Meeting the Needs of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) Individuals During Disasters and Emergencies

FEMA’s 2020 annual National Preparedness Report identified communities of color, single parents, lesbian, gay, bisexual, and transgender people as being at the highest risk or more severely impacted during disasters.

There are a range of issues that may lead to increased vulnerability for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people in the time leading up to and including emergency events. For example, LGBTQI+ youth experience high rates of homelessness, making it more difficult to reach them during an emergency. LGBTQI+ seniors are more likely to be isolated and are less likely to have children or other family compared to other seniors; therefore, they may need additional assistance in receiving emergency messages and accessing resources. LGBTQI+ couples and families may not be recognized by some first responders. Transgender people may not be able to access shelter consistent with their gender identity or to receive culturally sensitive emergency health care. Some LGBTQI+ people have reported that they have experienced shelters refusing to allow them to enter and reside as a family with their partner and children.

These kinds of stressors may make LGBTQI+ individuals reluctant to seek emergency shelter or even disaster services and care.  Additionally, LGBTQI+ community members may not trust  emergency responders and health care systems based on prior discrimination or other negative experiences.
To ensure access to medical and disaster behavioral health services after a disaster, emergency planers should strive to provide safe access to, and experiences in, emergency shelters for LGBTQI+ individuals and families.  A lack of safe access to disaster health services for LGBTQI+ individuals can negatively impact their disaster health outcomes, straining community recovery as a whole. 

What Can Emergency Planners Do to Create a More Inclusive Environment at Shelters?

• Communicate with emergency providers in advance about establishing policies and practices concerning sheltering or assisting LGBTQI+ individuals and families.
• Include LGBTQI+ community groups, stakeholders, and leaders in emergency preparedness planning and training.
• Train emergency shelter staff on LGBTQI+ inclusive practices and policies.
• Ensure that public facing documents are available in relevant languages for individuals with limited English proficiency and are accessible by individuals with disabilities.
• Establish a LGBTQI+ community liaison or champion within the emergency management agency or planning group, who can help identify and promote inclusive services during emergency events and in hotwash processes. If essential post-disaster services are provided to the public through faith-based organizations, establish agreements that LGBTQI+ community members will not be denied services on any religious basis.
• Consider establishing a nondiscrimination pledge for all disaster support agencies and organizations in your jurisdiction.
• Share resources on serving LGBTQI+ community members with professional and volunteer staff.

What Can LGBTQI+ Community Members Do to Be Ready for Disasters? 

Encourage LGBTQI+ peers to prepare for emergencies by placing important identification and legal documents on cloud storage or in a disaster kit for easy access, such as:

• Marriage/Domestic Partner/Civil Union License;
• Adoption Decrees; and
• Powers of Attorney (Medical, Financial Living Will/Advanced Directive).
• Prescription medication(s) and medication list, including for gender-affirming hormone therapy.
• Advocate for the LGBTQI+ community to be represented in community-level emergency preparedness planning. LGBTQI+ clergy, community organization leaders, business owners, and other community leaders can be part of coordinated outreach to emergency management authorities to help communicate community needs in planning processes.
• Consider volunteering in groups such as the ASPR-supported Medical Reserve Corps, the American Red Cross, or FEMA-supported CERT teams.
  

What Can Shelter Providers  Do to Create a More Inclusive Environment at Their Shelters?

Housing

• Admit LGBTQI+ couples and families without requiring documentation of relationship status.
• Never separate LGBTQI+ parents from their children or place LGBTQI+ partners in a singles shelter.
• Avoid intrusive questions about family structure which can deter LGBTQI+ individuals from seeking needed medical or mental health treatment after a disaster.
• Have clear policies that prohibit harassment, bullying, or unwanted engagement toward anyone, including LGBTQI+ individuals. Such policies should include specific processes for reporting incidents.
• Report any incident of harassment or violence to the head of the emergency shelter and to law enforcement.
• Allow LGBTQI+ individuals to reside closer to security guards or volunteers if harassment is occurring.

Supporting Services and Counseling

• Recognize that hate crimes and other acts of anti-LGBTQI+ violence occur before, during and after disasters.
• Be prepared to offer emergency behavioral health services and support.
• Incorporate training in culturally appropriate services to lesbians, gay men, bisexual people, and transgender people (including non-binary individuals) as part of the training curriculum for mental health providers. Helpful resources are available from the Substance Abuse and Mental Health Services Administration (SAMHSA)-funded Center of Excellence on LGBTQI+ BehavioralHealth Equity.
• Family Assistance Centers and other sites where death notifications are provided to survivors should train staff to recognize LGBTQI+ couples and families and provide services to same-sex partners and spouses and families of choice.
• Offer surviving same-sex spouses the same supportive services and counseling that is offered to other surviving spouse.
• If shelter organizations partner with faith-based groups for supporting services and counseling, include faith organizations who are welcoming, inclusive, and affirming of LGBTQI+ people.
  

Public Health and Medical Services

• Ensure that individuals taking medications (i.e., those with HIV/AIDS, individuals who take medications as part of their gender-affirming health care treatment) have enough doses of any necessary medication to last throughout the anticipated displacement.
• Make arrangements for any medications that need to be refrigerated.
• Assist individuals who have lost or run out of their prescriptions to get their needed medications to avoid potentially serious adverse health effects that may result from interruption of these medication regimens.
• For assessment or intake forms that ask patients their gender or sex, use forms that are inclusive of transgender and non-binary people. Examples of form language are available from the Centers for Disease Control and Prevention (CDC).
• Respond appropriately, based on valid public health science, to misinformation or inaccurate rumors regarding LGBTQI+ people as infectious disease risks to the general population.
• Encourage training in LGBTQI+ health care on the part of disaster medical services providers. To learn more, see the training curric​ula for primary care practitioners from SAMHSA and the Health Resources and Services Administration (HRSA).
  

Restroom and Shower Access

• Give individuals access to restroom and shower facilities that are consistent with their gender identity.
• Ensure privacy and safety for all shelter users by adding shower curtains or doors.
• Equip shelters with gender-neutral restrooms.

Confidentiality

• Reduce the risk of discrimination and violence against an LGBTQI+ individual by keeping that individual’s sexual orientation or gender identity confidential and on a “need to know” basis.
• Refrain from disclosing an individual’s HIV/AIDS status to other evacuees or volunteers.
• Incorporate compliance with all federal laws addressing the privacy of personal health information in training of emergency personnel.
• Employ universal precautions in order to ensure the health and safety of all staff and residents without compromising the confidentiality or equal access of HIV-positive shelter residents.
• Be sensitive to the privacy and confidentiality of every family member.
• When unsure how to address someone, politely ask, and respect the answer you receive.