Sydney Duncan, 44, an attorney in Alabama, has been so focused on managing the increased legal needs of her clients that she rarely has time to address her own mental health needs, including her anxiety.
Since the start of the coronavirus pandemic, Duncan has devoted nearly her whole waking day to her work at Birmingham AIDS Outreach, an Alabama nonprofit. Helping her transgender clients obtain vital name changes has become a prolonged process due to court backlogs piling up, helping them acquire driver's licenses has become harder while Social Security offices are closed, and increased unemployment among the community she serves has complicated a variety of services her nonprofit provides.
“We're so busy trying to resolve other people's issues — which objectively are more pressing than anything I have going on in my life — that it's hard to slow down and feel the weight of the problems in your own life,” Duncan said.
Duncan, who is transgender, is among many LGBTQ Americans grappling with the added strain of the coronavirus crisis as they continue to adjust to a “new normal.” Meanwhile, the United States is poised to deal with a third spike in Covid-19 cases and hospitalizations, nine months into the pandemic.
Prior to the global crisis, lesbian, gay, bisexual, transgender and queer Americans were already at greater risk of mental health problems, according to the Centers for Disease Control and Prevention. This elevated risk — due to a host of factors, including stigma and discrimination — combined with a global health crisis that has upended life as we once knew it, is presenting unique challenges for LGBTQ people.
“The physical distancing, economic strain and housing instability caused by Covid-19 have the potential to exacerbate these barriers among LGBTQ young people,” Dr. Amy Green, vice president of research at The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization, told NBC News.
‘Barely making it by’
Duncan had hoped to begin the year by supplementing her nonprofit salary by working as a comic-book writer. She made her debut with Dark Horse Comics at the end of last year but said her family is now “barely making it by” as opportunities have dried up.
“I feel like I'm better off than most, so don't want to take someone else's place if they need it more,” said Duncan, who added that she has been having “more sleepless nights” amid the pandemic. However, “opportunities seem fewer,” she added, which has affected more than just her finances.
"I've buried myself in working constantly to not pay attention to anything, but at some point it's going to crash, and I don’t know what I'll do then."
“To make it to a level and have it erode from beneath you — the loss feels more profound,” she said. “Second chances for someone like me feel further away.”
Many LGBTQ people work in industries that have been disproportionately affected by Covid-19, according to research by the Human Rights Campaign. These industries include jobs that have been contracted due to the pandemic, as well as other industries that have put workers at direct risk of exposure to the virus.
The report found that in addition to being at risk for precarious employment conditions, LGBTQ people were less likely to have health insurance, putting them further at risk from Covid-19.
On the other side of the coin, as many work remotely, the lines between work and home life have evaporated, putting an additional strain on mental health.
Rebecca Mix, 25, a queer author from Michigan, said that being overworked has just become a normal part of her routine with little sign of that changing.
“I think I'm barreling towards burnout,” Mix told NBC News. “I've buried myself in working constantly to not pay attention to anything, but at some point it's going to crash, and I don’t know what I'll do then. But I feel like I don't have any other option.”
Loss of community
One of the biggest losses Covid-19 has robbed Duncan of is her sense of community. Seeing friends and colleagues on video conferencing has become exhausting, she said, and a poor substitute for having a community to help lift one another up.
“For me, community is support,” Duncan said. “Without community, I feel less supported, less confident in my place in the world. I feel this underlying anxiety every day.”
Many around the country have begun feeling “zoom fatigue,” while working to implement social distancing measures at work and with friends.
There is also worry about the long-term impact that the loss of in-person connections could have on LGBTQ people coming into their own with their sexual orientation and gender identity and presentation. A lack of a supportive community could stunt that formative time for many, according to research from Boston University’s School of Public Health.
A recent poll conducted by The Trevor Project showed that 40 percent of LGBTQ youth across the country said that “Covid-19 impacted their ability to express their LGBTQ identity,” with that number jumping to 56 percent for transgender and nonbinary youth. In addition, another report found that 2 in 5 LGBTQ youth in the United States have "seriously considered" suicide in the past year, highlighting the direness of the situation for many this year.
Access to therapy
The combination of economic strain and lack of available space to express themselves has also conspired against LGBTQ Americans by blocking access to a vital mental health resource: therapy.
Green, of the Trevor Project, said many LGBTQ youth have lost their job amid the pandemic and the health insurance that came with it.
“Finding providers who are not only affordable and available but also well versed in LGBTQ youths’ identities and unique mental health challenges can prove incredibly difficult in many areas of the country,” she said. “And concerns around parental permission, being outed and privacy could be heightened for LGBTQ youth who find themselves confined to unsupportive home environments and isolated from affirming LGBTQ communities.”
One of the silver linings of the pandemic has been the increased access to teletherapy as health care providers shift to remote work. This has been particularly helpful for those who had little access to affirming mental health care in their physical area.
“By and large, I have found it has worked really well,” Dr. Alex Keuroghlian, director of the Fenway Institute’s National LGBT Health Education Center and Massachusetts General Hospital’s Psychiatry Gender Identity Program, told NBC News this year. “I’ve had almost no no-shows in my schedule, and patients are answering the phone very appreciative that we can give them care despite what’s happening.”
Remote therapy, while easier to access in some respects, still does not make it accessible for everyone. Mix, for example, began teletherapy during the pandemic, but then had to quit once the costs started piling up.
“At one point, I felt so spiraling-out-of-control depressed and anxious, but I had to stop because I couldn’t afford it,” Mix said. “I’ve noticed everything is harder and more exhausting — things as simple as phone calls to household tasks like laundry and dishes.”
Therapy in addition to medication helped stem feelings of spiraling out of control and depression, but the longer the pandemic rages on the harder it will be to stay on top of certain tasks and remain motivated in day-to-day life, Mix said.
Others, who are sheltering in place with people unsupportive of their LGBTQ identity, may not have a space to privately participate in a mental health video visit. And some may be skeptical of a new platform for accessing health services altogether.
A combination of unemployment, unsupportive families and reduced in-person services at LGBTQ centers have created an acute crisis of housing precariousness for the community.
Wren, 20, who is nonbinary and uses ze/hir pronouns and asked that hir surname not be published to protect hir privacy, has spent the past year moving to different parts of the country to avoid infecting family members, to keep job prospects alive and have space to finish college classes. For Wren, this involved moving in with hir partner on a farm in Appalachia, working in exchange for rent.
For around two months, Wren returned home to see hir family, but that only brought old traumas and threats of violence. Wren is back on the farm with hir partner, trying to navigate an uncertain future amid the pandemic.
“The uncertainty about where I would be living, the worry I felt for my community in the city who were at higher risk for Covid and were facing violence from police during the protests this summer, and stressed family relationships compounded pre-existing mental health issues I have been dealing with for years,” Wren said.
Mental health investment
The implications of the Covid-19 pandemic on the state of mental health care won’t be known for some time, the Trevor Project's Green added, but the disparities in our current system show that urgent investment is needed before more LGBTQ people get left behind without access to care.
“Investing in mental health and social services is the best strategy for proactively preventing worse mental health consequences in the future,” Green said.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386.