Denying gay people the right to legally wed can have an adverse impact on their mental health -- that's according to a policy paper from the National Sexuality Resource Center at San Francisco State University.

The paper was co-authored by the center's director, Gilbert Herdt, and Robert Kertzner, a member of the center's advisory board.

The authors state that the potential harm to gay men and lesbians and their communities is significant enough to call for laws and policies that allow for same-sex marriage in the United States.

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Nancy Murrell of Penn Hills said she can relate to the stress caused when a gay couple does not have the benefits afforded those who are allowed to marry.

"I think people look at this and they think of it as something that just hurts our feelings," she said. "That's really not the problem. The problem is all of the things that not being able to be married keeps us from."

She cited as an example a medical emergency involving her partner Cynthia Weis, who was thought to have a burst appendix.

Ms. Murrell rushed to the hospital from work, so her health-care power of attorney was at home.

"I got there and I realized that I had no proof of what I was to her except she was on my insurance," Ms. Murrell said.

She felt very vulnerable and at the mercy of the hospital administration, which in this case did cooperate with the couple, she said.

Questions that can arise -- such as what happens if one partner dies without a will or whether employers have same-sex health benefits -- increase the stress for gay couples beyond the crises faced by others, Ms. Murrell said.

Michael Olich, an associate professor at Carnegie Mellon University's School of Drama, and his partner, Keith Teague, were married in Seattle in 2003 and a few days later in British Columbia.

The Seattle marriage is not legal. The one in British Columbia is legal there but not recognized here.

"There is definitely a stress around issues that have to do with property rights, post-death rights of access and ownership," he said.

He and his partner have a will and a health-care power of attorney.

"Those are two of the examples of the extra legal formalizations that have to be put into place for nonrecognized partnerships," Mr. Olich said, adding that the lack of legal, social and community protection afforded to married couples can cause self-esteem issues for gay people.

"We feel insecure sometimes -- not between each other but between us and the community we're in," he said.