Re-Framing the Narrative: Exploring Vulnerability within 2S/LGBTQ+ Mental Health

Decades of research have made it extremely clear: 2S/LGBTQ+ communities experience marginalization and inequities due to intersecting forms of oppression, discrimination, stigma, and trauma. Numerous studies have reported 2S/LGBTQ+ communities have poor mental health with greater risks of suicide, mood disorders, and anxiety than heterosexual populations[1][2][3][4]. While certainly true, the ways in which 2S/LGBTQ+ communities are positioned in this literature (and in other areas) are oftentimes problematic.

There’s a tendency to simply label 2S/LGBTQ+ individuals as “vulnerable” and suggesting this vulnerability is the driver for us experiencing poorer mental health. While the linguistic shortcut may be a useful tactic to raise public concern, attract political interest, or attain funding, it can also create an uncritical lens on vulnerability and 2S/LGBTQ+ communities. Such a framing can often invite a deficit discourse, or language that emphasizes deficiencies rather than strengths of our communities[5][6]. For this blog entry, we explore the challenge of using deficit discourses within the 2S/LGBTQ+ mental health realm and encourage readers to re-frame narratives using strength-based discourses.

The Challenges of Vulnerability & a Deficit Discourse

Previous academic research has explored public health literature that used the term “vulnerable,” “vulnerable groups,” or “vulnerable populations” to better understand the context in how these terms are used and defined. Findings from Katz et al. highlighted these terms were often defined vaguely, or not at all. Vague associations to vulnerability with little context removes accountability and leaves readers to try and determine on their own who is vulnerable, why they are vulnerable, and to what they are vulnerable.

2S/LGBTQ+ communities, or any group for that matter, are not inherently vulnerable. When no context or definition is provided, the implication is that vulnerability is a built-in deficit internal to our communities. This leaves us to focus on downstream interventions rather than the systemic and structural causes of inequities and the roles we play in withholding them. The vagueness associated with using a deficit discourse has been argued to conceal the structural nature of inequities that 2S/LGBTQ+ communities experience[7].

In the case of 2S/LGBTQ+ mental health, a deficit framing presents challenges in our ability to fully interrogate and address the roles of heteronormativity, homophobia, genderism, and transphobia on our mental health. It places a greater focus on linear cause and effect of individual downstream factors such as stigma, substance use, and social stressors[8][9]. If the goal of our work is to improve the health and well-being of 2S/LGBTQ+ folks, we must actively address and dismantle structural and systemic barriers that produce inequities in our communities. As such, the language we use and the ways in which we frame ourselves become central to our ability to achieve these goals.

Actively Re-Framing the Narrative

There has been a paradigm shift away from deficit discourses towards strength-based discourses, which focus on community strengths rather than problems that need to be addressed[10]. Rather than viewing communities as the source of the problem, they suggest that communities are being impacted by a problem. It no longer makes vulnerability an inherent deficit but holds us accountable to holistically examine the structural, sociopolitical, and cultural factors that have an impact on our communities’ health and well-being[11].

As we continue to further explore and publicize 2S/LGBTQ+ mental health research, it is critical we consider the context of our experiences. From this point of view, we must ask ourselves what strengths and community assets can we leverage to improve our communities’ mental health? How can we incorporate community strengths in our framing of 2S/LGBTQ+ mental health issues? Does our framing of 2S/LGBTQ+ mental health issues further strengthen community strengths?

2S/LGBTQ+ mental health is complex and our response to addressing our mental health should take in these complexities. Rather than highlighting the disparities we face, the framing should focus on addressing the structural issues to contribute to our disparities. To support our thinking in how we re-frame the narrative, Dr. Lindsay McLaren and co-authors shared the following questions in their commentary for the Canadian Journal of Public Health: [12]

  1. How do we effectively situate our work within, or against, existing power structures and relations between those who are oppressed and the ostensible oppressors?
  2. How do we avoid perpetuating the status quo of a deficit-based mentality in public health?


Moving Forward

2S/LGBTQ+ mental health is largely influenced by poorly acknowledged structural and systemic upstream forces[13].  Recognizing the real-world pressures (attracting funding, gaining political interest, or public attention) and the challenges to shift away from the familiar deficit-based discourses, it is certainly appealing to continue using deficit-based discourses within the 2S/LGBTQ+ mental health sphere.

However, if we truly want to address 2S/LGBTQ+ mental health, we have a responsibility to begin shifting our framing rather than perpetuating discourses that conceal the structural and systemic nature of our poor mental health conditions.

Written by David Absalom

David Absalom is a public health professional committed to bridging the worlds of research, policy, social justice, and advocacy. He works across the health system to advance the health and well-being of GBT2Q and Black communities.

[1] King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC psychiatry, 8, 1-17.

[2] Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. American journal of public health, 106(5), e1-e12.

[3] Budge, S. L., Adelson, J. L., & Howard, K. A. (2013). Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. Journal of consulting and clinical psychology, 81(3), 545.

[4] Rutherford, L., Stark, A., Ablona, A., Klassen, B. J., Higgins, R., Jacobsen, H., ... & Lachowsky, N. J. (2021). Health and well-being of trans and non-binary participants in a community-based survey of gay, bisexual, and queer men, and non-binary and Two-Spirit people across Canada. PLoS One, 16(2), e0246525.

[5] Agergaard, S., & Lenneis, V. (2023). Rethinking the Vulnerability of Groups Targeted in Health-Promoting Sports and Physical Activity Programs. Social Sciences, 13(1), 6.

[6] Smylie, J., Lofters, A., Firestone, M., & O’Campo, P. (2011). Population-based data and community empowerment. In Rethinking social epidemiology: towards a science of change (pp. 67-92). Dordrecht: Springer Netherlands.

[7] Katz, A. S., Hardy, B. J., Firestone, M., Lofters, A., & Morton-Ninomiya, M. E. (2020). Vagueness, power and public health: use of ‘vulnerable ‘in public health literature. Critical Public Health, 30(5), 601-611.

[8] Rutter, H., Savona, N., Glonti, K., Bibby, J., Cummins, S., Finegood, D. T., ... & White, M. (2017). The need for a complex systems model of evidence for public health. The lancet, 390(10112), 2602-2604.

[9] Ibid

[10] Martin-Kerry, J., McLean, J., Hopkins, T., Morgan, A., Dunn, L., Walton, R., ... & Prady, S. L. (2023). Characterizing asset-based studies in public health: development of a framework. Health promotion international, 38(2), daad015.

[11] Ibrahim, N., Michail, M., & Callaghan, P. (2014). The strengths based approach as a service delivery model for severe mental illness: a meta-analysis of clinical trials. BMC psychiatry, 14, 1-12.

[12] McLaren, L., Masuda, J., Smylie, J., & Zarowsky, C. (2020). Unpacking vulnerability: towards language that advances understanding and resolution of social inequities in public health. Canadian Journal of Public Health= Revue Canadienne de Sante Publique, 111(1), 1.

[13] Mathias K, Bunkley N, Pillai P, Ae-Ngibise KA, Kpobi L, Taylor D, et al. (2024) Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa. PLOS Glob Public Health 4(3): e0002575.



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Re-Framing the Narrative: Exploring Vulnerability within 2S/LGBTQ+ Mental Health
Re-Framing the Narrative: Exploring Vulnerability within 2S/LGBTQ+ Mental Health
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