Psychology & Sexuality
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/rpse20
Mental health issues and needs of LGBTQ+ asylum
seekers, refugee claimants and refugees in
Toronto, Canada
Nick J. Mulé
To cite this article: Nick J. Mulé (2022) Mental health issues and needs of LGBTQ+ asylum
seekers, refugee claimants and refugees in Toronto, Canada, Psychology & Sexuality, 13:5,
1168-1178, DOI: 10.1080/19419899.2021.1913443
To link to this article: https://doi.org/10.1080/19419899.2021.1913443
Published online: 07 Apr 2021.
Submit your article to this journal
Article views: 1433
View related articles
View Crossmark data
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at
https://www.tandfonline.com/action/journalInformation?journalCode=rpse20
PSYCHOLOGY & SEXUALITY
2022, VOL. 13, NO. 5, 1168–1178
https://doi.org/10.1080/19419899.2021.1913443
Mental health issues and needs of LGBTQ+ asylum seekers,
refugee claimants and refugees in Toronto, Canada
Nick J. Mulé
School of Social Work, School of Gender, Sexuality & Women's Studies, York University, Toronto, Canada
ABSTRACT
ARTICLE HISTORY
LGBTQ+ people experience mental health challenges due to their minor­
itized status, systemic inequities and structural disparities. For LGBTQ+
asylum seekers, refugee claimants and refugees the impact on their
mental health can be compounding. This study, which featured a series
of focus groups with LGBTQ+ asylum seekers, refugee claimants and
refugees in Toronto, Canada, was part of a larger international study
‘Envisioning Global LGBT Human Rights’ that looked at colonising effects
on LGBTQ people in the Commonwealth. The migration process, – often
forced due to persecution in their country of origin based on sexual
orientation or gender identity and expression – produced traumatic
experiences involving life-changing decisions, accessing information and
resources, cultural shifts, conceptualisation of identities, and navigating
the refugees claims process. The specialised experiences of LGBTQ+ asy­
lum seekers, refugee claimants and refugees can have a deleterious effect
on their mental health that a critical psychology perspective can address
clinically by recognising the particularised needs of this population and
systemically by addressing the structural inequities.
Received 24 November 2020
Accepted 31 March 2021
KEYWORDS
Asylum seekers; Canada;
LGTBQ+ people; mental
health; refugee claimants;
refugees; Toronto
The mental health issues and needs of lesbian, gay, bisexual, transsexual, transgender, 2-Spirit,
intersex and queer (LGBTQ+) asylum seekers and refugees are numerous. Often not understood by
the general population such issues and needs have a compounding negative psychological effect on
these populations (King et al., 2008; Meyer, 2003). This article presents the findings of one compo­
nent of a larger international research study, Envisioning Global LGBT Human Rights, that more
broadly examined the colonising effects on LGBTQ people in the Commonwealth. Part of that
research studied the experiences of LGBTQ+-identified asylum seekers and refugees that had
migrated to Toronto, Ontario, Canada. The findings of this component of the study are premised
on a critical psychological perspective and a focus on LGBTQ psychology that contextualises the
Canadian socio-political environment during the time of the study and its lasting implications.
Both psychology and psychiatry have held prominent and influential roles in science and society,
contributing to the process of defining norms, sometimes to the benefit and other times to the
detriment of these disciplines and society in general (Glassgold & Drescher, 2007). Critical psychol­
ogy challenges the pathologizing role of the discipline, recognising the stigmatising effects of such
practices (Moreno et al., 2020) and how this contributes to mental health issues experienced by
LGBTQ+ populations (Matza et al., 2015). Critical psychology takes an affirmative approach to LGBTQ
+ people recognising their sexual orientation, gender identity and expression as having legitimacy,
being healthy and thus the norm (Bidell, 2016; Veltman & Chaimowitz, 2014; Victor & Nel, 2016), an
approach explicitly supported by some psychological bodies (International Psychology Network for
CONTACT Nick J. Mulé
nickmule@yorku.ca
York University, Toronto, Canada
© 2021 Informa UK Limited, trading as Taylor & Francis Group
PSYCHOLOGY & SEXUALITY
1169
LGBTI Issues – IPsyNet, 2018; Ordre des Psychologues du Québec, 2012; Victor & Nel, 2017; Victor
et al., 2014). Regardless of whether affirmative LGBTQ+ stances exist or not, for the most part,
professional psychology bodies do abide by international classifications (e.g. International
Classification of Diseases – ICD-10 and the Diagnostic and Statistical Manual of Mental Disorders,
5th Edition: DSM-5), codifications that continue to pathologize these populations, especially on the
trans and paraphilias fronts (Daley & Mulé, 2014; Mulé, 2019).
LGBTQ psychology, which is within the realms of critical psychology, has and is contributing to
LGBTQ research, theory and practice as part of the science of psychology (Burnes & Stanley, 2017;
Clarke & Peel, 2007). In some ways, LGBTQ psychology has become a speciality within psychology for
it distinguishes itself from the hegemonic centring of heterosexual and cisgender people in main­
stream psychology to focus on the lives and unique experiences of LGBTQ people (Clarke et al.,
2010). Critical psychology is aligned with LGBTQ psychology in that they are committed to social
change (Clarke & Peel, 2007). A means by which psychologists can affect social change regarding
LGBTQ issues is through advocacy for these communities (Stevenson, 2005), which may concern
LGBTQ immigrants, asylum seekers and refugees ((Moreno et al., 2020). A critical (Hopkinson et al.,
2017) and/or liberationist psychology (Martin-Baro, 1996; Watkins & Shulman, 2008) perspective is
important to this research as it calls for a broader structural-systemic approach to a marginalised
population that is persecuted for a social location, the focus here being a sexual and/or gender
minority, towards social justice.
Laws and legislation shifted in North America from sexual orientation being a basis for exclusion
from immigration to a basis for relief according to international human rights law (Lee & Brotman,
2011; Piwowarczyk et al., 2017), with immigration relief eventually extended to gender identity and
expression (Benson, 2008). Such protections were instituted due to the persecution criminally and/or
socially of gender and sexual minorities in numerous countries around the world (Ramón Mendos,
2019). Persecution of LGBTQ+ people may include torture. One study found that of 50 LGB torture
survivors 76% experienced high rates of major depression, 70% post-traumatic stress disorder
(PTSD), and 28% had generalised anxiety disorder (Piwowarczyk et al., 2017). Minority stress has
been found to be experienced by LGBTQ people in general, due to the mental stress of having to
navigate identity-specific stressors that heterosexual and cisgender populations generally do not
need to deal with (Meyer, 2003). LGBTQ asylum seekers and refugees can be directly impacted either
for having been tortured and most by the concept of minority stress as a result of having to deal with
identity concealment, accessibility challenges in attaining LGBTQ community connectedness (Frost &
Meyer, 2012) and finding LGBTQ mental health supports (Hatzenbuehler, 2009).
When compared to non-migrant LGBTQ individuals, LGBTQ asylum seekers and refugees face
numerous challenges including cultural and linguistic barriers (Berry, 1997) impacting their ability for
social integration (Gowin et al., 2017; Piwowarczyk et al., 2017), which can also extend to difficulties
in connecting to host LGBTQ communities (Kahn, 2015). Making connections with those from their
countries of origin or related culture can be a challenge due to risk of persecution, real or perceived
(Gowin et al., 2017; Piwowarczyk et al., 2017). Studies have shown that having language fluency
(Roberts et al., 2016) and approved immigration status (Silove et al., 2007) have positive mental
health outcomes for the general immigrant populations, not identified as LGBTQ. It is unknown
whether the same is true for the latter. The above barriers all contribute to other research findings
that indicate significant barriers to accessing mental health services for both the general population
of newcomers (Bartolomei et al., 2016) and LGBTQ people (McGuirk et al., 2015), not to mention
structural barriers (i. e. poor housing, limited employment opportunities, racism, ongoing homo­
phobia, exclusion from mainstream LGBT scene) that inhibit integration and settlement (Envisioning
Global LGBT Human Rights, 2015).
The mental health of LGBTQ asylum seekers and refugees must be understood in terms of their
experiences both pre and post-migration and how they influence each other. In pre-migration,
LGBTQ asylum seekers must live with hypersensitivity to anticipated homophobia and transphobia
(Hopkinson et al., 2017), which could lead to severe forms of persecution such as arrest, detention,
1170
N. J. MULÉ
death threats, rape, torture and in some cases the death penalty (United Nations High Commissioner
for Refugees (UNHCR), 2011). The resettlement process post-migration can be very stress inducing
due to harassment and/or discrimination in the pursuit of housing and employment (Gowin et al.,
2017; Logie et al., 2016). The asylum and refugee process has been taken up at various stages from
deciding to depart to the refugee status determination stage to integration into the host community
from international perspectives (Güler et al., 2019). For example, the inherent homonormative biases
in the adjudication process creates a burden of proof as detrimental to the wellbeing of asylum
seekers and refugees as abuse experienced in their country of origin (Murray, 2014). Recognition of
all these factors can assist in addressing the social determinants of mental health (Acevedo-Garcia
et al., 2012) for LGBTQ asylum seekers and refugees (Kahn et al., 2018).
The purpose of this paper is to examine the mental health issue and needs of LGBTQ asylum
seekers and refugees in Toronto, Canada from a critical psychology perspective. The aim is to
critically understand how LGBTQ asylum seekers and refugees are impacted by their experience
via the following research questions: Did they have adequate access to information and resources?
How did they manage socio-cultural shifts in understanding the concept of identities? How did they
navigate the refugee claims process? How did they manage trauma? How has their experience
impacted their mental health?
Methods
It is acknowledged that LGBTQ+ (lesbian, gay, bisexual, transsexual, transgender, 2-Spirit, intersex
and queer) is very much a North American term, used in various parts of the world, but it is also
neither all-embracing nor exclusive. In certain parts of the world LGBTQ+ may not hold similar
relevance. An ‘asylum seeker’ is a person fleeing persecution and in need of protection, regardless of
desire, eligibility, or attainment of a particular status within the refugee system (pre-applicant).
A ‘refugee claimant’ is an individual formally seeking refugee status, by application (pre-claimant).
A ‘refugee’ is an individual in need of protection who has successfully obtained refugee status (postclaimant).
This study employed a participatory action research approach that developed a collaborative
relationship between community-based partners in the settlement sector of Toronto, communitybased researchers and academic researchers (Nicol et al., 2014). Through announcements and
advertising made by these partners to their service recipients we were able to recruit LGBTQidentified focus group participants. Some biases were detected regarding certain services serving
higher numbers of participants from certain regions of the world. Both pre and post-hearing
claimants (N= 92) participated in 17 focus groups. Seven of the focus groups were conducted with
pre-hearing refugee claimants, post-hearing claimants participated in eight and the remaining two
included both pre and post-hearing claimants. All participants reviewed and signed an Informed
Consent Form in accordance with the Research Ethics Board’s approval of the study.
Participants completed a demographic form. Given that some questions allowed for multiple
responses and that some participants chose not to answer all questions totals did not necessarily add
up to 100%. Participants consisted of 52 men, 33 women and seven who identified as gender queer.
Regarding sexual orientation and gender identity/expression, 38 identified as gay, 24 bisexual, 18
lesbian, two transgender, two queer, two straight, two 2 Spirit, one pansexual. The age range of the
participants was between 16–64 with the average age being 25. Participants came from Uganda (15),
Jamaica (13), Nigeria (12), Saint Lucia (8), the Bahamas (7), Barbados (4) and Russia (4). Two
participants came from each of Antigua, Cameroon, St. Kitts, Tobago, Trinidad and Turkey. Then
one participant each from Bahrain, China, Djibouti, Egypt, Gambia, Grenada, Grenadines, Guyana,
India, Iran, Namibia, St. Vincent, Suriname and Swaziland.
Each focus group met once for a two-hour period that was co-facilitated by a community-based
(having participated in a research training workshop provided by the project) and academic
researcher and audio-recorded for transcription purposes. A series of open-ended semi-
PSYCHOLOGY & SEXUALITY
1171
structured questions were asked regarding experiences in their homeland, their decision to flee,
how they accessed information, what supports they had if any, their arrival in Canada, seeking
resources, the refugee claims process and settlement issues including getting integrated into the
LGBTQ community in Toronto. Participants, community-based and academic researchers all
engaged in qualitative thematic data analysis of the focus group transcripts drawing from major
themes that arose based on the content provided by focus group participants regarding their
experiences. The data analysis was then discussed at a roundtable exercise to produce a technical
report (Envisioning Global LGBT Human Rights, 2015) that in turn was used as a tool to advocate
for policy change. Representatives from each of the participant groups above co-presented this
report at conferences in which immigration and settlement policy makers were present. The
quotes from participants to substantiate the findings in the next section have not been corrected
for grammar.
Results
Access to information and resources
The daunting experience of interviewees’ arrival in Canada sets the tone for the beginning of their
arduous settlement process. Many participants identified housing to be a top concern, along with
finding a lawyer, accessing health services as well as accessing information about the refugee
application process. The need for work and some degree of economic security contributed to their
sense of personal safety. Both personal (i.e. not having enough money, not knowing anyone in
Canada etc.) and systemic challenges (i.e. in terms of accessing support services, legal services,
housing, language barriers) were experienced. Such challenges may be experienced by anyone
arriving without status, yet for our participants they are in addition to the burden of an as yet
undisclosed gender or sexual minority status.
The following quotes illustrate the challenges upon arrival at the airport regarding seeking out
shelter and a lawyer and knowing how to find the right speciality regarding the latter:
Because I first step out of the airport, what comes in my mind is accommodation. How, where am I going to
sleep? How am I going to move? When I came out, it took me a while. I was wandering and wandering and
wandering. I saw a cab driver. I moved away from the airport to be comfortable with myself. He looked like an
African. I asked him where is there a shelter that I can sleep. He said ‘hotel’, I said ‘no’. Like a shelter or a church
where they can accommodate you for a while. I am just coming from Nigeria. He took me Bethlehem United
shelter on Caledonia Road.
At first, when I came, I came to the airport. I was wondering if I could get a lawyer. Because you are so freaked out
when you come to the airport. You’re nervous. And honestly, the behaviour is not so welcome to you. Especially
because maybe the country I am coming from, the image they have. I don’t blame anyone – - but it was the first
thing I think it was lawyer. I really had big issues finding the lawyer. I asked agents at the airport – they gave me
number. None of them accept me, lawyer
What has been hard for me, but getting the right lawyer. You hear, you are just being directed call this number,
call this number. Any lawyer, you don’t know. Some lawyer may not know what the LGBT people need. It’s so
hard.
Limitations on access to health services can seriously impact on both physical and mental health:
Last time I went round and round looking for a doctor. I was so sick. I had to take a taxi and I went round and
round looking for a doctor to take care of me. Sick. I couldn’t even walk. I don’t know.
Similarly, another participant said, ‘because I was a refugee, they would be saying that I don’t have
a health card, I am not eligible for this service, everything.’
Trying to secure employment to sustain oneself in the midst of getting settled can also be
a primary concern:
1172
N. J. MULÉ
Ah, I think is the first thing that comes to my mind is how to show my working experience back home country
and make them match here. So, I can find a job that is suitable for me, then I carry on. So, I find it difficult for us in
getting a job.
The waning supports a person has while disconnected from community resources increases
isolation:
My mom can’t help because she’s all the way back home. She doesn’t know the process. She’s trying to learn the
process, each day, you know, when I tell her stuff. She is trying to accept my sexuality. So, pretty much I had no
help from anyone, and I had no way of finding information.
Identities
Sexuality-based labels were seen as sites of contestation by the study participants. For many they
struggled and/or resisted being defined by labels and stereotypes about homosexuality and felt
that definitions of sex/gender played a large part in their experiences of exclusion and social
isolation. Overall, although labels were often viewed to be inadequate and restrictive, they were
also seen to be necessary. The paradox that language not only plays an important role in defining
LGBTQ communities but can also play a role in discriminating against these communities became
apparent.
Yes, free of tortures, they can live openly, you know? They can, they can do whatever you want. They can live
their own life, for example, like if you are gay or lesbian, if you belong to any sexual minority in ____ (country) or
____ (country), you will got lots of problems. You won’t be able to live, this–it’s extremely hard there to survive.
And for me Canada, seemed a country where you can escape all those tortures, persecution and like fear. So–but
here, . . . we got to prove who we are and sometimes it’s pretty difficult, not so easy.
The closing of the above quote speaks to the need to prove one’s sexual orientation or gender
identity/expression during the Canadian refugee claims process when basing one’s claim on these
grounds. While the quotes below speak to the navigational process between and within cultures
regarding being ‘out.’
For me, I think the most challenging was . . . back home, you had to hide what you’re doing. But here, when I just
came, I get the feeling I have to beg somebody for this or beg somebody for that. I’m not use to that. So, for me,
I was intimidated that someone may judge me for my sexuality, and I wouldn’t be treated fairly.
Back home, I was an HIV/AIDS activist. I’m a human rights activist. But it was still kinda underground. You can’t go
out and say, but you want to. So just dealing with, like the whole culture thing and embrace what I know and
apply it to Canada. I ended up living in a youth shelter. I had to be DL [down low] because of the guys there.
I couldn’t be myself. I only told my staff, my case worker. So that was psychologically messing me up. I came to
Canada to be open but now I can’t be open.
Refugee claims and process
For many arriving in a foreign land that they hope to settle in, without status nor knowing how to go
about the process, who to speak to, where to find resources, can be overwhelming (Tabak & Levitan,
2014). This intense sense of insecurity is compounded onto escaping a traumatic past of persecution
and facing an uncertain future.
Because of my sexual orientation, I escaped to the United States. I lived there for 11, 10 years. But I never knew
before with my partner, I didn’t know I could apply as a refugee claimant based on my sexual orientation. I didn’t
know.
The following two quotes address just some of the systemic challenges faced by LGBTQ refugee
claimants.
PSYCHOLOGY & SEXUALITY
1173
Just trying to trust people after all that BS that happened. And still dealing with the refugee process. Because in
this time period, I still don’t have a job. Not working. I went on OW [Ontario Works, a social security benefit]. They
give you a certain amount of money, then you have nothing left.
Everything is tough when you don’t know if you’re going to stay here or not. You don’t know if you are stable or
not. Better if the process is getting shorter. All the problems start from here because you are here for a long time,
but you are not a resident. you don’t have the advantages other people have. You can’t go to school. It takes
5 months to get a work permission. All of those problems are coming from here, so you can make it faster.
Trauma (oppression/violence/discrimination)
Most participants had been victims of oppression, violence and/or discrimination due to their sexual
orientation or gender identity and expression and the reason for their taking refuge. Yet, these
experiences often carried over into Canada both in terms of post-traumatic affects and the retraumatisation of the settlement process.
These quotes describe various traumatic scenarios from one’s country of origin, carry over effects
with a family member in Canada and post-traumatic affects:
Ok, in my country, about your sexuality, you need to keep it in the closet. Keep it to yourself. Because if they
know, they will kick you to the curb. If you say anything, they will beat you, they will kick you. Honestly speaking,
in my country, people like me . . . dead. Honestly, awful stuff if I told you. Oh my god. They would pit sticks in our,
down there. Many of us, people like me dying, because my country is homophobic. Very homophobic.
I didn’t plan for it. I had threats back home . . . from my ex and family members. I have a brother here. He said
I will buy the ticket. Within a matter of days, I was here. In month, he said ‘Ok, get out of my house’. It was very
difficult because, I mean, you think ‘you’re safe’, then you lose another family member. It was very difficult. I was
just 18 and . . . I had nowhere to go.
It never happened back home, but now going through all the stress, I now have anxiety and panic attacks. I went
to the psychologist and they identified a lot of the issues I actually had. The best way that I deal with it, is usually
I don’t have them alone. People usually snap me out of it. I black out, I cry. A friend will shake me out of it like
‘dude’. Everything, everything. I don’t keep it in, ’cause I know it’s not good.
Mental health
Although all of the findings point to the detrimental effects on the mental health of LGBTQ asylum
seekers and refugee claimants some participants spoke specifically about impacts on their mental health.
The next two quotes describe the intense mental health stressors a couple of our participants
experienced:
For me personally, I always prayed that night wouldn’t come. . . . Sometimes I wake up 3 times before dawn
breaks. I take a walk, drink a glass of water. Wait for the nightmare to go. Now it’s a little bit better, but I still
prefer the day. Sleep is hard because of the agony I passed through back home. It’s like they are coming after me
all the time.
When I first came here, I would only sleep one hour. I would wonder what’s wrong with me. I would stay up and
I would just be thinking about stuff. I would think ‘Am I losing it?’. I think there was a point that I decided to
control it. When I saw a car outside, I would flick the curtain. When you would see me, I would flick the curtain.
Honestly, that’s how I was feeling. I did that for one month. Just stay in. I didn’t talk to no one. Just stay in.
Another participant speaks to the socio-economic impact on one’s mental health trying to survive
on social assistance in Canada’s capitalist society and a high cost city such as Toronto, ‘How can I be
happy? I am healthy, but I am not healthy. How do I stay healthy with 500, USD 600 USD?’
1174
N. J. MULÉ
Discussion
The findings corroborate much of the literature and reveal that LGBTQ asylum seekers, refugee
claimants and refugees experience high levels of stress and isolation in their countries of origin, in
their early years in Canada, and due to the refugee claim process resulting in major mental health
challenges. Yet, what must not be overlooked is the exceptional courage and resilience many of
these individuals exhibit. Nevertheless, as outlined by Ramón Mendos (2019), many face homopho­
bia and transphobia frequently reflected in state laws as well as interpersonal relationships culminat­
ing in discrimination, stigmatisation and alienation from family, friends and mainstream supports as
found by Shidlo and Ahola (2013). Similar to Cowen et al. (2011), Envisioning (2014), and Reading and
Rubin (2011) barriers are thus erected to accessing safe spaces, social supports, and professional
services that promote and support mental health and wellness.
LGBTQ asylum seekers may feel isolated due to lack of explicit support because of their sexual
orientation or gender identity/expression upon their arrival in Canada, which may not meet their
expectations of social acceptance. They may initially be confused or uncertain about the refugee
claims process, which when made apparent may become daunting. Additionally, LGBTQ asylum
seekers inhabit multiple minority spheres upon arrival in Canada: a sexual/gender minority, a cultural
minority and possibly a racial minority, among others. These instabilities and uncertainties can
contribute to mental stress (Envisioning, 2015; Organization for Refuge Asylum and Migration
(ORAM), 2012), for as Berg and Millbank (2009) and Murray (2014) found, it may not be safe to
disclose one’s sexual/gender minority status in some of those spheres.
Although LGBTQ communities in Canada have human rights protections, a degree of acceptance
and relative freedom in Canadian society, this study as with McKenzie et al. (2009) and Shidlo and
Ahola (2013) juxtaposes the shame and fear associated with sexual orientation or gender identity for
LGBTQ asylum seekers due to the intimate and/or taboo nature of these topics in their countries of
origin. Along with Reading and Rubin (2011), we found the imperative to disclose, whether socially or
in official contexts (including the asylum and refugee claims processes), can be so stressful some may
avoid accessing support and services. Additionally, LGBTQ asylum seekers may not have the support
of or be at risk within their country-of-origin community ((ORAM), 2012) in Canada (Envisioning,
2014, 2015). Discrimination within these communities can trigger memories of abuse in their
homeland, create new psychological trauma further contributing to isolation. This discrimination
and isolation may also extend to religious communities in Canada. Their declining of mental health
services may also be due to internal guilt, cultural, religious and language barriers. In Canada
(Envisioning, 2015; McKenzie et al., 2009) and elsewhere (Millbank, 2007; Reading & Rubin, 2011),
mental illness itself is stigmatised causing some dealing with mental health issues to not seek out
help out of fear of they themselves being labelled. Additionally, despite Canada’s human rights
protections and relative social acceptance of the LGBTQ communities, as with Luibhéid (2008), we
also found that when migration, race, and sexual, and gender identity intersect, sites of margin­
alisation can be produced for being outside of common gay, white, middle class males.
Further complicating matters is the need to prove one’s sexual orientation or gender identity/
expression during the Canadian refugee claims process, should one’s case be premised on these
grounds (Mulé, 2020). As with Reading and Rubin (2011), we also found such matters can be deeply
personal and sensitive topics and can cause feelings of intense shame and embarrassment. Apart
from the impossibility of proving one’s sexual orientation as argued by Mulé (2020), the LGBTQ
asylum seeker or refugee claimant may hold deeply entrenched survival strategies, such as hiding
their identity, a necessity in their country of origin. Producing proof may need to fit a certain ‘coming
out’ narrative that is aligned with Canadian culture’s identity-based conceptualisation of gender and
sexuality. This narrative may not accurately reflect the experience or cultural context of the claimant.
Similar to the Envisioning report (2015) acquiring letters of support, photographs, and other
evidence from family and friends in their homeland is difficult and carries potential danger for
loved ones who may be targeted for discrimination and violence in the country of origin. That is
PSYCHOLOGY & SEXUALITY
1175
should family and friends even be willing to provide such materials. Further corroborating Mulé
(2020), the expectation of producing appropriate evidence to support the claim was reported as
a source of major stress for LGBTQ asylum seekers and refugee claimants, while they simultaneously
face increased familial and social isolation compared with other asylum seekers.
Consistent with Reading and Rubin (2011) and Shidlo and Ahola (2013), we also found the
asylum and refugee claims process, which involves discussing past trauma and fear of future
persecution with strangers in official roles such as legal counsel, asylum officers, immigration
adjudicators and health providers may contribute to retraumatization, since LGBTQ asylum seekers
may harbour mistrust towards government officials, often the perpetrators of persecution in their
country of origin. The cumulative mental challenges in the findings indicate compounding stress
can cause LGBTQ asylum seekers and refugee claimants great difficulty constructing a thorough
narrative regarding their fear of persecution. Facing the asylum and refugee claims process, while
carrying histories of and reliving past trauma and shame, can negatively impact claimants’ ability
to recall pertinent information, which in turn may affect the claim outcome. Additionally, and
along with Envisioning (2014) and Millbank (2007), feelings of being disbelieved, misunderstood or
misinterpreted can produce stress and feelings of disempowerment and helplessness for asylum
seekers.
Critical psychology can address the findings of this study in two ways. First, a recognition of the
existence of LGBTQ people and their persecution in various parts of the world (Ramón Mendos, 2019)
that leads to their forced migration and seeking of asylum or refugee status (United Nations High
Commissioner for Refugees (UNHCR), 2011). Acknowledging such recognition obliges the discipline
to provide effective services to address the mental health needs of this specified population. Second,
is to note the systemic implications of the asylum seeking and refugee process on LGBTQ people
who are attempting to escape persecution in their countries of origin (Envisioning, 2015).
Understanding how the system impacts the mental health and wellbeing (Watkins & Shulman,
2008) of LGBTQ asylum seekers and refugees can assist in developing more sensitised psychological
services to mitigate the negative effects.
Knowledge of LGBTQ people’s lives in general and LGBTQ asylym seekers, refugee claimants and
refugees in particular can vary considerably among psychologists (King et al., 2007). As Lewin and
Meyer (2002) point out, finding a psychologist who is sensitive to the specific mental health needs of
these populations can be especially difficult, particularly outside of major urban centres. Similar to
Berg and Millbank (2009) and Murray (2014), fear of being outed loomed large in our study, even
when services are available, hence this population’s hesitation to disclose their sexual orientation or
gender identity. Consistent with (ORAM) (2010) and Tabak and Levitan (2014), we found nonconsensual disclosures are a common catalyst for LGBTQ-based persecution in countries lacking or
with poor LGBTQ rights protections. Fear of rumours within communities from their home country
may prevent LGBTQ asylum seekers using the services these communities provide. The same fears
may apply when using LGBTQ community services (Envisioning, 2015).
Conclusion
Through a series of focus groups with LGBTQ+ asylum seekers, refugee claimants, and refugees that
discussed an array of semi-structured qualitative questions, a number of themes emerged that
revealed how the mental health of these populations are seriously compromised. From the persecu­
tion they faced in their countries of origin due to the criminalisation or social denigration of their
sexual orientation or gender identity and expression, to the need to flee to a host country seeking
safety and protection, to navigating the refugee claims process, all while in need of basic supports
such as housing, employment and food to resources such as a lawyer, health workers and social
supports – the mental health of persecution-related LGBTQ+ people is heavily impacted. This
indicates that the needs of these populations require focused, nuanced and careful attention as
they are not necessarily aligned with those of heterosexual and cisgendered asylum seekers, refugee
1176
N. J. MULÉ
claimants, and refugees. Both policies and services need to be cognitive of and responsive to such
needs towards non-discriminatory and relevant approaches to settlement work.
Despite having engaged with participants from 27 countries, a limit to this study is that all of our
participants were English speaking. Future studies through translation resources may study a larger
sample for which language would not be a barrier. Also, these countries and some therein had higher
levels of representation due to the prevalence of service recipients at partner organisations. Some ingroup differences also emerged regarding lesbians with children and, trans populations at varying
stages of transition. The findings of this study point to numerous unique mental health challenges based
on gender identity and/or expression and sexual orientation due to systemic heterosexism, homopho­
bia, and transphobia resulting in specified needs of LGBTQ+ asylum seekers, refugee claimants, and
refugees. Critical psychology along with social service, health care and settlement workers can con­
tribute to resolving many of the unique challenges of these communities in the migration sector.
Disclosure statement
No potential conflict of interest was reported by the author.
Funding
This work was supported by the Social Sciences and Humanities Research Council of Canada under Grant: 435-20121805.
Notes on contributor
Nick J. Mulé, PhD is an associate professor in the School of Social Work, cross appointed to the Faculty of Health and the
School of Gender, Sexuality and Women’s Studies where he is currently serving as Coordinator of the Sexuality Studies
Program at York University in Toronto, Ontario, Canada. His research interests include the social inclusion/exclusion of
LGBTQ populations in social policy and service provision and the degree of their recognition as distinct communities in
cultural, systemic, and structural contexts. He also engages in critical analysis of the LGBTQ movement and the
development of queer liberation theory. He has co-edited LGBTQ People and Social Work: Intersectional Perspectives
(2015); Queering Social Work Education (2016); The Shifting Terrain: Nonprofit Policy Advocacy in Canada (2017) and
Envisioning Global LGBT Human Rights: (Neo)colonialism, Neoliberalism, Resistance and Hope (2018); and directed, wrote
and executive produced his first feature documentary ‘QueerEdge: From Gay to Queer Liberation’ (2019). A queer
activist for many years, Nick is the founder, past chairperson and currently secretary of Queer Ontario. In addition, he is
a psychotherapist in private practice serving LGBTQ populations in Toronto.
References
Acevedo-Garcia, D., Sanchez-Vaznaugh, E. V., Viruell-Fuentes, E. A., & Almeida, J. (2012). Integrating social epidemiology
into immigrant health research: A cross-national framework. Social Science & Medicine, 75(12), 2060–2068. https://doi.
org/10.1016/j.socscimed.2012.04.040
Bartolomei, J., Baeriswyl-Cottin, R., Framorando, D., Kasina, F., Premand, N., Eytan, A., & Khazaal, Y. (2016). What are the
barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health
caregivers and primary care workers. BMC Psychiatry, 16(1), 336. https://doi.org/10.1186/s12888-016-1048-6
Benson, C. J. (2008). Crossing borders: A focus on treatment of transgender individuals in US asylum law and society.
Whittier Law Review, 30(1), 41–66.
Berg, L., & Millbank, J. (2009). Constructing the personal narratives of lesbian, gay and bisexual asylum claimants. Journal
of Refugee Studies, 22(2), 195–223. https://doi.org/10.1093/jrs/fep010
Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34. https://doi.org/10.1111/j.
1464-0597.1997.tb01087.x
Bidell, M. P. (2016). Mind our professional gaps: Competent lesbian, gay, bisexual, and transgender mental health
services. Counselling Psychology Review, 31(1), 67–76.
Burnes, T. R., & Stanley, J. L. (2017). Teaching LGBTQ psychology: Queering innovative pedagogy and practice. American
Psychological Association.
PSYCHOLOGY & SEXUALITY
1177
Clarke, V., & Peel, E. (2007). From lesbian and gay psychology to LGBTQ psychologies: A journey into the unknown (or
unknowable)? In V. Clarke & E. Peel (Eds.), Out in psychology: Lesbian, gay, bisexual, trans and queer perspectives (pp.
11–35). John Wiley & Sons Ltd.
Clarke, V., Ellis, S., Peel, E., & Riggs, D. W. (2010). Lesbian, gay, bisexual, trans and queer psychology: An introduction.
Cambridge University Press.
Cowen, T., Stella, F., Magahy, K., Strauss, K., & Morton, J. (2011). Sanctuary, safety, and solidarity: Lesbian, gay, bisexual,
transgender asylum seekers and refugees in Scotland. Equality Network BEMIS and GRAMNet. March 2011.
Daley, A., & Mulé, N. J. (2014). LGBTQs and the DSM-5: A critical queer response. Journal of Homosexuality, 61(9),
1288–1312. https://doi.org/10.1080/00918369.2014.926766
Envisioning Global LGBT Human Rights. (2014). Envisioning LGBT refugee rights in Canada: The impact of canada’s new
immigration regime. Envisioning Global LGBT Human Rights. http://envisioninglgbt.blogspot.ca/p/publicationsre
sources.html.
Envisioning Global LGBT Human Rights. (2015). Envisioning LGBT refugee rights in Canada: Is Canada a safe haven?
Frost, D. M., & Meyer, I. H. (2012). Measuring community connectedness among diverse sexual minority populations.
Social Science Study Sex, 49(1), 36–49. https://doi.org/10.1080/00224499.2011.565427
Glassgold, J. M., & Drescher, J. (2007). Activism and LGBT psychology: An introduction. Journal of Gay & Lesbian
Psychotherapy, 11(3–4), 1–8. https://doi.org/10.1300/J236v11n03_01
Gowin, M., Taylor, E. L., Dunnington, J., Alshuwaiyer, G., & Cheney, M. K. (2017). Needs of a silent minority. Health
Promotion & Practice. 1524839917692750.
Güler, A., Shevstova, M., & Venturi, D. (2019). LGBTI asylum seekers and refugees from a legal and political perspective :
Persecution, asylum and integration. Springer.
Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation
framework. Psychology Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441
Hopkinson, R., Keatley, E., Glaeser, E., Erickson-Schroth, L., Fattal, O., & Nicholson Sullivan, M. (2017). Persecution
experiences and mental health of LGBT asylum seekers. Journal of Homosexuality, 64(12), 1650–1666. https://doi.
org/10.1080/00918369.2016.1253392
IPsyNet. (2018). IPsyNet statement on LGBTIQ+ concerns. International Psychology Network for Lesbian, Gay, Bisexual,
Transgender and Intersex Issues.
Kahn, S. (2015). Cast out: “Gender role outlaws” seeking asylum in the West and the quest for social connections. Journal
of Immigrant & Refugee Studies, 13(1), 58–79. https://doi.org/10.1080/15562948.2014.894169
Kahn, S., Alessi, E., Kim, H., Woolner, L., & Olivieri, C. (2018). Facilitating mental health support for LGBT forced migrants:
A qualitative inquiry. Journal of Counseling & Development, 96(3), 316–326. https://doi.org/10.1002/jcad.12205
King, M., Semlyen, J., Killaspy, H., Nazareth, I., & Osborn, D. (2007). A systematic review of research on counselling and
psychotherapy for lesbian, gay, bisexual & transgender people. British Association for Counselling and Psychotherapy.
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), 70. https://doi.
org/10.1186/1471-244X-8-70
Lee, E. O. J., & Brotman, S. (2011). Identity, refugeeness, belonging: Experiences of sexual minority refugees in Canada.
Canadian Review of Sociolology, 48(3), 241–274. https://doi.org/10.1111/j.1755-618X.2011.01265.x
Lewin, S., & Meyer, I. H. (2002). Torture and Ill-treatment based on sexual identity: The roles and responsibilities of
health professionals and their institutions. Health and Human Rights, 6(1), 161–176. https://doi.org/10.2307/
4065319
Logie, C. H., Lacombe-Duncan, A., Lee-Foon, N., Ryan, S., & Ramsay, H. (2016). “It’s for us -newcomers, LGBTQ persons,
and HIV-positive persons. You feel free to be”: A qualitative study exploring social support group participation
among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada.
BMC International Health and Human Rights, 16, 18. https://doi.org/10.1186/s12914-016-0092-0
Luibhéid, E. (2008). Queer/migration: An unruly body of scholarship. GLQ: A Journal of Lesbian and Gay Studies, 14(2),
169–190. https://doi.org/10.1215/10642684-2007-029
Martin-Baro, I. (1996). Writings for a liberation psychology. Harvard University Press.
Matza, A. R., Sloan, C. A., Kauth, M. R., & DeBakey, M. E. (2015). Quality LGBT health education: A review of key reports and
webinars. Clinical Psychology, 22(2), 127–144. https://doi.org/10.1111/cpsp.12096
McGuirk, S., Niedzwiecki, M., Oke, T., & Volkova, A. (2015). Stronger together, a guide to supporting LGBT asylum seekers.
LGBT Freedom and Asylum Network. http://www.lgbt-fan.org/wp-content/uploads/2015/06/Stronger_Together_
FINAL.pdf
McKenzie, K., Hansson, E., Tuck, A., & Lurie, S. (2009). Improving mental health services for immigrant, refugee, ethnocultural and racialized groups. Mental Health Commission. Centre for Addiction and Mental Health.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual
issues and research evidence. Psychological Bulletin, 129(5), 674–697. http://dx.doi.org.ezproxy.library.yorku.ca/10.
1037/0033-2909.129.5.674
Millbank, J. (2007). Constructing the personal narratives of lesbian, gay and bisexual asylum claimants. Journal of
Refugee Studies, 22(2), 195–223. https://doi.org/10.1093/jrs/fep010
1178
N. J. MULÉ
Moreno, A., Ardila, R., Zervoulis, K., Nel, J. A., Light, E., & Chamberland, L. (2020). Cross-cultural perspectives of LGBTQ
psychology from five different countries: Current state and recommendations. Psychology & Sexuality, 11(1–2), 5–31.
https://doi.org/10.1080/19419899.2019.1658125
Mulé, N. J. (2019). Kink and the DSM-5: Pathologization, regulation, stigmatization. In S. Petrella (Ed.), Erotic subjects and
outlaws: Sketching the borders of sexual citizenship (pp. 131–155). Brill Rodopi.
Mulé, N. J. (2020). Safe haven questioned: Proof of identity over persecution of SOGIE asylum seekers and refugee
claimants in Canada. Journal of Immigrant & Refugee Studies, 18(2), 207–223. https://doi.org/10.1080/15562948.2019.
1639238
Murray, D. A. (2014). Real queer: “Authentic” LGBT refugee claimants and homonationalism in the Canadian refugee
system. Anthropologica, 56(1), 21–32. http://www.jstor.org/stable/24469638
Nicol, N., Gates-Gasse, E., & Mulé, N. J. (2014). Envisioning global LGBT human rights: Strategic alliances to advance
knowledge and social change. Scholarly and Research Communication, 5(3), 16. https://doi.org/10.22230/src.
2014v5n3a165
Ordre des Psychologues du Québec. (2012). Les interventions qui visent à changer l’orientation sexuelle [Press release].
Ordre des Psychologues du Quebéc. https://www-ordrepsy-qc-ca.ezproxy.library.yorku.ca/documents/26707/63191/
Les+interventions+qui+visent+à+changer+l’orientation+sexuelle/b57fed59-38cb-4496-8976-2a5b832cf035
Organization for Refuge Asylum and Migration (ORAM). (2012). Blind alleys, guidance for NGOs. Governments, UNHCR &
Program Funders.
Organization for Refugee Asylum and Migration (ORAM). (2010) . Rights & protection of lesbian, gay, bisexual, transgender
& intersex refugees & asylum seekers under the yogyakarta principles. ORAM.
Organization for Refugee Asylum and Migration (ORAM). (2012). Rainbow bridges: Community guide to rebuilding lives of
LGBTI refugees and asylees. ORAM.
Piwowarczyk, L., Fernandez, P., & Sharma, A. (2017). Seeking asylum: Challenges faced by the LGB community. Journal of
Immigrant and Minority Health, 19(3), 723–732. https://doi.org/10.1007/s10903-016-0363-9
Ramón Mendos, L. (2019). State-sponsored homophobia (13th ed.). ILGA. https://ilga.org/downloads/ILGA_State_
Sponsored_Homophobia_2019.pdf
Reading, R., & Rubin, L. R. (2011). Advocacy and empowerment: Group therapy of LGBT asylum seekers. Traumatology, 17
(2), 86–98. https://doi.org/10.1177/1534765610395622
Roberts, L. R., Mann, S. K., & Montgomery, S. B. (2016). Mental health and sociocultural determinants in an Asian Indian
community. Family & Community Health, 39(1), 31–39. https://doi.org/10.1097/FCH.0000000000000087
Shidlo, A., & Ahola, J. (2013). Mental health challenges of LGBT forced migrants. Forced Migration: Sexual Orientation and
Gender Identity and the Protection of Forced Migrants, 42, 9–11.
Silove, D., Steel, Z., Susljik, I., Frommer, N., Loneragan, C., Chey, T., Brooks, R., Le Touze, D., Ceollo, M., Smith, M., Harris, E.,
& Bryant, R. (2007). The impact of the refugee decision on the trajectory of PTSD, anxiety, and depressive symptoms
among asylum seekers: A longitudinal study. American Journal of Disaster Medicine, 2(6), 321–329. https://doi.org/10.
5055/ajdm.2007.0041
Stevenson, M. R. (2005). Uncle Sam needs you: Public policy and LGBT psychology. Division 44 Newsletter, 21, 12–15.
Tabak, S., & Levitan, R. (2014). LGBTI migrants in immigration detention: A global perspective. Harvard Journal of Law &
Gender [Serial Online], 37(1), 1–44. Accessed September 24, 2014., Available from: Legal Source, Ipswich, MA. http://
digitalcommons.wcl.american.edu/facsch_lawrev
United Nations High Commissioner for Refugees (UNHCR). (2011). Working with lesbian, gay, bisexual, transgender and
intersex persons in forced displacement. https://www.refworld.org/pdfid/4e6073972.pdf
Veltman, A., & Chaimowitz, G. (2014). Mental health care for people who identify as lesbian, gay, bisexual, transgender,
and (or) queer. The Canadian Journal of Psychiatry, 59(11), 1–7. https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4244881/
Victor, C. J., & Nel, J. A. (2016). Lesbian, gay, and bisexual clients’ experience with counselling and psychotherapy in
South Africa: Implications for affirmative practice. South African Journal of Psychology, 46(3), 351–363. https://doi.org/
10.1177/0081246315620774
Victor, C. J., & Nel, J. A. (2017). Developing an affirmative position statement on sexual and gender diversity for
psychology professionals in South Africa. Psychology in Russia: State of the Art, 10(2), 87–102. https://cyberleninka.
ru/article/n/developing-an-affirmative-position-statement-on-sexual-and-gender-diversity-for-psychology-profes
sionals-in-south-africa
Victor, C. J., Nel, J. A., Lynch, I., & Mbatha, K. (2014). The psychological society of South Africa sexual and gender diversity
position statement: Contributing towards a just society. South African Journal of Psychology, 44(3), 292–302. https://
doi.org/10.1177/0081246314533635
Watkins, M., & Shulman, H. (2008). Toward psychologies of liberation. Palgrave Macmillan.