New Medical Center Initiative Addresses Health Care Concerns of LGBT Community

Gay rights activists have notched significant victories as well as some high-profile defeats in the struggle for equality. Yet as young people come out at an earlier age and same-sex couples start families, health care professionals sometimes find themselves uncertain how to provide the best care for lesbian, gay, bisexual and transgender (LGBT) patients.

A new initiative at Columbia University Medical Center is focused on improving physical and mental health care for gay, lesbian, bisexual and especially transgender individuals. The project, a collaboration among Columbia’s School of Nursing, the Department of Psychiatry and the New York State Psychiatric Institute, will involve research, education, clinical care, and advocating for changes in public policy.

Clinicians, residents and medical students are asking how to treat LGBT patients sensitively and better provide the care they need, says Anke A. Ehrhardt, professor of medical psychology, director of the initiative and director of the division of gender, sexuality, and health in the Medical Center’s Psychiatry Department and the Psychiatric Institute. They want to know specific questions to ask when a patient discloses his or her sexual orientation, for example, or how to deal with a young person who is coming out. Indeed, applicants to Columbia University Medical Center’s residency programs frequently express interest in LGBT health.

“The need is just tremendous,” says Walter O. Bockting, the initiative’s codirector and professor of medical psychology at the College of Physicians and Surgeons and the Nursing School, came to Columbia last fall from the University of Minnesota. “Research and training in evidence-based, culturally competent health care has lagged behind increased public awareness and acceptance,” he says.

Bockting, a clinical psychologist and sexuality researcher, recently served on a prestigious Institute of Medicine committee charged with reviewing the current state of LGBT health. He points to a host of physical and mental health care issues that the LGBT community faces, including higher rates of depression and suicide, and in the case of lesbians specifically, low numbers of women who seek preventive care. “We need to know why and what can be done,” he says.

Researchers involved in the initiative will serve as consultants and liaisons to other parts of CUMC. That includes encouraging more LGBT-related content in the medical school curriculum and residency training, working with student health services to improve the climate for LGBT students, and providing referral sources for physicians, psychologists and other clinicians.

Ehrhardt says she hopes the initiative will attract funding for more senior-level researchers, post-doctoral fellowships and eventually, a comprehensive, multidisciplinary center.

The first research project—a study of lesbian and gay parenting—got underway this spring as part of a collaboration between Ehrhardt and Susan Golombok of the University of Cambridge. With a grant from the Wellcome Foundation, researchers will follow 150 families with children between 3 and 8 years old—50 with lesbian mothers, 50 with gay fathers and 50 with heterosexual parents—to study gender development in the children and other mental health issues. A study of transgender families will be next.

Bockting, whose research has focused on transgender health, has submitted a grant proposal to the National Institutes of Health to study the coming out process for transgender youth. By following a group of young people over time, researchers hope to see what helps them deal with the stigma of coming out and develop programs to build on those findings.

Columbia has been a pioneer in LGBT health research since Ehrhardt founded the HIV Center for Clinical and Behavioral Studies in 1987, at the height of the AIDS epidemic. A longtime research partner has been the Hetrick-Martin Institute, a New York-based social services agency that works with LGBT youth, which is working with Bockting to develop the NIH study.

“It is of historic importance that the resources of a major academic department, in collaboration with a distinguished school of nursing, will be devoted specifically to translating advanced research on LGBT health into state-of the-art clinical care, teaching and training of health professionals and public policy analysis and formulation,” says Jeffrey Lieberman, chair of Psychiatry and director of the Psychiatric Institute.

“We see a real shift in society,” says Ehrhardt. “It is important to take advantage of these moments to increase knowledge, sensitivity and progress.”