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Just like everybody, lesbian, gay, bisexual and transgender (LGBT) consumers deserve support and affirmation from their mental health care providers. They deserve to be able to tell their stories in safety and to be listened to with respect.

Unfortunately, this doesn't always happen. Sometimes we don't realize that we deserve acceptance, so we have a hard time asking for it. Sometimes we feel too shy to tell our stories. And sometimes we're afraid of being labeled as mentally ill just because we're LGBT.

Like most institutions, the mental health professions have not always been very accepting or supportive toward LGBT people. Up until 1973, the American Psychiatric Association considered homosexuality itself to be a mental illness. In other words, if you were gay, you were crazy. So maybe it's not surprising that even today, LGBT consumers are sometimes shy about talking with their therapist or psychiatrist about their sexual or gender identity.

There are other reasons why LGBT people are sometimes shy about "coming out" to their mental health care providers. Nearly every LGBT person has painful memories of losing friends, or family members, or the support and acceptance of a religious community, just because they told someone about their sexual orientation. Because of this, LGBT people are sometimes very careful about who they tell. LGBT consumers don't want to lose the support of their therapists or psychiatrists. Sometimes they'll do anything to keep that support, including keeping their mouths shut about their sexuality.

This is a shame because when we can't share our innermost thoughts and feelings with our care providers, they can't really get to know us and understand us. If we don't share our real selves, our real thoughts and feelings, and the real challenges that we face every day, our therapists and psychiatrists can't give us the help we need. Many therapists and psychiatrists are very understanding, accepting and supportive. When we don't come out to them, we cheat ourselves out of the support we could be getting from them.

There's another important reason to come out to your care providers. Some of them have no idea how many LGBT people are sitting in their waiting rooms. If we don't let them know we're here, how else will they find out?

It can be equally challenging for our straight brothers and sisters to feel comfortable talking to care providers about their desires, thoughts and feelings in an atmosphere of acceptance and support. We all have issues, thoughts and feelings that we're shy about sharing with our care providers. But if we could find the courage to say these things, we would all get better treatment, feel better, and give our care providers more of the information they need.

Sometimes, though, our care providers aren't perfect. That's OK. We can help them understand what we need from them. In the next issue, I'll talk about how we can help our care providers to help us.