A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

2023 | VOLUME 18 | ISSUE 4 

LGBTQIA+ Communities and Disasters 

The Dialogue 
The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which 

is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) 

Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster 

behavioral health professionals share information and resources while examining the 

disaster behavioral health preparedness and response issues that are important to the field. 

The Dialogue also provides a comprehensive look at the disaster training and technical 

assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local 

entities so they can deliver an effective disaster behavioral health response. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health 

professionals plan for and respond effectively to mental health and substance misuse needs 

following a disaster. 

To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa. 

hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac. 

CONTENTS 

3 In This Issue 

4 Contributors 

6 Two-Spirit and LGBT+ Disaster Vulnerabilities 

10 Glossary of Terms: Sexual Orientation, Gender Identity, and Gender Expression 

14 LGBTQ+ Communities and Disasters: Supporting Resilience and Improving Outcomes 

20 LGBTQIA+ People and Disasters: New Government Resources 

24 Recent Technical Assistance Requests 

COVER Photo by Adobe Stock 
2023 | VOLUME 18 | ISSUE 4 | PAGE 3 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

In recent years, communities of people who are 

LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, 

questioning, intersex, asexual, and part of other gender 

identity and sexual orientation minority populations) 

have gained visibility, accompanied by significant

advancements in civil rights, legal protections, and 

social acceptance. However, despite these positive 

strides, these communities face challenges, including 

those stemming from natural or human-caused disasters. 

Disasters not only amplify preexisting inequalities but 

also expose unique vulnerabilities within LGBTQIA+ 

populations, significantly impacting mental health and

overall well-being. 

Understanding how to best serve LGBTQIA+ 

communities’ disaster behavioral health needs requires 

a multidisciplinary approach that draws upon insights 

from fields such as psychology, sociology, public

health, emergency management, and social work, and 

most importantly, from LGBTQIA+ individuals and 

communities. Such an approach allows for a better 

understanding of the factors that shape the experiences 

of LGBTQIA+ individuals before, during, and after 

disasters, as well as the specific challenges they face

when accessing and receiving adequate mental health 

and substance use support and care. 

This issue of The Dialogue seeks to shed light on 

the unique challenges LGBTQIA+ individuals face 

during disasters and strategies for improvement. We 

aim to advance knowledge and promote evidencebased practices that can better address the needs of 

LGBTQIA+ individuals in disaster situations, ultimately 

contributing to more inclusive and effective disaster

response and recovery efforts.

The issues impacting behavioral health disparities 

and vulnerabilities among LGBTQIA+ individuals in 

disaster contexts include discrimination, stigma, and 

prejudice; intersectionality and the compounding effects

of being part of multiple marginalized groups during 

In This Issue 

disasters; and lack of access to health care and support 

services in disaster-affected areas. Inclusive disaster

preparedness, response, and recovery planning for 

LGBTQIA+ populations examines and acknowledges 

these issues and seeks to serve LGBTQIA+ communities 

and address their needs while developing strategies for 

promoting resilience, coping, and post-disaster recovery. 

In the following pages, contributing authors explore 

the disaster behavioral health needs of LGBTQIA+ 

disaster survivors. The first article features experts

from the SAMHSA Tribal Training and Technical 

Assistance Center sharing information about Native 

American LGBTQIA+ populations and the unique 

challenges of serving these intersectional communities. 

The second feature is a glossary of currently accepted 

terms pertaining to sexual orientation, gender identity, 

and gender expression. In the third article, thought 

leaders delve into recent research and recommendations 

for equitable LGBTQIA+ disaster behavioral health 

planning and response. The final article summarizes

new federal resources focused on enhancing equity for 

LGBTQIA+ people and fostering health, well-being, and 

overall quality of life for sexual orientation and gender 

identity minority populations. 
2023 | VOLUME 18 | ISSUE 4 | PAGE 4 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

communities. They are also a board member for OUT 

for Sustainability where they will be publishing a 

first-of-its-kind report on LGBTQ+ considerations for

emergency managers. 

Goldsmith holds a master of environmental management 

from the Yale School of the Environment and a B.A. 

in environmental studies from Oberlin College. He 

will be pursuing his Ph.D. at the Yale School of the 

Environment, starting in fall 2023, to continue his 

research. 

Kate Hough, M.A. (she/her) 

manages materials development 

for the Substance Abuse 

and Mental Health Services 

Administration (SAMHSA) 

Disaster Technical Assistance 

Center (DTAC). She manages 

production of The Dialogue and the Supplemental 

Research Bulletin, as well as development and 

updates to the SAMHSA Disaster Behavioral Health 

Information Series resource collection. She also supports 

development and production of other SAMHSA DTAC 

Contributors 

Leo Goldsmith (he/they) serves 

as a Senior Climate and Health 

Specialist for ICF, where he 

coordinates the Interagency 

Crosscutting Group on Climate 

Change and Human Health 

and several chapters of the 

Fifth National Climate Assessment (NCA5). They have 

significant experience in working with community

organizations, nonprofits, and subnational governments

on environmental justice activities. 

Outside of ICF, his research focuses on climate change 

impacts on the health of LGBTQ+ populations and 

those with intersecting marginalized identities. They 

have published two articles related to the subject in 

leading journals. He has given many professional 

talks and lectures to federal agencies, academic 

institutions, scientific institutions, and nongovernmental

organizations on the subject. His subject matter 

expertise has led to him being invited as a technical 

contributor on sexual and gender minorities for 

the NCA5 and to provide recommendations to the 

National Academy of Medicine Action Collaborative 

on Decarbonizing the U.S. Health Sector on frontline 

If you have experience with LGBTQIA+ disaster 

behavioral health planning, other planners and 

responders can learn from your efforts and experience.

Please contact us to share your stories and lessons 

learned. ■

CAPT Erik Hierholzer, B.S.N., Program Management 

Officer, Emergency Mental Health and Traumatic Stress

Services Branch erik.hierholzer@samhsa.hhs.gov 

Nikki Bellamy, Ph.D., Public Health Advisor, 

Emergency Mental Health and Traumatic Stress 

Services Branch nikki.bellamy@samhsa.hhs.gov 

Shannon Loomis, M.A., Director, Substance Abuse 

and Mental Health Services Administration (SAMHSA) 

Disaster Technical Assistance Center (DTAC) dtac@ 

samhsa.hhs.gov 

A note about language: In this issue of The Dialogue, 

we use various acronyms in referring to diverse sexual 

orientations, gender identities, and gender expressions. 

In doing so, we are following the language used by the 

authors and data sources. 
2023 | VOLUME 18 | ISSUE 4 | PAGE 5 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

materials, including tip sheets, posters, and guides. 

She has done work for SAMHSA DTAC since 2010, 

with contributions ranging from editing to writing to 

research. She holds an M.A. in professional writing from 

Carnegie Mellon University. 

Sarah Lake, M.A. (she/her) is 

a Communication Coordinator 

and Technical Writer for the 

SAMHSA Tribal Training 

and Technical Assistance 

Center. Lake earned her 

B.A. in writing, rhetoric, and 

technical communication and M.A. in communication 

and advocacy from James Madison University. She 

enjoys advocacy and previously worked with paralyzed 

veterans before supporting prevention of suicide and 

substance use in tribal communities. She lives in 

Richmond, Virginia, with her dog, Cedar, and they enjoy 

hiking around the James River. 

Michael Méndez, Ph.D. (he/ 

him) is an Assistant Professor 

of Environmental Policy and 

Planning at the University of 

California, Irvine; an Andrew 

Carnegie Fellow; and Visiting 

Scientist at the National Center 

for Atmospheric Research (through a National Science 

Foundation Early Faculty Career Award). He previously 

was the Pinchot Faculty Fellow in Sustainability Studies 

at the Yale School of the Environment. Méndez has 

more than a decade of senior-level experience in the 

public and private sectors, where he consulted and 

actively engaged in the policymaking process. 

His first book, Climate Change from the Streets, 

published through Yale University Press (2020), is 

an urgent and timely story of the contentious politics 

of incorporating environmental justice into global 

climate change policy. The book was the winner of 

the Harold and Margaret Sprout Award, sponsored by 

the International Studies Association, and the Betty 

and Alfred McClung Lee Award by the Association 

for Humanist Sociology. In 2021, he became the first

Latinx scholar to receive the National Academies of 

Sciences’ Henry and Bryna David Endowment Award 

for his wildfire and migrant research. The David

Endowment makes an annual award (research grant) to 

a “leading researcher who has drawn insights from the 

behavioral and social sciences to inform public policy.” 

In addition, he was awarded the 2023 William R. and 

June Dale Scholar Prize. The Dale Prize honors scholars 

and practitioners for excellence in urban planning and 

environmental justice work and research. 

Gary Neumann has over 

30 years of experience in 

the fields of prevention and

human resource development. 

Neumann has worked 

successfully with a variety 

of tribal, state, and federal 

agencies on program design, implementation, and 

evaluation focusing on at-risk youth, their families, and 

communities. Neumann served as the Project Manager 

of the Rocky Mountain Tribal Access to Recovery III 

program and as the Training and Technical Assistance 

Director of the Native American Center for Excellence. 

Having developed and conducted Affordable Care

Act (ACA) trainings for Montana/Wyoming tribes, 

Neumann’s work experience includes extensive 

knowledge of the ACA and of the Tribal Law and Order 

Act and how they apply to American Indians and Alaska 

Natives. Neumann is skilled in assessment, capacity 

building, prevention specialization, marketing, grant 

writing, methamphetamine prevention, youth violence, 

bullying and suicide prevention, and sustainability. 

Neumann has developed several culturally appropriate 

training curricula and community-based organizing 

modules and presented and trained at many national and 

international conferences throughout the United States, 

Alaska, and Canada. Neumann is an enrolled member 

of the Confederated Salish & Kootenai Tribes of the 

Flathead Indian Nation. 
2023 | VOLUME 18 | ISSUE 4 | PAGE 6 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

The coronavirus disease, or 

COVID-19, pandemic was declared 

a nationwide emergency in 2020. It 

was and continues to be the largest 

national disaster in recent history. 

Many were sick and emergency 

response was needed around the 

clock. For those who were not sick, 

quarantine efforts kept them isolated

from family, friends, and the rest 

of the world in hopes of keeping 

the virus at bay. These experiences 

brought to the forefront the impact 

disasters have on two-spirit, lesbian, 

gay, bisexual, transgender, and 

queer (TSLGBTQ+) communities. 

According to a survey conducted by 

the Wabanaki Two-Spirit Alliance, 

the pandemic caused an increase 

in mental health concern, racism, 

domestic or family violence, 

depression, suicidal thoughts, 

transphobia, and queerphobia 

(Sylliboy et al., 2022). TSLGBTQ+ 

Two-Spirit and LGBT+ Disaster Vulnerabilities 

By Gary Neumann, Salish and Pend d’Oreille, SAMHSA Tribal Training and Technical Assistance Center; Sarah 

Lake, M.A., SAMHSA Tribal Training and Technical Assistance Center 

individuals have unique needs, 

and many emergency response 

systems do not have the resources 

and capabilities to meet these needs 

during an emergency. Even worse, 

some experienced an outright 

refusal or lack of help because of 

discrimination based on their Native 

and two-spirit identity. 

Factors Impacting Disaster 

Recovery for TSLGBTQ+ 

Individuals 

Disasters are nondiscriminatory and 

affect all ages, races, genders, and

sexualities. However, someone’s 

identity influences the rate or

success of their recovery after a 

disaster. According to the Center 

for Disaster Philanthropy (CDP), 

some factors increase vulnerabilities 

for TSLGBTQ+ communities 

during or after a disaster. These 

factors include isolation, distrust, 

disrespect, lack of medications, nonaffirmation of gender, harassment,

and violence. TSLGBTQ+ seniors 

or older people experience high 

Pride flag for TSLGBTQ+ communities.

“Traditionally, Native American two-spirit 

people were male, female, and sometimes 

intersex individuals who combined activities of 

both men and women with traits unique to their 

status as two-spirit people. In most tribes, they 

were considered neither men nor women; they 

occupied a distinct, alternative gender status.” 

—Indian Health Service 
2023 | VOLUME 18 | ISSUE 4 | PAGE 7 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

rates of isolation, meaning they are 

more likely to be alone during an 

emergency. They are less likely to 

have friends or family providing 

care or aid during a disaster. A bleak 

history of emergency responders and 

healthcare systems discriminating 

against the TSLGBTQ+ population 

compounds the issue. Rightfully, 

TSLGBTQ+ people have a lack 

of trust from past experiences, 

such as emergency or recovery 

services disrespecting nontraditional 

families. This results in families 

becoming separated or unable 

to access appropriate resources. 

During emergency situations, 

access to HIV medication or 

hormones is sometimes limited as 

providers are unavailable or the 

importance of maintaining a regimen 

is undervalued. For two-spirit 

individuals living on reservations 

or in rural areas, emergency or 

recovery services are frequently 

delayed. When they do receive 

assistance, they may encounter 

discrimination based on their Native 

identity, as well as their gender and 

sexual orientation. 

Emergency shelter accommodations 

are not always welcoming or 

accepting of gender identity for 

TSLGBTQ+ individuals and, often, 

cultural understanding is absent. 

Access to bathrooms, showers, 

or safe sleeping places presents 

problems in shelters. People can 

be forced to stay in a shelter not 

matched to their gender identity 

and/or expression because of the 

gender listed on their identification.

TSLGBTQ+ people experience 

harassment or physical violence in 

congregate living settings. These 

factors, along with Native identity, 

impede ability to recover after a 

disaster. This struggle to return to 

“normal” life and mental well-being 

creates more trauma for TSLGBTQ+ 

individuals. 

Stigma, discrimination, and 

overrepresentation among people 

experiencing homelessness are other 

key areas noted by the CDP as issues 

in disaster response and recovery 

for the TSLGBTQ+ population. The 

Williams Institute shares that as of 

March 2023, TSLGBTQ+ people 

comprise about 4.5 percent of the 

total U.S. population. However, 

that statistic is recognized as being 

underreported by TSLGBTQ+ 

communities for various reasons, 

“Two Spirit [is] a term used in a number 

of Native American cultures to describe a 

third gender that is embraced by some 

non-heterosexuals.” 

—Indian Country Today 

“‘Two-Spirit’ is an intertribal umbrella term that 

serves as an English-language placeholder for 

tribally specific gender and sexual orientation

identities that are centered in tribal worldviews, 

practices, and knowledges. Tribes have their 

own specific term for gender statuses (e.g.,

in Navajo, Nádleehí refers to one who is 

transformed), and many go beyond the binary 

construct of male or female and are part of a 

holistic view of personhood that encompasses 

not only gender or sexual orientation identity, 

but also a social and cultural position that shapes 

and defines all aspects of one’s life.”

—National Academies of Sciences, Engineering, 

and Medicine 
2023 | VOLUME 18 | ISSUE 4 | PAGE 8 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

including mistreatment people may 

face upon identifying themselves as 

part of TSLGBTQ+ communities 

or fear of relationships worsening 

or ending with acquaintances, 

coworkers, friends, or loved ones 

who do not accept TSLGBTQ+ 

identities. Additionally, “At least 

25-40 percent of homeless youth 

are members of the LGBTQ+ 

community” (CDP). The ability of 

youth experiencing homelessness 

to access emergency information is 

reduced, and they lack the resources 

to prepare or evacuate effectively.

After a disaster, prices for safe 

living options typically increase, 

causing an additional complexity for 

unhoused TSLGBTQ+ communities. 

Disaster Responders 

Can Support TSLGBTQ+ 

Individuals During Recovery 

Timely, useful, and inclusive 

emergency responses can help in 

the physical and mental well-being 

of TSLGBTQ+ individuals after 

a disaster. As CDP highlighted, 

TSLGBTQ+ communities 

experience many factors that 

delay aid or cause additional 

harm. Communities and disaster 

responders can take steps to help 

foster inclusion and improve postdisaster experiences for TSLGBTQ+ 

people: 

• The general population can 

help combat the additional 

barriers TSLGBTQ+ people 

face in disasters by showing 

support for TSLGBTQ+ issues 

in their community, including 

using pronouns in their own 

introductions, and using the 

pronouns each person identifies as

their own. 

• Disaster responders, emergency 

managers, and public health 

professionals can include 

TSLGBTQ+ issues in 

discrimination policies and 

include responses to TSLGBTQ+ 

community needs in disaster 

planning. Inclusive response and 

care for marginalized identities can 

and should be a part of all disaster 

planning and response. 

For more information on issues 
2023 | VOLUME 18 | ISSUE 4 | PAGE 9 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

IN PRACTICE 

Supporting TSLGBTQ+ People Around Disasters 

■ Show support for TSLGBTQ+ issues in your

community. 

■ Use pronouns in your introductions, and use

the pronouns people identify as their own. 

■ Include protections for TSLGBTQ+ people in

discrimination policies. 

■ Include responses to the needs of TSLGBTQ+

communities in disaster planning. 

around the impact of disasters 

on TSLGBTQ+ communities, 

visit the CDP website at https:// 

disasterphilanthropy.org/resources/ 

lgbtq-communities-and-disasters. 

The National Disaster Interfaiths 

Network has a tip sheet for 

TSLGBTQ+ needs and disaster 

response for religious leaders. It is 

available in the SAMHSA Disaster 

Behavioral Health Information 

Series online resource collection at 

https://www.samhsa.gov/resource/ 

dbhis/lgbt-lesbian-gay-bisexualtransgender-needs-disaster. ■

About the SAMHSA 

Tribal Training and 

Technical Assistance 

(TTA) Center 

The SAMHSA Tribal TTA 

Center offers products and

services to help American 

Indian and Alaska Native 

communities to prevent 

mental and substance use 

disorders and promote 

mental health. Services 

include curriculum 

development, capacity 

building, and training. 

The SAMHSA Tribal TTA 

Center can be reached by 

toll-free phone at 1–800– 

953–1379, via email at 

ta-request@tribaltechllc. 

com, or through a contact 

page on their website. 

Source: Wilson et al., 2022, p. 9 

U.S. Poverty Rates by Race and Ethnicity, 2021—LGBT and Straight/Cisgender 

BY THE NUMBERS 

? POLICY

 POLICY

? POLICY

? POLICY
2023 | VOLUME 18 | ISSUE 4 | PAGE 10 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

This glossary has been created 

to provide disaster behavioral 

health practitioners with important 

information to help them support 

people who are lesbian, gay, 

bisexual, transgender, queer, 

questioning, intersex, two-spirit, 

or people with other sexual 

orientations, gender identities, or 

gender expressions with minority 

demographic status (LGBTQ+). 

Language related to LGBTQ+ 

communities, like all of language, 

is always changing. This glossary is 

intended to capture language use at 

a specific moment in time; it is not

exhaustive or final.

Definitions in this glossary come

primarily from three sources: 

• The SAMHSA Disaster Technical 

Assistance Center’s Key Diversity, 

Equity, and Inclusion Terms web 

page 

• Measuring Sex, Gender Identity, 

and Sexual Orientation, a report 

by the National Academies of 

Sciences, Engineering, and 

Medicine 

• SOGIE Glossary of Terms, 

available from the Resources page 

of the website of the SAMHSA 

Center of Excellence on LGBTQ+ 

Behavioral Health Equity for 

download in English, Spanish, or 

Portuguese, and encompassing 

terms related to sexual orientation 

and gender identity and expression 

(SOGIE) 

Agender is used to describe an 

individual who identifies without

gender or who does not identify with 

any gender. 

Allosexual describes anyone who 

feels sexual attraction toward other 

people but may or may not engage in 

romantic relationships or experience 

romantic attraction. 

An ally is a person, group, or 

organization that supports people 

in LGBTQ+ communities or 

a particular issue in LGBTQ+ 

communities. 

Androgynous describes an 

expression of gender that has 

both feminine and masculine 

characteristics. 

Aromantic is used to describe a 

person who experiences little or no 

romantic attraction and who may or 

may not experience sexual attraction 

or have sexual relationships. 

Asexual describes a person who 

experiences little to no sexual desire 

or attraction and who may or may 

not experience romantic attraction 

Glossary of Terms: Sexual Orientation, Gender 

Identity, and Gender Expression 

By the SAMHSA Disaster Technical Assistance Center 

“ The U.S. Census Bureau in July [2021] 

began asking Americans about their sexual 

orientation and gender identity [through 

the Census Bureau’s Household Pulse 

Survey. This [is] the first time the federal 

government has tried to capture data on 

LGBTQ+ Americans in its large real-time 

national surveys” (Carrazana & Rummler, 

2021).
2023 | VOLUME 18 | ISSUE 4 | PAGE 11 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

or have romantic relationships. 

People sometimes shorten this term 

to “ace.” 

Bi+/Bisexual+ is a term for a person 

who experiences any type of 

attraction to more than one gender. 

Bisexual describes a person sexually 

oriented toward their own gender as 

well as other genders. 

Cisgender means a person whose 

gender identity is the same as the sex 

they were assigned at birth. 

Coming out is the process of 

accepting personal sexual orientation 

or gender identity to yourself and/or 

other people. This can be a lifelong 

and daily event which is often 

incorrectly assumed to be a one-time 

event. 

Cross dress describes when a person 

wears clothing associated with 

another gender within their culture 

and historical timeframe. It is not 

an expression of gender identity or 

sexual orientation. 

Deadname (noun) describes the 

birth name of a trans person that the 

individual no longer uses. Deadname 

(verb) is the act of calling a trans 

person by the name they no longer 

use. 

Drag queen/king is not a description 

of a person’s sexual orientation 

or gender identity but describes a 

person who dresses and performs 

as another gender in a theatrical 

and often exaggerated manner for 

entertainment. 

Endosex is a term used for a person 

whose sex characteristics match 

medical and social expectations of 

their sex documented at birth. 

Feminine is a gender expression for 

the socially constructed, culturally 

specific gender behaviors expected

of women by society. 

Gay describes a person attracted to 

the same sex. It most commonly 

describes men attracted to other 

men. It may also describe and be 

used by people who are attracted to 

the same gender as themselves. 

Gender is a constellation of 

characteristics, behaviors, sex 

traits, gender expressions, gender 

identities, and cultural expectations 

around status, behavior, and other 

attributes associated with sex traits. 

It includes behaviors and norms 

related to being androgynous, other, 

feminine, or masculine. Gender is 

not a biological construct but is a 

social one. 

Genderqueer is an umbrella term 

to describe anyone whose gender 

identity does not fit with the binary

of man or woman. 

Gender identity is a key component 

of an individual’s sense of self, a 

person’s internal sense of being a 

woman, a man, nonbinary, agender, 

or another gender. It exists on a 

spectrum and may change over the 

course of a person’s life. 

Gender role is a term for the social 

and cultural expectations regarding 

attitudes and behaviors that are 

expected of a person based on their 

perceived or assigned sex at birth. 

Heteronormativity is the belief that 

being heterosexual is superior or 

About 1.3 million U.S. adults 

(about 0.5 percent) identify as 

transgender. Among youth ages 13 to

17, about 300,000, or 1.4 percent, identify 

as transgender (Herman et al., 2022). 

The Pew Research Center has

estimated that 1.6 percent of 

U.S. adults are transgender 

or nonbinary (Brown, 2022). 
2023 | VOLUME 18 | ISSUE 4 | PAGE 12 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

ideal in comparison to other sexual 

preferences and that it is natural. 

Heterosexual (straight) describes 

a person sexually oriented toward 

people of a gender other than their 

own. 

Hormone replacement therapy (HRT) 

is the process of using hormone 

treatment to match a person’s 

secondary sex characteristics with 

their gender identity. 

Homosexual describes a person 

sexually, emotionally, or 

romantically oriented toward people 

of the same gender. This term is 

discouraged from use unless an 

individual uses it to self-identify, as 

it has a history of stigma and past 

categorization as a mental illness. 

Intersex describes people with sex 

traits that do not all match a single 

sex. 

Lesbian is a sexual orientation most 

often used to describe women who 

are only attracted to other women. 

It may also be used by people of 

other genders who are exclusively 

attracted to women. 

LGBTQI+ is an abbreviation used to 

refer to individuals who are lesbian, 

gay, bisexual, transgender, queer, 

questioning, intersex, or part of 

other sexual orientation and gender 

identity minority populations. 

Masculine refers to the socially 

determined and culturally specific

behaviors expected of men. 

Misgendering is the use of language 

to describe a person in a way that 

doesn’t match with that person’s 

gender identity. 

Nonbinary is a term for gender 

identities outside of binary gender; a 

person whose gender is not only boy 

or girl, or man or woman. 

Pansexual describes a person 

attracted to others of any sex, gender 

identity, or gender expression. 

Pronouns are words used in place of 

other words. People often like others 

to use specific personal pronouns

that align with their gender but 

may also use no pronouns or any 

pronouns. Examples of personal 

pronouns include “she/her,” “he/ 

him,” “they/them,” and other 

Americans’ Self-Identification as LGBT by Generation

BY THE NUMBERS 

Source: Jones, 2022 
2023 | VOLUME 18 | ISSUE 4 | PAGE 13 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

gender-neutral pronouns such as 

“ze/hir.” 

Queer is a term that refers to 

people sexually oriented to 

multiple genders; it also refers to 

a person belonging to LGBTQI+ 

communities. It embraces the 

spectrum of sexuality and gender. 

Historically, this word was used 

as a slur. It is now used by choice 

by some members of LGBTQI+ 

communities. This term should not 

be used to describe someone unless 

permission is granted to do so by 

that person. 

Questioning describes a person 

unsure about or exploring their 

sexual orientation or identity. 

Same gender loving (SGL) is a term 

that describes sexual orientation that 

was created and is used by African 

American and Black people who 

view “gay” and “lesbian” as words 

connected to whiteness. 

Sex is defined by physiological and

anatomical traits such as gonads, 

chromosomes, genitalia, hormones, 

and secondary sex characteristics. 

Sex assigned at birth is the 

documented biological category 

(male, female, or intersex) assigned 

at birth based on the biological 

characteristics (anatomy, hormones, 

etc.) of an individual. 

Sexual orientation is a person’s sense 

of their own sexual attraction to 

others, and of those they are and are 

not attracted to. Examples include 

gay, straight, bisexual, pansexual, 

lesbian, queer, and asexual. 

Transgender is a broad term used 

to refer to a person whose gender 

identity or gender expression is 

different than the sex they were

assigned at birth. 

Transition describes the process of 

changing from one gender or sex 

to a different one. This may include

telling family and friends, using 

a new name, using new personal 

pronouns, hormone therapy, 

dressing differently, surgery, and

changing names and/or sex on legal 

documents. This is not an exhaustive 

list, and actual steps involved 

are up to the individual who is 

transitioning. 

Two-spirit is used by some Native 

American communities to describe 

a person who has the qualities or 

role of both men and women. These 

individuals are often recognized and 

respected as healers, peacemakers, 

and shamans. Some tribes may not 

recognize this term, while others 

may have other definitions. ■

“

Some 5.1 percent of adults younger than 30 

are trans or nonbinary . . . . This compares 

with 1.6 percent of 30– to 49–year–olds and 

0.3 percent of those 50 and older who are 

trans or nonbinary” (Brown, 2022).
2023 | VOLUME 18 | ISSUE 4 | PAGE 14 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

LGBTQ+ Communities and Disasters: 

Supporting Resilience and Improving Outcomes 

By Leo Goldsmith, M.E.M., ICF, OUT for Sustainability, Michael Méndez, Ph.D., University of California, Irvine, 

and Kate Hough, M.A., SAMHSA DTAC 

When “Queer and Present Danger: 

Understanding the Disparate 

Impacts of Disasters on LGBTQ+ 

Communities” was published in 

2021, it was among the first of

its kind: a peer-reviewed journal 

article focusing on the unique issues 

LGBTQ+ communities in the United 

States face in disasters. Co-authors 

Goldsmith, Raditz, and Méndez 

have also released their findings and

recommendations in a webinar and 

policy brief. Their work has already 

inspired more investigations—a 

trend they hope will continue. The 

Dialogue spoke with Goldsmith and 

Méndez about how their article came 

to be, vulnerabilities and strengths 

of LGBTQ+ communities, and 

recommendations to foster LGBTQ+ 

disaster resilience. 

What was the genesis of your 

Queer and Present Danger 

paper? How did you start 

pursuing these areas of 

research? 

Leo Goldsmith: The work began 

through my lived experience as 

somebody who grew up low-income 

and with a parent who is Colombian 

and is a woman of color. Growing 

up I saw a lot of disparities across 

race and class, and so I’ve always 

thought about who is missing from 

the conversation. I came out as 

queer and transmasculine, before 

I attended grad school at the Yale 

School of the Environment, where 

I focused on climate and health 

and environmental justice. As I 

was attending courses and reading 

through climate and health literature, 

I noticed that sexual orientation and 

gender identity weren’t included. I 

was taking an environmental justice 

course Mike [Michael Méndez] 

was teaching at the time and for my 

final paper, I decided to explore that

topic to see what literature existed. 

What I found was that it was all 

primarily internationally based. A 

group of Australian researchers was 

doing some of this work, and there 

were a few articles on Hurricane 

Katrina and the impacts on lesbian, 

gay, and bisexual individuals. Mike 

approached me and suggested 

we work on a paper on LGBTQ+ 

people in disasters. He also invited 

Vanessa Raditz, a Ph.D. student at 

the University of Georgia who is 

working on a docuseries and has 

interviewed over 30 queer and trans 

INTERVIEW 
2023 | VOLUME 18 | ISSUE 4 | PAGE 15 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

folks who survived Hurricanes 

Maria and Irma (2017), as well as 

the Tubbs Fire in California in 2017, 

to learn about their experiences, 

mutual-aid efforts, and services they

would have liked to have better 

access to. 

That’s how the paper came to be. 

We published it in 2021 in the 

journal Disasters, and from there 

it’s taken off. A lot of folks from

academic institutions, federal 

agencies, and other areas have been 

interested in it. Recently FEMA [the 

Federal Emergency Management 

Agency] co-hosted a webinar on 

mitigation and preparedness for 

LGBTQ+ individuals with the 

U.S. Department of Homeland 

Security’s Center for Faith-Based 

and Neighborhood Partnerships 

and OUT for Sustainability, an 

organization working to achieve 

climate resilience and environmental 

justice for LGBTQ+ communities. 

Mike was one of the panelists. A 

webinar on response and recovery 

on April 25 had another set of 

speakers. OUT for Sustainability 

will be publishing a report based on 

the input from these two webinars in 

June 2023. 

What are some of your highlevel findings?

Goldsmith: LGBTQ+ individuals 

exist in all populations that may 

be affected by disasters. They are

also overrepresented in populations 

at higher risk for negative disaster 

impacts, including those who are 

unhoused, are experiencing poverty, 

have a mental illness, have a chronic 

illness, lack access to health care, or 

are incarcerated. And also, LGBTQ+ 

individuals are invisible within 

disaster- and climate-related policies 

and infrastructure. For example, 

the Stafford Act, which covers all

disaster services across federal 

agencies, includes only the term 

“sex,” which means that depending 

on who the administration is in 

office at the time can interpret

this how they like. In previous 

administrations, “sex” meant that 

there were only two genders and did 

not cover sexual orientation. 

Michael Méndez: Disparities 

of disaster impacts on LGBTQ+ 

communities could be a very 

uncomfortable issue for some, 

and controversial in some 

regions of the country. However, 

it’s an important issue that needs 

to be discussed, particularly in the 

anti-LGBTQ climate sweeping 

the nation, in particular antitransgender legislation. Hundreds 

of bills are being tracked by the 

Human Rights Campaign and other 

organizations that highlight how 

this trend is creating inequitable 

and discriminatory state policies 

for LGBTQ communities. Some 

of these states also have religious 

and moral exemptions that allow 

faith-based organizations and 

other service providers to withhold 

services, including health care, 

to LGBTQ communities. So we 

question in our research, both in the 

journal article and our recent essay 

in Issues in Science and Technology, 

what is to happen if a disaster 

strikes? Will those discriminatory 

practices carry over into a disaster 

context? For many people, 

regardless of gender, sexuality, 

or gender identity, disasters may 

be among the worst times in their 

lives. So if they are confronted in 

the disaster response and recovery 

process, either at a shelter or 

through the process of applying 

for assistance, with discriminatory 

practices—the impact of the already 

difficult disaster experiences could

be amplified. Through our research,

we are trying to highlight how these 

individuals before a disaster have 

According to a recent Gallup poll, 

7.1 percent of U.S. adults 

identify as lesbian, gay, bisexual, 

transgender, or something other than 

heterosexual and cisgender (LGBT+).

This percentage more than doubled within a 

decade (from 2012 to 2021) (Jones, 2022). 
2023 | VOLUME 18 | ISSUE 4 | PAGE 16 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

the social vulnerabilities that Leo 

mentioned—housing insecurity, 

as well as health disparities—and 

when a disaster strikes, these 

socioeconomic and health disparities 

are exacerbated in what some are 

calling a hyper-marginalization 

of this population. We also want 

to move away from the idea that 

LGBTQ individuals are all White, 

wealthy, and male. Lots of people 

have seen television and movies 

where queer people are almost 

always wealthy and White. So 

we don’t think of them as being 

vulnerable and lacking resources to 

prepare themselves for disasters. 

Goldsmith: Also, regarding mental 

health, LGBTQ+ individuals are 

much more likely to experience 

anxiety, depression, PTSD 

[posttraumatic stress disorder], 

and other conditions, as well as 

ecoanxiety, compared to cisgender 

heterosexual individuals. These 

disparities relate to the minority 

stress model created by Ilan Meyer 

in the 1990s that built on a theory 

focused on race and class and 

added in sexual orientation and, 

eventually, gender identity. He 

basically said that in addition to all 

the general stressors people face 

every day, LGBTQ+ individuals 

also experience unique external 

and internal stressors that then 

lead to negative mental health 

outcomes. External stressors 

include violence, discrimination, 

and bias. Internal stressors include 

concealment of identity, expectation 

of being discriminated against, 

and internalized homophobia and 

transphobia. These additional 

stressors then can lead to issues and 

conditions, but the pathway can be 

modified by community and social

support, which is really key. 

When thinking about disasters 

as well, a lot of research says 

that having community and 

social support is really critical 

for resilience. Some LGBTQ+ 

individuals are not accepted by 

their parents or their biological 

family and may be disowned, so 

they often have to find other folks

that they consider “chosen family,” 

which is not biologically or legally 

based. A lot of the policies in place 

do not acknowledge those different

types of family structures and other 

relationships people have. Not being 

Americans’ Self-identified Sexual Orientation or Gender Identity

 

Younger 

adults in the

United States are 

likelier than 

older ones to

identify as LGBT+ 

(Jones, 2022). 

BY THE NUMBERS 

Source: Jones, 2022 Source: Jones, 2022 
2023 | VOLUME 18 | ISSUE 4 | PAGE 17 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

supported by your family or those 

around you increases mental health 

issues, and, as Mike was saying, 

the proliferation of anti-trans and 

anti-LGBTQ+ bills is creating a 

space where people are allowed to 

discriminate and have a justification

for not providing services people 

need, especially health care. 

So you have all of these 

compounding impacts before 

disasters hit, and then once the 

disasters occur, the spaces LGBTQ+ 

individuals have may be destroyed 

or made inaccessible. So you have 

all of these folks who don’t have 

any place where they can feel 

affirmed or safe, and they’re going

into temporary emergency shelters 

that aren’t considering their unique 

needs. 

Méndez: Our research seeks to 

connect our changing environment 

with an environmental justice 

lens to better safeguard LGBTQ 

communities, especially LGBTQ 

people of color. Forty-two percent 

of LGBTQ people identify as people 

of color, and that’s a much larger 

number than most people think. 

More LGBTQ youth than their nonLGBTQ peers are unhoused, and 

within that population of unhoused 

LGBTQ youth, people of color are 

dramatically overrepresented. This 

includes teenage youth that are more 

likely to be unhoused because of 

religious dogma or unsupportive 

parents and cultural issues that mean 

they are likelier to be kicked out by 

their parents than their peers are. 

This is an inequitable situation, and 

we’re using an environmental justice 

framework in how we approach and 

research it. 

Can you provide examples 

for our readers of LGBTQ+ 

people being excluded from 

sheltering, and generally 

from disaster preparedness, 

response, and recovery? 

Goldsmith: There are so many. 

One example that is widely used 

happened during Hurricane Katrina 

(2005), when two Black transgender 

women in Texas went to use the 

bathroom of their gender at a 

temporary emergency shelter and 

got arrested for doing that. One 

was a minor and was able to have a 

family member pick them up, but the 

other person who was an adult was 

told they would have to wait up to 6 

months before they could even get a 

hearing, though the Human Rights 

Campaign got her out within 6 days. 

That story shows the compounding 

impacts of policing on Black 

individuals, as well as policing of 

transgender women who are just 

trying to use the bathroom. 

LGBTQ+ individuals have been 

found to have lied about their 

relationships and pretended to be 

siblings in order to receive services. 

There have been documented cases 

of families being separated from 

one another, particularly those with 

parents who are not married but have 

a child that they adopted especially 

before same-sex marriage was 

legalized in 2015. Many individuals 

have experienced verbal, physical, 

“In the aftermath of 

[Hurricane] Harvey, 

the Montrose Center in 

Houston raised over a 

million dollars to provide 

direct support to the over 

35,000 people served by 

their core programs. And 

they collaborated with 

other groups, such as 

Organización Latina Trans 

in Texas, who provided 

emergency shelter to trans 

Latinas including those who 

are undocumented. The 

queer disaster literature 

highlights that throughout 

histories of marginalization, 

LGBTQ+ communities 

have crafted collective 

strategies for resistance 

and resilience in the face 

of pervasive structural 

oppressions, and these 

strategies are important 

resources during times of 

disaster” (Goldsmith et al., 

Queer and Present Danger 

webinar, 2021).
2023 | VOLUME 18 | ISSUE 4 | PAGE 18 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

or sexual violence within shelters on 

the basis of sexual orientation and 

gender identity. 

Also, many places that provide 

services after disasters tend to be 

faith-based, and for very good 

reason—they support community 

and provide shelter, food, and 

other services like childcare. 

However, there is a long history 

of discrimination and bias from 

religious organizations and also 

distrust that has developed over 

time between LGBTQ+ individuals 

and faith-based communities, even 

though there are also plenty of 

LGBTQ+ religious organizations 

and religious LGBTQ+ individuals. 

There are still LGBTQ+ individuals 

who would not want to go to a faithbased organization to get services 

because they think they might face 

discrimination. 

During Hurricane Fiona (2022), 

people lost access to medications, 

services, and affirming spaces.

About 70 percent of Puerto Rico 

was without power, and 40 percent 

was without running water. These 

impacts disproportionately affected

queer and transgender individuals 

as well as those living with HIV, 

due to the stigma. Hurricanes 

can also affect water quality, and

somebody living with HIV is 

immunocompromised, so not having 

access to clean and safe water can 

be life threatening. Without power, 

folks who are queer or transgender 

or both, who are disproportionately 

affected by chronic illness, would

not be able to maintain medications 

that need to be refrigerated. 

Also after a disaster, transgender 

people sometimes can’t access 

hormones, which is extremely 

important for their physical 

and mental health. People who 

are transgender may also lose 

identification records corresponding

to their gender. 

Could you say more about the 

minority stress model? That’s 

a fascinating idea. 

Méndez: The theory could be 

applied in general to LGBTQ 

communities, but it’s important 

to think about intersectionality. 

For example, for people who are 

LGBTQ as well as African American 

or Latino and transgender, we 

should acknowledge that they will 

experience multiple forms of harm 

during a disaster because of who 

they are and where they’re situated 

in our society. 

Do you have specific

recommendations for people 

involved in emergency 

management and disaster 

planning and preparedness, 

response, and recovery? 

Méndez: One of the three biggest, 

first and foremost, is that more data

should be collected, and tracking 

done on these issues. Across federal 

data collection, only the Household 

Pulse Survey asks about LGBTQ 

status and disaster experience. One 

of our major recommendations is 

the creation of a national task force 

by FEMA and other related agencies 

to better study this issue, because 

According to a Williams Institute report, 

“

A higher percentage 

of LGBT than non-LGBT people have incomes below the federal

poverty level (Wilson et al., 2023, p. 1). In 2021, 12 percent of

straight cisgender people were experiencing poverty, whereas 17 

percent of LGBT people were experiencing poverty. 

”
2023 | VOLUME 18 | ISSUE 4 | PAGE 19 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

again, there are few very robust 

studies, let alone government data. 

Having a data equity initiative that’s 

consistent with Biden’s executive 

order on data equity is important. If 

you can put some of the best minds 

in federal agencies with community 

advocates together to talk about this, 

I think something robust can come 

out. 

Another key issue is ensuring that 

FEMA and any grants or programs 

that provide funding to state and local 

governments require those entities to 

have anti-discriminatory policies that 

cover people with the full range of 

gender identities as well as lesbian, 

gay, and bisexual individuals. 

Goldsmith: Just to add onto the 

data and tracking discussion, there’s 

an equitable data working group 

at the White House level that has a 

subcommittee on sexual orientation 

and gender identity, and they recently 

put out a federal evidence agenda 

on LGBTQI+ equity. When you 

search for the terms “climate” or 

“disaster” in it, they appear only 

once in the text. I’m very, very glad 

these concepts are included. But it’s 

important to have those individuals 

also working with those who are 

doing emergency management within 

the federal government to really 

identify how and where we can get 

that data; that will be really key. 

Another recommendation is, if local 

or state governments are writing up 

emergency management plans or 

preparedness plans, they should reach 

out to LGBTQ+ organizations and 

leaders to ensure that plan language 

is correct, affirming, and designed to

address LGBTQ+ needs effectively

and thoroughly. 

We also recommend having more 

resources from federal, local, 

and state governments to help 

LGBTQ+ organizations be able to 

provide emergency services and 

relief to their own communities. 

Another recommendation is really 

emphasizing behavioral health 

services, particularly during 

disasters, for LGBTQ+ folks. 

Méndez: Leo, you touched on this 

a little bit, but I wanted to circle 

back about providing funding to 

community-based organizations 

that serve LGBTQ+ populations. 

It is important for them to have 

preparedness knowledge and 

training, but also to be ready to serve 

as disaster shelters. Increasingly 

and for good reason, state and local 

governments are relying on faithbased organizations and churches 

to provide shelter and aid. They 

fill important resource gaps, but

at the same time it’s imperative to 

understand that not all of these faithbased organizations are welcoming, 

or may have a history of being antiLGBTQ+. An LGBTQ+ individual 

could face additional trauma when 

they’re seeking assistance, so it’s 

crucial to ensure that there are secular 

disaster resource providers as well. 

We’re not advocating that there 

shouldn’t be faith-based disaster 

resource providers—they absolutely 

should be there. But there also should 

be secular providers, and funding 

offered specifically to LGBTQ+

organizations or LGBTQ+-serving 

organizations. 

Are there particular examples 

of resilience from within the 

LGBTQIA+ communities that 

our readers should know 

about? 

Méndez: There are many examples. 

Specifically, we’re recently seeing

in the field lots of examples of

how LGBTQIA+ communities 

and organizations are adapting to 

the changing climate, like heat 

waves. Organizations are adapting 

the services that they provide. For 

example, in California there have 

been increasing episodes of extreme 

heat, and LGBTQ+ community 

centers have reached out specifically

to LGBTQ+ youth and older adults 

with low incomes. They have served 

as cooling centers for members of 

their communities. These centers 

are having to literally adapt to the 

changing environment, but they are 

also changing their services to include 

disasters and be service providers as 

well as welcoming spaces. ■

There are about

13 million 

LGBT people 

in the United 

States (The

Williams Institute, 

n.d.).
2023 | VOLUME 18 | ISSUE 4 | PAGE 20 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

LGBTQIA+ People and Disasters: 

New Government Resources 

By SAMHSA DTAC staff

In keeping with several recent 

executive orders, federal 

departments have been taking steps 

to enhance equity for LGBTQIA+ 

people and to foster health, wellbeing, and overall quality of life 

for sexual orientation and gender 

identity minorities. Part of this 

work has included creating online 

information and resource hubs. 

The U.S. Department of Labor, 

for example, has set up a website 

highlighting executive orders and 

other actions by President Biden to 

advance LGBTQI+ equity, as well 

as resources in support of LGBTQI+ 

equity in the workplace. The U.S. 

Department of Health and Human 

Services has gathered information 

and resources about LGBTQI+ 

health issues and disparities, civil 

rights, and LGBTQI+ youth, as well 

as recent news. Departments have 

also assembled resource collections 

for specific populations, including,

for the U.S. Department of 

Education, LGBTQI+ students, and, 

for the U.S. Department of Veterans 

Affairs (VA), LGBTQ+ veterans 

accessing VA healthcare services. 

FEMA Resources

Individual agencies have also been 

making strides and producing and 

collecting materials in support of 

LGBTQIA+ people, including 

materials related to disasters and 

behavioral health. For example, the 

Federal Emergency 

Management 

Agency’s 

(FEMA’s) 

Equity web page 

discusses work 

FEMA has been 

doing toward greater equity for a 

range of communities that may be 

underserved in and after disaster, 

including LGBTQIA+ individuals 

and communities. And for the first

time in 2020, FEMA specifically

mentioned LGBTQIA+ communities 

in its annual National Preparedness 

Recent Executive Orders Regarding LGBTQIA+

Individuals and Communities 

• Executive Order (EO) 13985, Advancing Racial Equity and Support

for Underserved Communities Through the Federal Government,

January 2021

• EO 13988, Preventing and Combating Discrimination on the Basis of

Gender Identity or Sexual Orientation, January 2021

• EO 14004, Enabling All Qualified Americans To Serve Their Country

in Uniform, January 2021

• EO 14020, Establishment of the White House Gender Policy Council,

March 2021

• EO 14021, Guaranteeing an Educational Environment Free From

Discrimination on the Basis of Sex, Including Sexual Orientation or

Gender Identity, March 2021

• EO 14035, Diversity, Equity, Inclusion, and Accessibility in the

Federal Workforce, June 2021

• EO 14075, Advancing Equality for Lesbian, Gay, Bisexual,

Transgender, Queer, and Intersex Individuals, June 2022

• EO 14091, Further Advancing Racial Equity and Support for

Underserved Communities Through the Federal Government,

February 2023

 
2023 | VOLUME 18 | ISSUE 4 | PAGE 21 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Report as among those who may 

not have the resources to combat 

the effects of disaster (Frank, 2020).

Also, in FEMA’s strategic plan for 

2022–2026, the agency identifies as

one of its three main goals instilling 

equity as a foundation of emergency 

management, citing a definition of

equity from Executive Order 13985 

as “the consistent and systematic 

fair, just, and impartial treatment of 

all individuals, including individuals 

who belong to underserved 

communities that have been denied 

such treatment,” including “lesbian, 

gay, bisexual, transgender, and queer 

(LGBTQ+) persons” (FEMA, 

2022, p. 9). 

FEMA has also produced several 

webinars about LGBTQIA+ 

communities in disaster planning 

and preparedness, response, and 

recovery. The Region 2 National 

Preparedness Division hosted a 

webinar about U.S. LGBTQ+ 

communities, their diversity, and 

ways for emergency managers 

and disaster responders to ensure 

inclusion of LGBTQ+ people in 

disaster response and provision 

of equitable services to LGBTQ+ 

individuals. FEMA also co-hosted 

two webinars for emergency 

management and faith-based 

organizations that enlisted expert 

panels in exploring how to ensure 

better preparedness, mitigation, 

response, and recovery for LGBTQ+ 

individuals. The first of these

webinars, Helping the LGBTQIA+ 

Community Before Disasters: 

Preparedness and Mitigation 

Considerations, was produced by 

the U.S. Department 

of Homeland 

Security Center 

for FaithBased and 

Neighborhood 

Partnerships and OUT for 

Sustainability, as well as FEMA. 

Held on March 28, 2023, this 

webinar was an expert roundtable 

on ways LGBTQ+ communities 

are incorporated into disaster 

preparedness, gaps in incorporation 

and inclusion, and ways to 

address the gaps. A recording of 

the preparedness and mitigation 

webinar is available. The companion 

webinar, held on April 25, was titled 

Helping LGBTQ+ Survivors After 

Disasters: Response and Recovery 

Considerations, and the response and 

recovery webinar recording is also 

now available. 

SAMHSA Resources 

SAMHSA has produced a wealth of 

materials for and about LGBTQIA+ 

individuals and communities. One 

such item is a web page focused on 

LGBTQI+ behavioral health equity. 

This page highlights programs and 

initiatives to enhance LGBTQI+ 

behavioral health equity and related 

resources from SAMHSA, including 

the SAMHSA-funded LGBTQ+ 

Behavioral Health Equity Center 

of Excellence, and resources from 

other organizations and sectors. 

The LGBTQ+ Behavioral Health 

Center of Excellence offers many

great resources, including a tip sheet 

with steps organizational leadership 
2023 | VOLUME 18 | ISSUE 4 | PAGE 22 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

In the United States, there are 700,000 cohabiting same-sex

couples, 357,000 of whom are married (The Williams Institute, n.d.).

Of these same-sex couples, 

114,000 are raising children. 

Twenty-four percent are raising

foster or adopted children 

(The Williams Institute, n.d.). 

of behavioral healthcare facilities 

can take to establish policies 

and practices to affirm LGBTQ+

people and create a welcoming 

and inclusive environment in their 

facility. A tip sheet about Black 

LGBTQ+ mental health describes 

experiences for Black LGBTQ+ 

people that are shaped by both Black 

and LGBTQ+ parts of their identity. 

It explains that these experiences 

can be positive as well as negative 

and offers tips for mental health

professionals to support and foster 

resilience and well-being in Black 

LGBTQ+ people. Another resource 

about minority stress and coping 

among LGBTQ+ adolescents 

presents a table of stressors 

and “conversation starters” for 

behavioral healthcare professionals 

to use to help adolescents cope 

with stressors and build therapeutic 

rapport. 

SAMHSA funds several Mental 

Health Technology Transfer 

Centers (MHTTCs), one of which, 

the Northwest MHTTC, has put 

together a resource collection 

for LGBTQIA+ people, their 

loved ones, and behavioral health 

professionals who serve LGBTQIA+ 

individuals. Resources in the 

collection include organizations, 

educational tools, research, articles, 

webinars, and podcasts. The 

SAMHSA Center for Substance 

Abuse Prevention recently released 

Moving Beyond Change Efforts:

Evidence and Action to Support and 

Affirm LGBTQI+ Youth, a report 

for behavioral health professionals, 

school personnel, policymakers, 

researchers, and families about 

research on the impacts of efforts

to change the sexual orientation 

and gender identity of young 

people, therapeutic and other care 

approaches that evidence has shown 

may work well with LGBTQI+ 

youth and their families, and policy 

recommendations to improve 

LGBTQI+ youth’s behavioral health 

and well-being. The SAMHSA 

Disaster Technical Assistance Center 

has added resources for and about 

LGBTQIA+ individuals in relation 

to disaster to its SAMHSA Disaster 

Behavioral Health Information 

Series resource collection. ■

LGBTQ+ people are more likely to be part of the following populations, 

which are also more vulnerable to disaster and climate change: 

• People with low incomes/people experiencing poverty

• People experiencing homelessness

• People with a mental illness

• People with chronic illness

• People with limited or no access to health care

• People who are incarcerated (Goldsmith et al., Queer and

Present Danger webinar, 2021)
2023 | VOLUME 18 | ISSUE 4 | PAGE 23 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

RECOMMENDED RESOURCES 

Moving Beyond Change Efforts: Evidence and

Action to Support and Affirm LGBTQI+ Youth

Designed for audiences including behavioral health 

professionals, researchers, policymakers, and educators, 

this report from SAMHSA describes behavioral 

health concerns and appropriate care for lesbian, gay, 

bisexual, transgender, queer, questioning, and intersex 

youth and other sexual- and gender-diverse children 

and adolescents (LGBTQI+ youth). It covers which 

approaches and interventions are most helpful for 

these populations in various settings, as well as policy 

approaches to support LGBTQI+ youth health and wellbeing. 

https://store.samhsa.gov/product/moving-beyondchange-efforts/pep22-03-12-001

Emergency Preparedness and Lesbian, Gay, Bisexual 

& Transgender (LGBT) People: What Health 

Centers Need to Know 

Developed by the National LGBT Health Education 

Center, this guide stresses the importance of health 

centers’ considering the unique needs and vulnerabilities 

of LGBT individuals and families during an emergency. 

It offers tips for health centers prior to disasters, as part

of emergency preparedness, to help ensure that LGBT 

people feel welcome in their facilities, are included in 

planning and preparedness processes, and have medical 

needs met during and after disasters. 

https://lgbtqiahealtheducation.org/wp-content/uploads/ 

Emergency-Preparedness-for-LGBT-People-Final.pdf 

LGBTQIA+ People & Disasters

This 25-page report from DRR Dynamics goes over the 

impacts disasters may have on people in LGBTQIA+ 

communities and the importance of considering these 

populations in disaster preparedness, response, and 

recovery. It covers the vulnerabilities LGBTQIA+ 

people often have that should be considered when 

developing policy regarding disaster preparedness. The 

report concludes with recommendations and case studies 

highlighting real-world examples of organizations 

effectively meeting the needs of LGBTQIA+

populations after disasters. 

https://irp.cdn-website.com/cde3424c/files/uploaded/

LGBTQIA%2B report-3.pdf 

Meeting the Needs of Transgender People in Disaster 

Situations 

Louisiana Trans Advocates created this tip sheet to 

help disaster aid workers make sure transgender people 

can safely access shelters and receive emergency care 

without fear of discrimination. This sheet provides 

tips for interacting with transgender evacuees after a 

disaster, providing safety and security, and reporting 

mistreatment or discrimination. 

https://transequality.org/sites/default/files/docs/

blog/Meeting the Needs of Trans People in Disaster 

Situations-2.pdf 

Working With the Lesbian, Gay, Bisexual and 

Transgender Community: A Cultural Competence 

Guide for Emergency Responders and Volunteers 

This guide was developed by the Human Rights 

Campaign for local, state, and federal government and 

community organizations that assist disaster survivors. 

It provides direction on how to develop culturally 

sensitive policies and train anyone who communicates 

with survivors to do so in a manner that respects LGBT 

communities. The guide covers different definitions

and how to provide a welcoming environment for 

individuals and families. 

https://assets2.hrc.org/files/assets/resources/

EmergencyResponders_-_LGBT_Competency.pdf 
2023 | VOLUME 18 | ISSUE 4 | PAGE 24 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Recent Technical Assistance Requests 

In this section, read about responses SAMHSA DTAC staff have provided to recent technical assistance (TA) requests.

Send your questions and comments to dtac@samhsa.hhs.gov. 

Request: SAMHSA DTAC received a request to 

compile resources for crisis counselors experiencing 

compassion fatigue and in need of tips for self-care. 

Response: SAMHSA DTAC produced a list of 

resources specific to compassion fatigue and self-care

for crisis counselors and disaster responders. A sample 

of the resources provided is included below: 

4 Compassion Fatigue and Self-care for Crisis 

Counselors—Part of the Crisis Counseling Assistance 

and Training Program (CCP) toolkit, this web page 

provides information for both crisis counselors and 

CCP leadership. The web page is designed to further 

understanding of compassion fatigue and responding 

to signs and symptoms. The web page also provides 

information about and strategies for self-care. 

4 Professional Well-Being: The Adult Resilience 

Curriculum (ARC)—Provided by the SAMHSA 

Mid-America Mental Health Technology Transfer 

Center, this web page presents the ARC, a researchbased approach to address stress, burnout, and 

compassion fatigue for healthcare workers and 

service professionals. While the curriculum was 

developed specifically for coping with the COVID-19

pandemic, it is applicable to health care and 

education professionals at any time who are coping 

with stressors at work. The curriculum features 10 

modules for implementing self-care and coping to 

enhance resilience, as well as a podcast and interactive 

workbook. 

4 Stress Management Techniques, Healthy Coping 

Strategies, Breathing Exercise—This 8-minute 

video provides CCP crisis counselors, or anyone 

working with disaster survivors, with techniques 

for stress management and self-care. The video 

explains that providing support for disaster survivors, 

while important and rewarding, can cause distress; 

offers concrete tips for self-care; and includes a

demonstration of a breathing exercise to reduce stress. 

4 Tips for Disaster Responders: Understanding

Compassion Fatigue—This SAMHSA tip sheet 

describes compassion fatigue and its components: 

burnout and secondary traumatic stress. It offers

tips for coping with compassion fatigue, and it also 

describes compassion satisfaction and notes ways to 

foster compassion satisfaction among members of 

your response team. 

Request: SAMHSA DTAC received a voicemail from 

a program director at a nonprofit organization seeking

videos or PowerPoint slides about suicide awareness. 

The person was seeking this content for a newly created 

program for families of children with disabilities and 

other functional and access needs. 

Response: SAMHSA DTAC returned the program 

director’s call to discuss resources to distribute for 

the program, as well as possibly adding the program’s 

resources to SAMHSA DTAC’s resource collection. 

SAMHSA DTAC also followed up with the director 

via email to share resources from two installments of 

the SAMHSA Disaster Behavioral Health Information 

Series (DBHIS). Below are some of the resources 

shared: 

4 SAMHSA DBHIS: Suicidal Thinking, Behavior, and 

Attempts—This selection in the SAMHSA DBHIS 

provides a collection of resources surrounding suicidal 

thinking, behavior, and attempts. You can use the lefthand menu to make further selections based on your 

needs. Resources include helplines, assessment tools, 

organizations, online articles, and guides. 

4 SAMHSA DBHIS: People With Disabilities and Other 

Access and Functional Needs—This selection in the 

SAMHSA DBHIS provides a collection of resources 
2023 | VOLUME 18 | ISSUE 4 | PAGE 25 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

about people with disabilities and other access and 

functional needs. You can use the left-hand menu to 

make further selections based on your needs. 

Request: A representative from a statewide 

independent living council contacted SAMHSA DTAC 

regarding their bimonthly Partners in Preparedness 

webinar series. The council asked for potential speakers 

versed on subjects related to the intersection of disability 

or mental illness and emergency/disaster preparedness 

and planning. 

Response: SAMHSA DTAC shared several 

recommended experts that could participate in 

the webinar. SAMHSA DTAC encouraged the 

representative to reach out to the provided list of 

proposed speakers about the opportunity. 

Check out the new and updated 

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments. 

Are you looking for disaster behavioral health resources? 

https://www.samhsa.gov/resource-search/dbhis 

Help Improve SAMHSA’s Disaster Services and Products 

As a subscriber to this newsletter, you are invited to participate in a 

short, web-based survey to provide the SAMHSA Disaster Technical 

Assistance Center (DTAC) with feedback about your experiences 

with our products and services. The survey should take no more 

than 15 minutes. Complete the survey by going to the survey web 

page, or copy and paste the URL https://iqsolutions.qualtrics.com/ 

jfe/form/SV_ bjYCSJDUQAGi1h3 into your web browser. 
2023 | VOLUME 18 | ISSUE 4 | PAGE 26 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

REFERENCES 

Brown, A. (2022, June 7). About 5% 

of young adults in the U.S. say their 

gender is different from their sex

assigned at birth. Pew Research 

Center. https://www.pewresearch. 

org/fact-tank/2022/06/07/about-5-

of-young-adults-in-the-u-s-say-theirgender-is-different-from-their-sexassigned-at-birth 

Carrazana, C., & Rummler, O. (2021, 

September 24). The Census Bureau’s 

first ever data on LGBTQ+ people

indicates deep disparities. The 19th.

https://19thnews.org/2021/09/lgbtqcensus-data-federal-collection-firsttime 

Center for Disaster Philanthropy. 

(n.d.). LGBTQIA+ communities and

disasters. https://disasterphilanthropy. 

org/resources/lgbtq-communities-anddisasters 

Center of Excellence on LGBTQ+ 

Behavioral Health Equity. (n.d.). 

Sexual orientation, gender 

identity & expression glossary of 

terms. https://lgbtqequity.org/wpcontent/uploads/2023/04/SOGIEGlossary-4.23.pdf 

Federal Emergency Management 

Agency. (2020, December 22). 2020 

national preparedness report. U.S. 

Department of Homeland Security. 

https://www.hsdl.org/c/2020-nationalpreparedness-report 

Federal Emergency Management 

Agency. (2022). 2022–2026 FEMA 

strategic plan. https://www.fema.gov/ 

about/strategic-plan 

Goldsmith, L., Raditz, V., Blanchard, K., 

Méndez, M., & Knighten, J. (2021, 

December 2). Queer and present

danger: Understanding the disparate

impacts of disasters on LGBTQ+

communities [Webinar]. University 

of California, Irvine School of Social 

Ecology. https://www.youtube.com/ 

watch?v=0xHTa7dAwkE 

Gorman-Murray, A., Morris, S., Keppel, 

J., McKinnon, S. J., & DomineyHowes, D. (2017). Problems and 

possibilities on the margins: LGBT 

experiences in the 2011 Queensland 

floods. Gender, Place and Culture, 

24(1), 37–51. https://doi.org/10.1080/ 

0966369X.2015.1136806 

Herman, J. L., Flores, A. R., & O’Neill, 

K. K. (2022, June). How many adults 

and youth identify as transgender 

in the United States? The Williams 

Institute, UCLA School of Law. 

https://williamsinstitute.law.ucla.edu/ 

publications/trans-adults-united-states 

Indian Health Service. (n.d.). Two-spirit.

https://www.ihs.gov/lgbt/health/ 

twospirit 

Jones, J. M. (2022, February 17). LGBT

identification in U.S. ticks up to 7.1%.

Gallup. https://news.gallup.com/ 

poll/389792/lgbt-identification-ticksup.aspx 

Mesa-Miles, S. (2018, September 13). 

Two Spirit: The trials and tribulations 

of gender identity in the 21st century. 

Indian Country Today. https://ictnews. 

org/archive/two-spirit-the-trials-andtribulations-of-gender-identity-in-the21st-century?redir=1 

National Academies of Sciences, 

Engineering, and Medicine. (2022). 

Measuring sex, gender identity, and 

sexual orientation. The National 

Academies Press. https://doi. 

org/10.17226/26424 

Office for Victims of Crime. (2015).

Tools: Compendium of resources; 

Victim assistance: Planning and 

response. Helping victims of mass 

violence & terrorism: Planning,

response, recovery, and resources 

(NCJ 248647). https://ovc.ojp.gov/ 

sites/g/files/xyckuh226/files/pubs/mvttoolkit/victim-assistance.html 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

Center of Excellence on LGBTQ+ 

Behavioral Health Equity. (n.d.). 

SOGIE glossary of terms. Retrieved 

May 22, 2023, from https:// 

lgbtqequity.org/resources 

SAMHSA Disaster Technical Assistance 

Center. (n.d.). Key DEI terms. https:// 

www.samhsa.gov/dtac/disasterplanners/diversity-equity-inclusion/ 

key-dei-terms 
2023 | VOLUME 18 | ISSUE 4 | PAGE 27 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

Sylliboy, J. R., Bird, N., Butler, E., 

Wilmot, K., & Perley, G. (2022). 

Two-Spirits’ response to COVID-19: 

Survey findings in Atlantic Canada

identify priorities and developing 

practices. International Journal of 

Indigenous Health, 17(1). https://doi. 

org/10.32799/ijih.v17i1.36724 

The Williams Institute. (n.d.). Quick

facts: LGBT FAQs. University of 

California, Los Angeles (UCLA) 

School of Law. Retrieved April 7, 

2023, from https://williamsinstitute. 

law.ucla.edu/quick-facts/lgbt-faqs 

The Williams Institute. (2019). LGBT

demographic data interactive.

https://williamsinstitute.law. 

ucla.edu/visualization/lgbtstats/?topic=LGBT#density 

Wilson, B. D. M., Bouton, L. J. A., 

Badgett, M. V. L., & Macklin, M. 

L. (2023, February). LGBT poverty

in the United States: Trends at the

onset of COVID-19. The Williams

Institute, UCLA School of Law.

https://williamsinstitute.law.ucla.edu/

publications/lgbt-poverty-us

The views, opinions, and content 

expressed in this publication do not 

necessarily reflect the views, opinions,

or policies of the Center for Mental 

Health Services (CMHS), the Substance

Abuse and Mental Health Services 

Administration (SAMHSA), or the U.S.

Department of Health and Human 

Services (HHS).

“

Disaster preparedness and response starts at the individual level. 

However, even in communities with high levels of preparedness 

capability, there are individuals and families who are particularly 

vulnerable to disasters . . . . Identification with a 

historically disadvantaged group—including 

minorities and the lesbian, gay, bisexual, 

transgender, queer (LGBTQ+) community—are all 

factors that can increase vulnerability. The presence of

these characteristics indicates that affected individuals or groups are 

more likely than others to be severely impacted by disasters and may 

require additional or distinct support after a disaster occurs or during 

steady-state disaster preparation

”

 (FEMA, 2020, p. 61).
Prepare • Respond • Recover 

Inform • Assist 

SUBSCRIBE 

The Dialogue is a publication for professionals in the disaster behavioral health field to 

share information, resources, trends, solutions to problems, and accomplishments. Contact 

SAMHSA DTAC to be added to The Dialogue subscription list. 

SHARE INFORMATION

Readers are invited to contribute to The Dialogue. To author an article for an upcoming issue, 

please contact SAMHSA DTAC at dtac@samhsa.hhs.gov. 

ACCESS ADDITIONAL SAMHSA DTAC RESOURCES

The SAMHSA DTAC Bulletin is a monthly e-communication used to share updates in the field, 

post upcoming activities, and highlight new resources. Contact SAMHSA DTAC to be added 

to the SAMHSA DTAC Bulletin subscription list. 

The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, 

specific types of disasters, and other topics related to all-hazards disaster behavioral health 

preparedness and response. Visit the SAMHSA DTAC website at 

https://www.samhsa.gov/resource-search/dbhis to access these materials. 

CONTACT US

SAMHSA Disaster Technical 

Assistance Center 

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov 

https://www.samhsa.gov/dtac