23.2 LGBTQ FAMILIES AND THE U.S. SUPREME COURT

Abstract

This session aims to review the literature on how the Supreme Court of the United States (SCOTUS) decisions have impacted the mental health of LGBTQ families and the upcoming cases that may impact LGBTQ families, and to provide practical clinical recommendations on how to support families with the impact of these decisions. The peer-reviewed literature on the impact of recent SCOTUS decisions on LGBTQ mental health will be reviewed and discussed. Transcripts from oral arguments from recent cases were reviewed (Fulton v The City of Philadelphia, Obergefell v Hodges, Employment Division v Smith, Bostock v Clayton County), along with published commentary by constitutional scholars. In 2015, SCOTUS established marriage equality with its decision in Obergefell v Hodges. Marriage equality for sexual minority people has resulted in decreased mental healthcare visits and lower suicide attempt rates. These outcomes are thought to be secondary to broad cultural impacts on society’s views of homosexuality. Conversely, policies that limit LGBTQ civil rights, including those that permit the denial of services to LGBTQ people, have been linked to adverse mental health outcomes. SCOTUS recently heard oral arguments in Fulton v The City of Philadelphia, a case examining an organization’s right to refuse adoption screening services to LGBTQ people on the basis of religious beliefs. A case permitting such denial of services, based on extant literature, would be expected to result in worsening mental health outcomes for LGBTQ people. Past court precedent relevant to the case, including Employment Division v Smith, will be discussed. Recent changes in the court’s composition and their implications for this case and potential future cases will be discussed. The mental health impact of these cases will be discussed through the minority stress framework, and practical recommendations for supporting LGBTQ families in this regard will be reviewed. Public policies and related SCOTUS decisions have profound public health impacts in the realm of sexual minority mental health. These decisions have important implications for LGBTQ families, and clinicians should be aware of these implications and strategies to mitigate adverse impacts on mental health.