In-depth | LGBTI

Many LGBTI people in Kosovo are deprived of psychological services

The LGBTI community faces difficulties in accessing mental health services.

By - 30.12.1919

A young blonde man with Arabic script tatoos and carrying a bag with an Albanian flag stamped on it says “I am gay, I am a religious person and I go to the mosque. For me it is very important to support this parade.”

Mikael Sinan Amir was a Muslim guest from Denmark who wore a t-shirt that had “Kosova”  written on it. He expressed his willingness “to support people of the Balkans in their path toward emancipation.” His arrival at the pride parade in Prishtina — representing multiple identities — is an invitation to rethink the concept of freedom of identity and reevaluate the mental schemes through which we approach the world around us.

“For whom does your heart beat?” was the motto of Pride Week, which concluded with the parade held on October 10th in the main square of the Kosovar capital. That day, the atmosphere was buzzing and the square came alive with rainbow-colored clothes, balloons and flags. 

In addition to celebrating diversity, the event also intended to address a series of issues related to LGBTI rights. The parade was also a protest against discrimination, an appeal for accepting oneself, a celebration of diversity and a display of discontent.

Blert Morina, executive director of the Center for Equality and Liberty (CEL), says the pride parade shows only one side of the coin.

“In the parade we see one or two politicians who address LGBTI issues and then do not speak about this topic again throughout the whole year. While CEL continues to send people to shelters in Albania. There are no such facilities in Kosovo,” he says.

Blert is the first transgender person in Kosovo who has made a request — that has now transformed into a legal battle — to change his name and gender in his identification documents. 

“Transgender persons wander in and around the courts to obtain an elementary right… the reality of the status of people in this community is comprised of such episodes,” he says.

In an ideal society, the rights guaranteed by law would reflect the values of regulated interpersonal relations. Kosovo seems to be far from this ideal, because there is a discrepancy between the conservative mentality and liberal national laws. The failure to implement laws remains the main problem in Kosovo. This fact has been widely recognized. Traditional customs have proven to be stronger.

The pride parade on October 10, 2019, in Prishtina. Photo: Majlinda Hoxha / K2.0.

Legal structure vs mentality

Kosovo has taken important steps to create a legal structure for protecting and ensuring rights related to sexual orientation and gender identity. However, LGBTI people continue to face different forms of discrimination, exclusion and violence. 

During the first pride parade in Prishtina in 2017, Kosovo Police were notified that a person was threatened and verbally harassed by unidentified individuals. A Swiss citizen was also physically attacked by an unidentified individual. Moreover, a group of five protesters held anti-LGBTI signs. Although they did not display threatening or violent behavior. 

Activists say that transgender persons — individuals whose gender identity and/or gender expression does not correspond with their birth sex — are among the most misunderstood people of the LGBTI community.

Transgender people can choose to undergo hormonal therapy. This must be prescribed by a doctor, in order to harmonize their bodies with their gender identities. Some can choose to undergo surgery. However, transgender persons do not have to choose any or all of these steps. 

Many organizations, including the Center for Social Group Development (CSGD), the Center for Equality and Liberty (CEL) and their partners Civil Rights Defenders Kosovo and the Youth Initiative for Human Rights have advocated for LGBTI rights. They respond to the needs of this community and provide directives for improving legal infrastructure.

There is a discrepancy within Kosovo’s legal infrastructure. That causes problems in practice.

For example, CSGD held a meeting with representatives of the Civil Registry Agency and the Ministry of Internal Affairs “requesting the drafting of an administrative order that would enable people to change their gender markers in identification documents. Thereby redefining the legal recognition of gender.” CSGD and CEL also organized the pride parade.

Meanwhile, the work of the institutions to provide a comprehensive legal framework remains incomplete. The Constitution of the Republic of Kosovo prohibits discrimination of people in any form. Including discrimination based on sexual orientation. However, the Family Law describes marriage as a union between two people of different genders. The Law on Civil Status does not recognize the process of changing one’s gender. So there is a discrepancy within Kosovo’s legal infrastructure. That causes problems in practice.

However, laws are not sufficient for ensuring LGBTI rights and equality among all citizens regardless of gender or sexual orientation. Blert Morina from CEL says that the people who are in charge of implementing anti-discriminatory laws are the product of a mentality which feeds prejudice.

“No matter how great our laws are on paper, we lack adequate implementation,” he says. “For transgender persons there is no provision of even the most basic services. Let alone for mental health. That is considered a luxury in our society.”

Mental health of LGBTI persons endangered 

Research shows that suicidal thoughts, substance abuse and self-harming behavior are more prevalent among gay, lesbian and bisexual people than heterosexual people. According to recent studies, one of the main causes of this is the discrimination and exclusion that they regularly experience. 

Moreover, a Human Rights report stated that 60% of non-heterosexual youth feel sad or hopeless to the extent that these feelings seriously damage their day-to-day functioning. Transgender people who experience even more stigma and discrimination are more prone to mental health issues and suicidal behavior. 

Although research in Kosovo is lacking, Blert Morina believes that Kosovar society is not an exception with regards to the high prevalence of mental health issues among LGBTI persons. Especially when we understand that pressure, prejudice and discrimination against LGBTI people is more common in Kosovo than in developed countries.

“We cannot directly influence society to accept LGBTI people, but we can teach these individuals to respond to an unwelcome environment in a healthy way."

Blert Morina, CEL

Families can influence the mitigation of these problems by providing support for LGBTI persons. Some studies have shown that LGBTI youth who receive support and are accepted by their families report higher levels of self-esteem and better health in general. While youths who are not accepted by their families are three times more likely to consider suicide or attempt it.

Judging from this data, mental health and the availability of psychological help is very important for the welfare of people belonging to this community.

Since 2016, CEL provides psychological services free of charge for members of the LGBTI community. With the objective of preparing them to face society. 

“We cannot directly influence society to accept LGBTI people. But we can teach these individuals to respond to an unwelcome environment in a healthy way,” says Morina.

According to him, the problems that LGBTI people mostly seek help for are depression, anxiety and suicidal thoughts. However, the center has limited capacities for providing psychological help. Increasing these capacities requires additional funding. Meanwhile, “state institutions have not shown the willingness to support psychological assistance programs for LGBTI persons,” says Morina.

Blert Morina, executive director of CEL. Photo: Majlinda Hoxha / K2.0.

The lack of trained psychologists 

Psychological counseling for LGBTI persons remains one of the challenges that Kosovar psychologists aren’t properly trained to handle.

The Psychology Department at the University of Prishtina was established in 2014. It does not have a longstanding tradition. It is part of an education system that has been described as very weak.  It is surrounded by a culture that considers mental health a luxury. It faces difficulties producing psychological staff who are prepared to deal with the many different needs of a post-war society. 

Lend Mustafa from CEL says that it is very difficult to find psychologists who are knowledgeable about LGBTI issues.

“From my personal experience and the experience of many other people in the community, in general, psychologists are completely uninformed,” he says. “So sessions begin with the client educating the psychologist or psychiatrist.”

However, this problem did not occur during the recruitment of four CEL mental health specialists who were part of a similar program earlier. They were prepared to work with LGBTI people. The center currently has two psychologists and two psychiatrists. But according to Morina, if they attempt to increase the number of psychologists, [in this program] problems can easily emerge. 

For members of groups who are under constant pressure from society because of discrmination, it is very difficult to find adequate treatment. This is because society’s approach towards LGBTI people produces the idea — it is notable in state institutions as well —  that it is possible to correct “a deviation.”

The few studies that have been conducted in Kosovo show that the approach of institutions towards LGBTI people is not appropriate.

Morina speaks about the importance of CEL’s program for providing psychological treatment. 

“We do it so that LGBTI people feel comfortable and receive adequate services — people who come to CEL say that whenever they have sought psychological support, they’ve noted a tendency among psychologists to ‘sober them up’ or ‘turn them towards God,’” he says. “In reality, if you receive services in this form, I don’t think it contributes to mental health. On the contrary, it can have negative consequences.”

The few studies that have been conducted in Kosovo show that the approach of institutions towards LGBTI people is not appropriate. Morina tells us about the findings of a research study conducted by CEL and CSGD entitled “Social protection and access to healthcare for transgender people in Kosovo.” 

“We’ve noted that the situation is very bad in regards to the acceptance of LGBTI people from healthcare workers,” he says. “They hesitated to be interviewed for the study. We also noted that psychologists, endocrinologists and other healthcare workers lack basic information about the LGBTI community.”

Morina believes that it’s better not to receive psychological services at all than to receive these services from unprofessional doctors and psychologists. Because the treatment of cases without having necessary information about their specifics can exacerbate the condition of victims. In fact, one of the basic principles of psychology is to at least not cause harm when you cannot provide the necessary help.

Lend Mustafa, project coordinator at CEL. Photo: Majlinda Hoxha / K2.0.

To address the lack of staff and literature, CEL published a manual on psychological practice with transgender people and people with gender variance. The manual includes a series of definitions of important terms and ideas. Moreover, it addresses challenges that transgender people might face. Mainly by referring to different studies. 

In particular, the manual provides principles and directives that mental health professionals must keep in mind when beginning to treat transgender persons. For example, the first directive states: “Psychologists understand that gender is a non-binary construct that enables a series of gender identities and that the gender identity of a person might not correspond with their birth sex.”

One of the authors, Ajete Kërqeli, says that the manual can help psychologists, psychiatrists and social workers create healthy therapeutic relations with their transgender clients, increasing the efficiency of the psychotherapy. She encourages researchers to deal with LGBTI mental health issues. Because Kosovo lacks this kind of research.

At the University of Prishtina alone, every year tens of psychologists graduate with Bachelor’s and Master’s degrees. Therefore much research is being conducted each year. All the while we have an “information darkness” with regards to the condition of LGBTI persons. 

Difficult social, professional and institutional terrain

Research shows that families can play a very important role in the psychological welfare of LGBTI persons. However,  Blert Morina says that support from families and society is very rare. Making life very difficult for members of this community.

“We consider the family to be the main pillar where we expect more support. But the first break comes from the family,” he says. “This is traumatic. Especially for younger generations that are going through a delicate phase.”

“Each community within the LGBTI community has different needs."

Blert Morina, CEL

It seems that the lack of support is now a culture. Organizations that work to empower and raise awareness among citizens advocating for LGBTI rights, work in a difficult social, professional and institutional terrain. It is notable that CEL’s program has not received any help from state institutions. Despite having existed for many years.

Moreover, the number of organizations is too small to cover all that needs to be done. This is notable when we take into account that the community, in and of itself, is not a homogenous unit. Rather it is a diverse group.

“Each community within the LGBTI community has different needs,” says Morina. “Even within sub-communities there is a lot of diversity.”

Much work is being done to show that Kosovo is an inclusive country where human rights are respected. However,  Morina recalls that a 2018 study published by World Bank ranks Kosovo as the Western Balkan country that has the least acceptance of LGBTI people.K

Feature image: Majlinda Hoxha / K2.0.