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Mental health is indispensable to personal well-being, family/interpersonal relationships and one's contribution to society. But the effects of discrimination, homophobia, heterosexism and transphobia can take their toll on a person's well-being, both physically and mentally.

Indeed, some studies have found higher rates of major depression, generalized anxiety disorder and substance use among lesbian, gay, bisexual and transgender (LGBT) people compared to heterosexuals. Discrimination may help fuel these higher rates. A 2001 study by Cochran & Mays found a strong relationship between perceived discrimination and mental health status among lesbian, gay and bisexual people. At the same time, a study of lesbians reported equally strong levels of mental health as their heterosexual sisters and higher self esteem-the more "out" the women were, as measured by self-identification, number of years out and level of involvement in the gay and lesbian community, the less psychological distress they reported. In other words, therapy that facilitates the coming-out process is good for LGBT mental health.

LGBT people face unique and specific challenges in accessing quality mental health care. For example, they must confront anxieties about coming out in treatment, and they must find a professional who understands the unique joys and struggles of being LGBT and has experience helping people in the LGBT community.

In addition, many transgender individuals have lived in fear and isolation, stemming from daily encounters with a society that mistakenly believes transgender identities and experiences are sicknesses that can be cured. And LGBT people of color are often confronted with multiple stigmas and stressors. Recent immigrants are challenged by coming out in a culture that is new and different.

Because of pervasive homophobia and transphobia found in the health-care industry, some LGBT organizations have been proactive in developing services geared toward their community. One such program is Center CARE, the substance abuse/mental health prevention and intervention program of the Lesbian, Gay, Bisexual & Transgender Community Center in New York City, which assists LGBT people in attaining the skills necessary for developing a positive sense of self.

Representing the diversity of the LGBT community, Center CARE staff is keenly aware of cultural differences and their impact on LGBT lives. For more than 15 years, people have come to the Lesbian, Gay, Bisexual & Transgender Community Center for support and advocacy around issues such as coming out, substance abuse, HIV/AIDS, mental health, gender identity and bereavement concerns. Center CARE helps LGBT people move out of shame and isolation and into healthy and whole lives. It empowers LGBT people of color to embrace the complexity and diversity of their identities; for people of transgender experience, it offers people an opportunity to discover and acknowledge who they are while building community in a trans-identified space. And for those dealing with anxiety, depression and other mental health concerns, Center CARE offers confidential assessments, short-term individual interventions and referrals to its network of LGBT-affirmative or -identified counselors, psychotherapists and psychiatrists.

LGBT people find the care and support they deserve-and can't find elsewhere-through organizations such as the Lesbian, Gay, Bisexual & Transgender Community Center.

Mental health and well-being are vital to individuals and to society as a whole. As daunting as homophobia, heterosexism and transphobia are, we must continue fighting the ignorance and discrimination, all the while taking care of our own. That's what programs such as Center CARE are about-building a healthy community.