The Journal of Primary Prevention, Vol. 13, No. 4, 1993

Preventing Mental Health Problems Among Lesbian and Gay College Students Anthony R. D'Augeili 1,2

Young adults who self-identify as lesbian, gay, or bisexual experience major stresses in managing their sexual orientation. They are at risk for serious mental health problems, including suicide and depression. The mental health concerns of lesbian and gay male college students are reviewed. These problems result from the difficulties involved in developing a lesbian or gay personal identity, and are exacerbated by widespread negative attitudes, harassment, and violence directed toward lesbians and gay men on college campuses. Several systemic preventive interventions are recommended to decrease mental health problems in this population. KEY WORDS: homosexuality; homophobia; youth.

OVERVIEW The life challenges faced by teenagers and young adults who are lesbian or gay have only recently become the focus of the concerted attention of researchers and helping professionals (Boxer & Coehler, 1989; Gonsiorek, 1988; Herdt, 1989; Remafedi, 1987a, b; Ross-Reynolds & Hardy, 1985; Savin-Williams, 1990; Slater, 1988). Much of this concern centers on mental health problems of youth that result from stresses associated with managing their sexual orientation. Most troublesome is the conclusion that up to as many as 30% of all youth suicides may be related to issues of sexual orientation (Gibson, 1989). In addition, a recent study found that 30% of a sample of gay male youth had made at least one suicide attempt, and that half of these youth had made multiple attempts to take their own 1The Pennsylvania State University, Dept. of Human Development and Family Studies. 2Address correspondence to Anthony R. D'Augelli, HDFS, S-108 Henderson Building, University Park, PA 16802. 245 © 1993Human SciencesPress, Inc.

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lives (Remafedi, Farrow & Deisher, 1991). Youth who disclose their affectional orientation to peers and family run serious risks of rejection and hostility. Those who choose to refrain from such disclosure or who are uncertain about their feelings may jeopardize optimal development (Malyon, 1981). Regardless of their openness about their sexual orientation to others, all lesbian and gay youth and young adults are exposed to frequent derogatory comments about lesbian and gay people. Youth who are open about their sexuality or those who are assumed to be lesbian or gay, however, become the targets of these comments. In addition, victimization can be more serious than verbal abuse or threats, and some youth are the victims of the rising number of assaults and other hate crimes committed against lesbian and gay people (Comstock, 1991; Herek, 1989). Most men who later self-identify as gay typically report knowing about their affectional orientation during early adolescence, at which point they label long-standing feelings of "being different" as reflecting a gay sexual orientation (Malyon, 1981; Troiden, 1989). Women who come to label themselves lesbian in general do so several years after their male counterparts (Garnets & Kimmel, 1991). Self-acknowledgment represents the beginning of the process of identity exploration and consolidation; such personal acknowledgment precedes disclosure to someone else. The process of disclosure of lesbian/gay affectional status to others---"coming out"---may occur over a period of many years following self-awareness. There are multiple, overlapping processes involved in this developmental task, such as telling family (parents, siblings, extended family), friends (ranging from casual acquaintances to close friends), and the many important others in one's social network (co-workers, religious leaders, teachers, etc.). These disclosure processes facilitate a gradual exiting from heterosexual identity and its social expectations. This role exit is stressful both for the person and for social network members whose presumptions have been violated, and also sets up a set of new problems. In addition to negotiating exits from heterosexual expectations, gay and lesbian people must build a personal identity within a gay or lesbian context. Revealing lesbian or gay identity to others initiates another set of developmental processes. Lesbians and gay men must relate to lesbian/gay people, socialize in lesbian and gay settings, become involved in lesbian/gay communities, and integrate lesbian/gay status into all domains of personal life. Many of these processes involve stressful experiences, since they bring additional risks, including ventures into new situations and the creation of relationships with people in different social circles. For most lesbians and gay men, being seen in gay-identified settings or associating with others who are lesbian or gay exposes them to very real risks in employment and housing as well. There are only a handful of municipalities and seven states

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that provide legal protection against discrimination based on sexual orientation. State statutes criminalize consensual same-sex sexual experiences in half of the states as well (Rivera, 1991). These life challenges--psychological, social, and pragmatic--create enormous stress in the lives of young lesbians and gay men. These complex dilemmas are so problematic because few anticipatory socialization opportunities are available to help lesbian and gay youth cope with them. The purpose of this report is to review the psychological situation of lesbian and gay male young adults who are attending colleges or universities. This population is of particular interest to prevention professionals because of the role of the college experience on the lives of these individuals. Many aspects of college contexts pose problems for lesbian and gay youth, and conversely, can be changed to decrease mental health problems in such youth. This analysis will proceed in three sections. First, the psychological problems of lesbian and gay male young adults will be reviewed. Then, aspects of campus life that contribute to psychological distress and psychosocial problems will be described. Finally, several preventive intervention strategies that will help reduce future mental health problems among lesbian and gay youth on campuses will be presented. LESBIANS AND GAY MEN IN COLLEGE The late adolescent/early adulthood years of college and university life are culturally scripted as a time for identity exploration. For college students who are lesbian or gay, normative expectations of identity exploration are rendered much more complex as they simultaneously confront the processes of lesbian/gay identity development. The many conflicts and confusions of these years become greatly intensified as young lesbians and gay men essentially "recreate" themselves and begin to construct a new life trajectory. Although most lesbian and gay adults acknowledge their affectional orientation to themselves during adolescence, most have not "come out" by the time they enter a college or a university (D'Augelli, 1991a). Only a small minority of lesbian and gay youth disclose in junior or senior high school, and these youth often suffer serious psychological and family consequences (Gibson, 1989; Hetrick & Martin, 1987; Martin & Hetrick, 1988). For those who proceed to college, the most common pattern is to disclose lesbian, gay, or bisexual identity at some point during their college years. Few studies have addressed processes of identity formation of lesbian and gay college youth, although several studies involve college students in their samples (e.g., Savin-Williams, 1990). No reliable estimate of the number of such young people is available, and any estimate may underestimate

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the lesbian/gay college population and those for whom sexual orientation remains an ongoing developmental challenge. For example, a recent study of men seeking routine medical care at a university health service found that 11% of the men identified themselves as bisexual (4%) or gay (7%) (Wiesmeier, Forsythe, Sundstrom, Ullis, & Hertz, 1986). Since this information was nonanonymous, it is reasonable to assume that others in the study were also gay. Up to 15% of college students may identify as consistently nonheterosexual in their emotional and sexual attachments. Little is known about when during these years young lesbians and gay men disclose to someone else. Given the difficulties involved in studying self-identified lesbians and gay men (no less those who consciously hide their sexual identity or those whose identity is in process), it is not surprising that there are no data on the relative proportions of lesbians and gay men who disclose to others before, during, or after their college years.

Psychological Problems of Young Lesbians and Gay Men There are few empirical reports on the psychological problems of lesbians and gay men in college. Gibson (1989) reviewed the literature on suicide among lesbian and gay youth; his findings are of considerable relevance to college students. Gibson concludes that: 1) most suicide attempts by lesbians or gay men occur in their youth, 2) lesbian and gay youth are twice to three times as likely to attempt suicide than their heterosexual counterparts, and 3) lesbian and gay youth may constitute up to 30% of all completed youth suicides. A comprehensive analysis of a survey of mental health problems among lesbians was completed by the National Lesbian and Gay Health Foundation (1987). Surveying over 1900 lesbians on their life concerns, NLGHF's findings about women aged 17 to 24 have relevance to collegiate lesbians. Of the 167 women in this age bracket, 2% said they considered suicide often, 25% said sometimes, and 32% said rarely, for a total of 59% at risk. Further, about 1/4 had actually made a suicide attempt. Less severe mental health problems were also common. When asked how often they were so worried that they "couldn't do necessary things," 13% said they often felt this way, 29% sometimes felt this way, and 43% said rarely. Only 15% of these young women responded that they never felt overwhelmed. As a result, many sought help from counselors, both professional and informal. Table 1 shows the problems these young women shared with counselors. The importance of family problems and depression is clear in these results. These findings are consistent with results from a small study of gay college men completed by the author (D'Augelli, 1991a). The mental health concerns of the men in that study are shown in Table 2. Issues related to coming out to family and parents and dealing with prob-

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Table 1. Problems Lesbians Aged 17 to 24 Took to Counseling Problem

Percent Experiencing Problem

Lover Concerns

29% 46% 40% 26% 22% 23% 8% 6%

Family Sadness/Depression Anxiety Being Lesbian Growth Issues

Alcohol Use Drug Use

Source: National Lesbian and Gay Health Foundation (1987).

Table 2. Mental Health Concerns of Young Gay Men Concern Close relationships with other men Telling parents about homosexuality Dealing with one's emotions Relationships with family in general Fears Telling people at work about one's homosexuality Termination of a close relationship Depression Telling straight friends about one's homosexuality Anxiety Telling boss about one's homosexuality Worry about AIDS

Problem (%) 45% 93% 62% 60% 75% 78% 93% 63% 63% 77% 75% 92%

Source: D'Augelli (1991a).

lems in close relationships were the most troubling to these men. Both sets of findings underscore the salience of conflicts about families (especially parents) in understanding the psychological situation of lesbians and gay men in college. Remafedi et al. (1991) found that 44% of the gay male teens studied reported suicide attempts were precipitated by "family problems." The importance of parents to the adjustment of lesbian and gay youth is also seen in Savin-Williams' (1989) results. These data document the serious dilemmas faced by lesbian and gay youth. Some stresses are related to concealment of sexual orientation. All lesbians and gay youth have learned the need to hide, and this long-standing manner of coping exacts its costs in terms of psychological well-being

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(Martin, 1982). Herdt (1989) identifies four characteristics of lesbian and gay youth that have serious consequences for mental health: 1) their invisibility, 2) the assumptions of others--peers and family--that they are defective in some way, 3) the stigmatization that follows the assumption of deviance, and 4) others' assumption of homogeneity, that is, that all lesbians and gay men are alike. In a related analysis, Plummer (1989) lists other factors that compromise development--the absence of positive lesbian and gay role models, and the development of a "negative self" that results from the relentless heterosexism and homophobia to which young lesbians and gay men are exposed. Remafedi et al. (1991) note that one-third of gay male youth who attempted suicide saw personal or interpersonal conflict about their sexual orientation at the root of their attempts. Many made their suicide attempt in the same year they self-identified as gay. Given the stressors associated with identity formation, it is not surprising that the most common phenomenological experience of being a young lesbian or gay man is a profound sense of difference. This sense of "otherness" results from isolation from others who have similar feelings and from messages that lesbian/gay feelings are legitimate targets for rejection and hate (Heron, 1983; Schneider, 1988; Whitlock, 1988). A cyclical pattern emerges: feeling different (and often not being able to understand the feeling), the person withdraws from others, may distort his or her life, or may try to act "straight," with varying degrees of success. This widens the gap between core identity and public identity. The process also intensifies social vigilance, lest others figure out the person's "true" identity. As a result, anxiety and depression may increase, especially if the person has clearly understood the nature of her or his "difference." During this process, there are almost no sources of social support to offset the dynamic of withdrawal. Indeed, the avoidance of addressing sexual orientation concerns becomes highly reinforcing. During the initial period of recognition and labelling of sexual/affectional feelings, lesbian and gay youth have few, if any, helping resources to aid them in understanding their concerns. Lesbian/gay-affirming materials may be inaccessible or a person may feel embarrassed to buy them in their local communities; casual discussions with family and friends are risky; and, talking with counseling personnel in schools is hampered by fear of counselors' disclosure to others and by fear of judgment (Roles, 1989; Ross-Reynolds & Hardy, 1985). In some urban areas, such as Atlanta, Chicago, Los Angeles, New York, Pittsburgh, San Francisco, and Toronto, lesbian and gay youth can seek services from agencies devoted to their distinct concerns (Martin & Hetrick, 1988; Schneider, 1988). In other urban areas, youth can access telephone help/counseling systems anonymously, if they are aware of these systems and can overcome their fears. In many

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Table 3, Critical Mental Health Issues for Lesbian and Gay College Students • • • • • • •

Stress Associated with Management of Lesbian/Gay Identity Disruptions in Peer Relationships Conflicts about Disclosure to Family and Consequences of Disclosure Emotional Reactions to Close Relationship Development Isolation from Lesbian/Gay Affirming Contexts istress Caused by Discrimination, Harassment, and Violence Based on Sexual Orientation Anxieties Related to Sexual Health, Especially HIV Infection

areas, especially rural areas, however, such resources do not exist and the sense of isolation and lack of support can be profound (D'Augelli & Hart, 1987; Rounds, 1988). Sadly, even when there are helping resources available, only a slight percentage of lesbian and gay youth overcome hesitancies and seek help. Those who do not remain totally closeted tend to develop a small support system within their social networks, divulging aspects of their emotional life to well-chosen family members and friends from whom they can predict support and confidentiality (Cramer & Roach, 1988; D'Augelli, Collins, & Hart, 1987). Lesbian and gay youth are very dependent on these small networks of knowing friends; disruptions in these friendships can be exceedingly stressful, since they often offer the only predictable validation they may have. Having a small network of knowing friends while hiding one's sexuality from most others (including family) reinforces the sense of being "different" or deviant. Without the opportunity to discuss this feeling and have it disconfirmed, lesbian and gay youth can further internalize the negative views of society. Table 3 presents a summary of the critical mental health issues of this population. Most of these problems are the result of social stigma attached to lesbian/gay status in our society. Although college campuses are often seen as "safe havens" for personal and intellectual exploration, there is much evidence of pervasive antigay and antilesbian attitudes as well as harassment and violence on campuses, as will be shown below.

Campus Climate for Lesbians and Gay Men Widespread harassment and violence directed at open lesbians and gay men on college and university campuses has been well-documented (Comstock, 1991; Herek, 1989). In a comprehensive review of data from three universities, Comstock (1991) summarized the percentages of campus respondents who experienced violence based on their sexual orientation. This analysis reveals that 22% of lesbian or gay people had been chased

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or followed; 15% had objects thrown at them; 4% had been punched, hit, kicked, or beaten; 11% were the victims of vandalism or arson; 3% were spit at; and, 1% were assaulted with a weapon. Comstock concludes that lesbians and gay men are victimized at a far higher rate than others on campus, with rates four times higher than the rate of victimization reported for the general student population. The studies reviewed by Comstock only present a partial picture of the campus climate experienced by lesbian and gay students since they focus on actual victimization. Managing sexual orientation involves active avoidance of threatening situations and people. In Comstock's review, neither victimization that was avoided nor victimization by those not reporting it is included. Thus, his figures underreport the victimization of lesbians and gay men who do not tell the authorities as well as those who manage to escape actual harm (e.g., by running away from a potential assailant). In addition, actual incidents of direct harassment and violence against particular people are surely less common than hostile comments about lesbians and gay men in general. The range of problematic campus circumstances faced by lesbians and gay men can be illustrated by several studies conducted at a large state university (see D'Augelli, 1989a for a description of the university and its community). In the first study, openly lesbian and gay undergraduate students were asked about their experiences with discrimination and violence (D'Augelli, 1992). The results of the study were as follows: 1. 75% experienced verbal harassment. 2. 25% had been threatened with physical violence at least once; 22% were chased or followed; 5% were spit upon. 3. 17% had property damaged. 4. Gay men were more frequently the objects of verbal insults and threats of violence than lesbians. 5. Nearly all expected the average lesbian or gay man to be harassed on campus. 6. Most hid their sexual orientation from roommates and other students. 7. Nearly half made specific life changes to avoid harassment. 8. 64% feared for their personal safety on campus. This fear was associated with having been threatened, verbally abused, having property destroyed, or having been chased. Later studies involved the assessment of homophobia among students planning to work in campus housing as resident assistants (D'Augelli, 1989b), and an analysis of first-year students' attitudes about lesbians and gay men (D'Augelli & Rose, 1990). In the first of these two studies, these were the findings: 1. Men had significantly more homophobic attitudes than women.

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Attitudes about lesbians, while negative, were less negative than attitudes about gay men. 3. Only 5% of the women knew a gay man well; 6% knew a lesbian casually. O f the men, 9% knew a gay man well, and 5% knew a lesbian well. 4. K n o w l e d g e o f gay m e n and lesbians was r e l a t e d to l o w e r homophobia. 5. Everybody had heard antigay/antilesbian remarks. Most of the participants (67%) had made remarks themselves. Men made more homophobic comments than women. 6. Everybody thought that harassment of lesbians and gay men on campus was likely. The study of heterosexual freshmen's attitudes revealed these results: 1. 29% felt that the university would be a better place without lesbians and gay men. 2. Nearly half called same-sex behavior "wrong," called gay men "disgusting," or were indifferent to the problems of lesbians and gay men. 3. Men had more homophobic attitudes; attitudes toward gay men were more negative than attitudes toward lesbians. Men were more negative about gay men than about lesbians. 4. Students from "conservative" families were more homophobic (about gay men) than students from liberal or moderate families. 5. Over half did not know a gay man casually; only 17% knew a lesbian casually; 92% did not know a gay man well; 94% did not know a lesbian well. 6. Personal knowledge of lesbians and gay men was associated with less homophobic views. 7. Few students expressed interest in learning more about lesbians or gay men: only 3% were very interested; and 85% said they would not attend an educational program on the subject. Those least interested in learning more were more homophobic. 8. Nearly all had heard antilesbian or antigay comments; over 80% had made such comments themselves. Men made more comments more often. 9. Nearly all (91%) felt that harassment was likely for the average lesbian or gay man. These results, combined with Comstock's (1991) findings, provide overwhelming evidence of a hostile climate for lesbians and gay men on college campuses. Openness about one's sexual orientation is not required to be victimized by this hostile climate. This climate causes persistent anxi-

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eties in lesbians and gay men who are open, and surely influences closeted students who observe the consequences of openness. Based on these findings, some general predictions are possible. Heterosexism and homophobia on campuses---and the discrimination and violence that follow----will escalate in the 1990s. Paradoxically, this may be partly the result of increasingly accepting attitudes, which prompts more and more young lesbians and gay men to come out on campus. Even though most lesbian and gay male college students are nondisclosed or closeted, more and more will self-identify as lesbian or gay in college. Few of these students are known as lesbian, gay, or bisexual to their friends on campus, family, or faculty. Few attend lesbian/gay-affirming events on campus, most of which are sponsored by campus lesbian/gay/bisexual student organizations. Few assert their rights or make their needs known. Self-acknowledged but non-disclosed students may experience mental health problems related to sexual orientation concerns. For such youth, sexual orientation issues are highly psychologically salient. The issues have been in their awareness for longer periods than for earlier cohorts (Herdt, 1989). Greater social acceptance makes denial increasingly difficult to sustain. In addition to greater numbers of self-aware but non-disclosed youth, there will be more students coming out, and at earlier ages. As youth self-label at earlier ages, they will experience greater stress and will be a higher risk unless given support (Remafedi et al., 1991). The increased lesbian/gay/bisexual assertiveness will escalate heterosexist reactions, causing greater conflicts among lesbian and gay youth. As more and more conflict is experienced, more will seek mental health services on campus. Many will seek help as a result of the psychological consequences of persistent harassment, and some will need help to deal with reactions to incidents of violence. Thus, given their developmental challenges and the hostile climate they live in, the problems lesbian and gay college students will present to mental health professionals are predictable. It is likely they will seek help mostly under crisis conditions. The most predictable crises will concern disclosure of sexual orientation to others and concerns about developing relationships. These crises may be exacerbated by experiences with neglectful, abusive, or troubled families. Less routine crises related to victimization will also occur. And, the accumulated experience of coping with societal, peer, and familial ambivalence will manifest itself as depression or anxiety. The new assertiveness of this generation of lesbian and gay youth is a double-edged sword: it seems very hard for these young people to look back on the hurts of the past since they are too busy hoping to move ahead. The seeking of professional help is generally not acceptable, yet most young lesbians and gay men are in need of more support and nurturance than they receive. Young lesbians and gay men are the most poorly served group

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on campus as far as health and mental health services ar concerned. Fearing the consequences of allowing themselves to be vulnerable again, they do not make their needs known. Thus many psychosocial and personal issues remain unaddressed. INTERVENTIONS TO PREVENT MENTAL HEALTH PROBLEMS Professionals can play a major role in preventing problems in this at-risk population. Efforts can be taken to prevent mental health problems of lesbians and gay men on campuses. These efforts must be comprehensive. Changes in the following areas will have a significant preventive impact on the lives of lesbian and gay young people: 1) changes in mental health services, 2) the development of safe settings for identity development, 3) integration of lesbian and gay issues into the curricula, and 4) changes in institutional policy. Mental Health Services Development Campus mental health services are crucial resources for lesbians, gay men, and bisexual people given the developmental challenges they face and the years of confusion and conflict they have experienced. It is exceedingly important that campus mental health facilities be perceived by the informal community of lesbian, gay, and bisexual students as accessible and helpful. Assurance that staff do not display outright homophobia or heterosexism is a necessary but insufficient step. Services must be seen as affirmative; the presence of openly lesbian or gay professional staff is perhaps the best way to make such a "statement" to the campus community. Just adding an open staff member will not be sufficient, however; it is necessary that all staff participate in training experiences to expose them to contemporary views of sexual orientation and to affirmative modes of counseling and psychotherapy. Although professional staff may feel capable of seeing lesbians and gay men in their work, sufficient evidence of problematic practice exists to assume that such training is needed (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991; Graham, Rawlings, Halpern, & Hermes, 1984). In addition to providing unbiased and affirmative counseling, campus mental health facilities should take the initiative in outreach to the lesbian and gay student population. The subpopulations within this large group of young adults need specialized programs. For those who are closeted or uncertain of their sexual orientation, public lectures on human sexuality and sexual orientation that are not advertised as lesbian- or gay-oriented can be an important method for outreach. Another option for this group is a telephone help-line which can assure anonymity. The closeted group is the

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largest group of lesbians and gay men on campus; they are the neediest and the hardest to reach. Another enormous group are those who have taken some steps to come out to others. For this group, the most useful approach is a support group of other lesbians or gay men. Campus centers should have semester-long coming-out support groups, given the complex nature of the processes involved. Lesbian, gay, and bisexual students should be trained as facilitators and should be supervised by staff. Peer facilitation is most effective; over time, the center can develop a cadre of trained facilitators to meet the ever-increasing need. Finally, a whole array of specialized support groups and educational mental health workshops must be developed. The highest priority should be given to coping with disclosure to family and to developing close relationships. Workshops on sexual enhancement and safer-sex should also be offered. Clearly, the scope of issues involved is considerable, and the need for liaison to the local lesbian/gay/bisexual communities obvious. Because of the demands involved, it is recommended that a staff coordinator of lesbian/gay/bisexual services be appointed at campus mental health centers.

The Development of Safe Settings The accumulated evidence of heterosexism and homophobia on campus provides a strong case for the need to assure "safe spaces" on campuses for lesbians and gay men. Perhaps the most important settings in this regard are campus housing facilities. Much harassment and victimization takes place in campus housing. Opportunity to influence the campus climate exists in these facilities as well. Campus rules about intolerance and harassment must be systematically enforced by campus personnel; in most cases, the critical personnel are the resident assistants (RA's). These students are usually upper classwomen and men, but it should not be assumed that they are non-heterosexist or non-homophobic in their views or actions. They too must be trained in issues related to sexual orientation, and they must be made aware of their special role in creating a social climate in which expression of anti-lesbian and anti-gay views is unacceptable. Lesbian and gay students must be assured that their living spaces are free of harassment and victimization. This must be the highest priority for campus housing personnel. Other safe spaces are needed as well. Most campuses have a student organization for lesbian/gay/bisexual students. These groups have historically met all the needs of lesbian and gay students, since mental health centers and campus housing personnel at most universities have paid little attention to the problems of lesbian and gay students until very recently. Lesbian/gay student organizations still play a pivotal role in preventing

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mental health problems, since they will likely be the only organized groups that most students will access. Much informal counseling and crisis intervention occurs in these organizations, and this will continue, even if campus counseling centers organize the services suggested above. Because of its critical role in mental health prevention, it is important that the lesbian/gay/bisexual student organization be assisted in providing support. The administration should provide resources for programs, and must allocate adequate meeting space. A large, comfortable office, for instance, is particularly necessary, since many closeted students will take their first "baby-step" out of the closet by stopping by or calling the office of the student organization. This "safe space" literally represents the escape route for many lesbian and gay youth, so it is important that it be accessible. More and more campuses are supplementing the operations of student organizations with a center for lesbian and gay students, a place in which socializing and support can be found. Given the many years of isolation that lesbian and gay youth experience, such a center is a powerful preventive intervention. The first two sets of changes approach the issue of prevention in a direct way by providing a variety of person-centered services to individual lesbian and gay students. A commitment to the primary prevention of mental health problems among this population demands systemic changes in the larger context of the college or university as well. Two important directions to pursue are the integration of information about lesbian and gay life into the offerings of the institution and the review of relevant institutional policies. These will be described briefly below.

Curriculum Integration Lesbians and gay men are a hidden population on campus, and they are also invisible in the curriculum (D'Augelli, 1991b). Seldom, if ever, is material about lesbians and gay men included in classes, even if it is relevant. For example, few classes in developmental psychology cover lesbian and gay development; few classes in social psychology focus on the nature of homophobia; few classes in professional (clinical, community, counseling, school psychology) mention the needs of this population. Similar comments could be made about courses in other social sciences and in education. The problem is much broader, however; little is covered in the humanities or the arts either. This situation is slowly changing with the rapid advances in lesbian and gay studies, but generally lesbian and gay life is hidden from academic analysis and discussion. This omission helps to perpetrate the stereotypes which provide the foundation for the biases and victimization, which in turn produce mental health problems for lesbians and gay men.

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Although it might not seem a typical mental health promotion strategy, considerable indirect impact on campus climate can be affected if faculty initiate efforts to include discussions of sexual orientation in their courses. Such efforts not only help the many lesbian and gay students in these classes (who, perhaps for the first time, find their lives addressed), but it also educates heterosexually identified students and helps them consider and modify their heterosexist assumptions and acts. As more and more universities strive to address issues of "diversity" or "multicultural" education, it is crucial that sexual orientation issues be included. Policy Review

Colleges and universities contribute to the way lesbians and gay men are perceived on campuses by the nature of their formal policies, especially those that cover harassment or intolerance and those that cover discrimination in employment and access to services. By explicitly including sexual orientation in policy statements, institutions break the pattern of invisibility. The statement that harassment based on sexual orientation will not be tolerated not only speaks to the issue of verbal and physical abuse; it also implicitly conveys the idea that lesbians and gay men are part of the campus community. (Such statements also demand institutional mechanisms for implementation, resulting in prevention of harassment directly.) In addition to policies about harassment, the overall institutional policy concerning discrimination must include reference to sexual orientation. Without formal protection, lesbians and gay men (whether faculty or staff) can be removed from their jobs without cause. Many of the other changes noted above depend upon actions that could be compromised if simple protection from discrimination is not provided. Mental health center staff, for example, may hesitate to suggest programs for lesbian and gay students since they may fear reprisals. Housing personnel may be similarly hesitant to be "too" supportive since this may not only bring suspicions upon them, but because they may risk promotions. This aspect of human diversity is least protected by federal, state, and local law. Few institutions include sexual orientation among "protected classes" in prohibiting discrimination. Without formal protection in university/college policy, efforts to develop programs to prevent mental health problems among this population will be jeopardized by fear and hesitancy, some of which may be justifiable. CONCLUSIONS The mental health problems of lesbians and gay men on campuses are caused and exacerbated by systemic and institutional factors, and any

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preventive approach must address these larger issues to succeed. The first systemic step is institutional protection. All programs must be sensitive to diversity in sexual orientation. Institutional heterosexism must be eradicated. The next systemic step is institutional inclusion. Stating that lesbians and gay men cannot be hurt is a necessary but insufficient step for change. Inclusion must occur at the systemic level. Inclusion in the array of services provided by mental health services on campus is necessary, as is inclusion in curricula. Curricular review is especially important to break the transmission of stereotypes and biases. Both protective and inclusionary strategies will address the needs of current students and set in place mechanisms for primary prevention for later cohorts of lesbian, gay, and bisexual young adults. We must not revictimize lesbian and gay youth by setting our sights on self-contained, modest changes that ignore the pervasive heterosexism of the contexts in which they spend four crucial years of their young adulthoods. Considerable psychological tension occurs during the college years in the management of lesbian or gay identity with family, heterosexual friends, and co-workers. After the initial disclosure and with the building of a social network of lesbian/gay people and supportive heterosexual people who "know," increasingly complex issues in identity management must be confronted. The building of a lesbian or gay social identity progresses simultaneously with increased consolidation of personal confidence about being lesbian or gay such that these processes become intertwined. Increased professional attention must be directed toward helping young people deal with the very distinct dilemmas of becoming a lesbian or a gay male adult. The hostility expressed by many of their peers exacerbates the stresses of identity development, preventing them from seeking the support of others, lesbian, gay, or heterosexual. Mental health and other professionals must provide leadership in creating a more supportive campus climate, so that young lesbians and gay men can meet the routine challenges of college life. The need for concerted preventive interventions directed toward this population is intense and urgent.

ACKNOWLEDGMENTS The author thanks Sue Gibson, Scott Hershberger, William Holahan, and James Reid for their careful review of an earlier version of this report. The ongoing support of members of Penn State's Lesbian, Gay, and Bisexual Student Alliance (LGBSA) is also acknowledged.

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Preventing mental health problems among lesbian and gay college students.

Young adults who self-identify as lesbian, gay, or bisexual experience major stresses in managing their sexual orientation. They are at risk for serio...
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