with another identity that puts them at a systemic disadvantage, such as being a person of colour or an Indigenous person.

“Recovery programs and agencies and organizations really need to show their support to the queer community and signal that they are seen, that their experiences are respected, and that the facility is open to work with you,” Sullivan said.

While Sullivan advocates for big changes in the healthcare system, including hiring for diversity and developing organization-wide policies that reflect diverse perspectives, they also believe that small things can make a big difference. As an example, they described a recent situation when they brought a suicidal trans client who didn’t feel healthy at home to the hospital. Asking for help took tremendous courage, but the client was deadnamed three times in a row during the intake process, which almost made them reject treatment. (Deadnaming occurs when someone calls a transgender or non-binary person by the name they used before they transitioned. While deadnaming may be unintentional, it can feel stressful and traumatic because it questions or invalidates a person’s gender identity.)

“The hospital is supposed to be a healthy space, and most healthcare workers are well-intentioned, but systemic homophobia and racism can come out through the policies and the way things work,” they said. “Something as simple as restructuring medical charts so that gender information and preferred pronouns are easily available at a glance can change the experience. Or have care providers identify their pronouns, which is kind of like offering an invitation for that person to give you theirs too.”

Supporting 2SLGBTQ+ mental health

If you are a friend, partner, or family member of a 2SLGBTQ+ person exploring treatment options or actively in treatment or recovery, you can play an integral role in supporting their mental health and resilience.

For Sullivan, these communication tips can help to ensure they feel heard, seen, and supported throughout the journey.

Let them lead. “Your loved one might have a substance use issue, but if they’re not ready to hear it, don’t force it on them,” said Sullivan. “When people get scared, they make threats, like, ‘You need to get sober or else!’ But that ruins the opportunity and the trust.” Instead, let that person decide what they need and set the pace for treatment and recovery.

Keep an open mind. “Come at things with empathy and compassion. Listen to that person. Try to understand why they’re making the choices that they do.” Sullivan pointed out that for some members of the 2SLGBTQ+ community, the use of stimulants is an important part of their lifestyle and sexuality. “It all comes back down to the impact that the person’s substance use has on their life, and what that person identifies as being problematic.”

Respect their experience. “The trauma and the experiences that queer people have are different,” Sullivan explained. “Even if you’re cisgender and you get kicked out of your home, it’s still a different experience than someone being kicked out of their house because of who they are.” Respecting those differences can go a long way toward creating a space for authenticity and healing. 

Pride in mental health

Pride Month is a time to celebrate the queer community and bring attention to the challenges it continues to face. The elevated risk of mental health and addiction issues is an important part of the story, and one that Homewood Health Centre and other mental health and addiction facilities in Canada are highlighting this year. We all have a role to play in supporting and protecting the mental health of 2SLGBTQ+ individuals, and that role goes beyond raising the rainbow flag.

“We’re having a flag-raising ceremony in honour of Pride here at Homewood, but that’s just the first step,” said Sullivan. “It’s about creating intersectional representation. You want people of colour working in your organization, you want Indigenous perspectives, you want queer perspectives. Be willing to hear the experiences of the people you employ and the people you support. Find out what it is that they’re looking for.”

Learn more about LGBTQ+ mental health.

Learn how to support children who identify as LGBTQ2+.

“While most of us have experienced some pain and anguish in our family, that family system can be a source of strength in healing from that pain.”
Dr. Julie Burbidge
Clinical Director, Homewood Ravensview

The negative impacts of addiction on families is well known. Less well known is the positive impact families can have on the addiction recovery journey. Parents, grandparents, spouses, siblings, and even children can play a powerful role in supporting a family member in addiction recovery and beyond.

In this blog post, we look at the difference families can make in the recovery journey and what they can do to support their loved ones as they transition from an inpatient treatment program to daily life.

Family support has a measurable impact

Supportive family dynamics can have a transformative impact. Family support can uplift every aspect of an individual’s life, from emotional wellbeing to physical health to academic and career success.

Even for an issue as complex and uncompromising as addiction, family support can make a measurable difference.

• A study of nearly 1,200 women who underwent inpatient treatment for substance abuse found that those with supportive families were less likely to relapse within six months of their discharge.
• A study of adolescents undergoing substance use treatment found that those who perceived their parents to be highly supportive had better outcomes than those who did not.
• A meta-analysis of 16 research studies found addiction treatments that involve family are associated with a 6% reduction in substance use compared to individual therapies.
• 65% of Canadians in treatment for an addiction said marital, family, or other relationships were the most important factor in initiating recovery.

Supporting a family member on the path to sobriety is no easy task, but the research is clear: family support can make a big difference.

“Positive attitudes and reinforcement from family members can inspire clients’ commitment to recovery,” explained Dr. Julie Burbidge, the Clinical Director at Homewood Ravensview, a private inpatient facility for mental health and addiction recovery in British Columbia. “It can also help them adapt to new challenges or limitations as they reintegrate with the wider world after spending time in treatment.​”

Discharge is not the destination

When an individual completes a treatment program, it’s a major milestone and a cause for celebration, but it’s not the end of the road.

After the individual is discharged, the journey continues as they learn to resume their daily lives while remaining sober. The transition can be overwhelming, and it’s a time when family support in addiction recovery may be most needed.

While this transitional period is critical, it can be overlooked and under-resourced, which is why Homewood Clinics developed a series of post-discharge supports for patients and their families. Individuals who complete treatment are invited to participate in 12-month virtual support groups that meet weekly to focus on recovery management. For their families, an optional virtual meeting with a clinician is held each month at Homewood Ravensview. The facility is also launching a self-serve video hub where over 70 minutes of educational content covers a range of topics including talking to children about treatment, setting healthy boundaries, and understanding the stages of change in the journey to recovery. This will replace the virtual monthly meetings, and is meant to allow for more flexibility on when and how families receive these resources.

“Transitions are difficult because they involve uncertainty,” said Dr. Burbidge. “The more time and effort you put into planning for and discussing the transition plan, the more effective it will be.”

How to show your support

Supporting the recovery of an individual with an addiction isn’t easy, even for experts with years of specialized experience and training. For family members who don’t have that advantage, it’s even more intimidating.

Emotional dimensions can create further challenges. Even in families unaffected by addiction, relationships can be complicated. When addiction and mental health issues are added to the mix, the dynamics can be even more volatile.

“Being prepared for the transition home of a family member involves understanding your role in the recovery process,” said Dr. Burbidge. “It also means accepting that family life after treatment will be different and making a commitment to rebuilding relationships.” ​

Educating yourself ahead of time can help you prepare to provide family support in addiction recovery. Here are three of the most beneficial strategies for showing up in meaningful and constructive ways.

Understand the dynamics of change

People who undergo treatment for addiction are asked to change in profound ways, and that cycle of change doesn’t stop when they are discharged.

“Sometimes family members have the misperception that their loved one will be ‘fixed’ or ‘healed’ when they leave treatment,” Dr. Burbidge explained. “Treatment is an important step in a person’s healing and recovery, but the process continues long after their discharge.”

Understanding the stages of change can help family members recognize, accept, and meet people where they are in the journey.

The most important thing to understand about the path to change is that it isn’t tidy and linear. Just as a person with diabetes or asthma can relapse after being released from treatment, a person in addiction recovery may experience a relapse as they work toward sustained change. A relapse shouldn’t be seen as a failure but as one stage among many in the recovery process.

Stages of Change

As people pursue their recovery, they cycle through various stages that can involve new thoughts, attitudes, and behaviours. Every journey is different, and few journeys are perfectly linear. This diagram represents the change model used by Homewood Ravensview, a private inpatient facility for mental health and addiction recovery in British Columbia.

There are several ways you can help to prevent or mitigate the impact of a relapse:

• Talk to the person in recovery about relapse so they know you understand it’s something that might happen.
• Let them know that you are there to support them and ask if they would like you to play a role in their relapse prevention plan​.
• Pay attention to your own behaviours. Families can sometimes fall back into old, destructive patterns.

Learn to communicate effectively

Effective communication is the key to healthy interpersonal relationships, but it’s easy to slide into defensiveness and blame during times of stress and anxiety.

Dr. Burbidge advises family members to try using a form of assertive communication called “‘I’ statements” to create a connection with the person they’re speaking to and avoid slipping into harmful communication patterns that rely on accusing, blaming, and shaming. ‘I’ statements focus on your own experience and how you feel about it ​rather than focusing on what you think the other person is doing wrong.

“This gives us a way to express our feelings in a manner that is respectful and increases the likelihood that the other person will be open to hearing what we have to say​,” said Dr. Burbidge.

You can express yourself with ‘I’ statements using a simple formula: “I feel [describe your feeling] when you [describe the person’s actions] because [describe the reason it makes you feel a certain way].

Here’s an example:

Set and respect boundaries

​During treatment for addiction, people learn how to create boundaries as a way of staying on the path toward healing. As the family member of a person in recovery, you can support them by recognizing and respecting those boundaries. Setting boundaries of your own can also be very helpful in allowing you to preserve your energies and self-respect as you explore new ways of relating to that person.

“Boundaries are a way to establish where you end and other people or external influences begin,” explained Dr. Burbidge. “They are a way of setting healthy limits around what we will and won’t accept or do in our relationships with others.”​

To set a healthy boundary with someone:​

• Describe the boundary you are setting or the action that is causing you discomfort.
• Express how the situation makes you feel using ‘I’ statements.
• Describe the behavioural change you are looking for in the future​.
• Without making threats, describe the action you will take if your boundary is crossed.

​Here is an example:

​“I feel angry when you interrupt me because It’s important to me that I’m able to share my ideas with you and feel heard by you. Moving forward, I would like it if we could each take turns speaking. This will help us better understand each other and hopefully feel more connected. The next time you interrupt me, I will leave the room and we can continue the conversation later.”

Take the next step together

An individual who has completed an inpatient addiction treatment program has done some hard and courageous work toward furthering their recovery. Re-entering their normal lives post-treatment is the next big step in their journey. By understanding the stages of that journey and learning new ways of communicating and interacting along the way, families can make a positive difference in the individual’s recovery experience and outcomes.

“To truly understand the individual, we have to understand the family system of that individual,” Dr. Burbidge said. “While most of us have experienced some pain and anguish in our family, that family system can be a source of strength in healing from that pain.”

For more insight into supporting a family member in addiction recovery, read these articles from Homewood Ravensview, an addiction treatment program in British Columbia, Canada.

Understanding Family Dynamics: What healthy family traits look like, and how to identify toxic family dynamics.

Supporting Those with Addiction: How to support family members who haven’t reached out for help yet.

1. Empathize, don’t criticize. Every time you point a finger, you could be pushing your loved one farther away. Ask questions and listen.There is great power in a supportive loved one communicating with empathy and without judgement.

2. Be firm but fair. Specify some ground rules. Make it clear to them that you will not support their addictive behaviour, and try to set healthy boundaries. With these boundaries in place, they may just be motivated enough to start thinking about quitting.

3. Tell them how you feel. Sometimes, a person living with addiction may not realize how their behaviour has affected you and others in their life. Don’t be afraid to share your feelings with them; doing so could show a significant level of care and support.

4. Use “I” statements. As you express your emotions to your loved one, make sure not to point fingers or fault toward them. They already suffer from their own guilt and shame, so you may risk them shutting down completely. Rather than passing blame and telling them what they did, turn it back around to you. Making statements using “I feel” instead of “you” can help promote healthy communication.

5. Address their fears. A huge factor in resisting treatment is fear of the unknown. Hop onto our site and educate yourself. Knowledge is power when it’s time to have that conversation.