A recent article, published in the Journal of Psychiatric and Mental Health Nursing, conducted a qualitative synthesis review for LGBT individuals’ experience of accessing mental health care and their specific mental health needs. The researchers propose that mental health nursing education should incorporate models that promote equity, inclusion, and respect for gender and sexual minorities.
“The dominant culture in mental health nursing and psychiatry is hetero and cis-normative,” the lead author, Samuel Rees from the University of Otago in New Zealand, points out. “Gender and sexual minorities within the western medical model are pathologized and often viewed as deviant individuals who required legal and medical attention.”
Based on minority stress theory, LGBT individuals experience greater stress from three different pathways: internalized homophobia, actual instances of prejudice, and perceived stigma, leading to poorer mental health and higher suicide rates. In addition, systematic discrimination within healthcare also creates unique barriers for LGBT communities to access care. If the providers from mental health nursing and psychiatry do not have in-depth awareness and understanding of LGBT individuals’ specific needs, LGBT communities are exposed to a higher risk for mental health concerns and experience greater health disparities.
“Given the growing rates of mental disorder, there is a need to identify how to best address the mental health needs of the LGBT communities,” the researchers add.
The authors did a comprehensive literature search, excluding quantitative studies, on four major databases, including Medline, Embase, CINAHL, and PsycINFO from 1996 to 2020. After removing the duplicates, there were 380 papers identified with qualitative information of LGBT individuals’ lived experience and perception regarding their mental health needs and their experience of mental health services. The study removed articles without full-text, where data was not solely from LGBT individuals and those that included responses from individuals over the age of 65. In the end, there were 14 studies included in the qualitative synthesis review.
Two main themes were identified from the review for LGBT individuals’ experience of mental health services: (1) experiencing stigma and (2) lack of knowledge and understanding of LGBT people’s needs. Twelve of the studies had LGBT individuals’ reports on experiences of homophobia, biphobia, and transphobia as well as monosexism and heterosexist bias when engaging with mental health services.
Also, many participants described feeling ignored or mistreated because of their sexual minority status. Seven of the studies found that participants were often exposed to health professionals with limited knowledge of the specific needs of the LGBT communities, and they were left feeling vulnerable and hopeless.
“The studies identified that there remains a lack of understanding and knowledge of the mental health issues faced by the LGBT communities and that more time and resources are required to improve the care provided to this minority population,” the authors write.
“The embedded heterosexism, homophobia, biphobia, and transphobia throughout all social institutions continue to reinforce the social exclusion experienced by the LGBT communities, and that means their needs are invisible.”
As for review for the specific mental health needs of LGBT individuals, two main themes were identified: (1) having LGBT friendly services or spaces that acknowledge the different mental health care that is required for those communities, and (2) services that provide informed care that promotes self-acceptance.
Seven of the studies identified that providers should be non-judgmental, comforting, and should not assume the individual is heterosexual. Five of the studies pointed out the deficiency in current health services for transgender affirmative therapy and treatment. All of the studies found that participants wanted informed care that did not pathologize their sexuality or assume their mental health symptoms were associated with their sexual identity issues.
Eleven of the studies identified the need to access talk therapy in an affordable and timely manner and the importance of accessing culturally sensitive therapists. Some participants suggested that services are needed to promote self-acceptance and to address the struggle with internalized norms, past experiences associated with harassment, abuse, violence, and other adversities associated with sexuality.
“Access to talking therapies that promoted self-acceptance and supported the principles of equity, inclusion, and respect for diversity was a theme across many of the studies,” the authors wrote. “Despite putative socioeconomic, legal, and political equality, many in the LGBT communities described specific struggles associated with hetero-normativity, complex dynamic in long-term relationships and processes within gay culture as impacting on their mental health.”
Based on the results of the review, the authors suggested that mental health nursing and psychiatry practices should ensure treatment provide reflects (1) self-awareness of personal and societal LGBT biases, prejudices, and stigma, (2) knowledge of important LGBT health care and psychosocial issues, and (3) LGBT clinical skills grounded in professional ethics, guidelines, and standards of care.
The Health Equity Promotion Model is proposed to honor LGBT individuals’ rights to good health so they can obtain their full health potential. The authors conclude:
“The (LGBT) community faces unique challenges when engaging with mental health systems with consequent unmet mental health needs. Mental health nurses need to incorporate a health equity promotion model of care into their practice to ensure equity, inclusion, and respect for diversity. That care needs to be destigmatizing, accepting, and promoting of self-acceptance.”
Rees, S. N., Crowe, M., & Harris, S. (2020). The Lesbian, Gay, Bisexual, and Transgender (LGBT) communities’ mental health care needs and experiences of mental health services: An integrative review of qualitative studies. Journal of Psychiatric and Mental Health Nursing. (Link)