A Qualitative Investigation of Engagement in Mental Health Services Among Black and Hispanic LGB Young Adults

Abstract

Objective: Little attention has been paid to engagement in mental health services among racially and ethnically diverse youths who identify as a sexual minority, despite research indicating that they face significant mental health disparities. In this study, the authors assessed the service use experiences of black and Hispanic lesbian, gay, and bisexual (LGB) young adults to identify factors that promoted or hindered their engagement.Methods: Semistructured interviews with 38 young adults regarding past and present experiences with mental health services were analyzed thematically for perceived challenges to and support for engagement. Participants' service use histories were reviewed for significant interruptions in services reported over the past year.Results: Seventeen participants (45%) reported disengagement despite continuing to need services. Factors that influenced engagement were identified across four domains: personal, social environment, accessibility, and provider characteristics. Stigma related to sexual orientation and cultural attitudes presented engagement barriers, whereas providers who were knowledgeable about sexual-minority issues were important engagement promoters. Additional barriers to engagement were ambivalence about treatment efficacy, lack of family support, and difficulty finding suitable and affordable care. Peers who identified as a sexual minority helped participants locate LGB-affirming services. Rapport with providers and health care autonomy assisted participants to manage barriers to engagement. Conclusions:These findings offer insights about factors that can influence engagement with treatment among black and Hispanic LGB young adults. The findings reveal important provider competencies and can inform interventions to improve engagement and reduce mental health inequities among these youths.

An Environmental Scan of Ontario’s Mental Health and Addiction Services Exclusive to LGBTQ2S+ Youth During COVID-19

“…There are limitations to this approach, however. Individual clinician competency can vary, and as youth may engage with multiple service providers within a given organization, there is risk or perception of risk of having their identity stigmatized by providers, which may result in a youth not disclosing their identity or acting as a barrier to seeking out support (Moore et al, 2020). There can also be risk or anticipation of risk of experiencing discrimination and harassment from other participants such as in the waiting room or in group settings which may act as a barrier to care (Cochran, Peavy, & Cauce, 2007).…”

“…LGBTQ2S+ young adults identi ed several additional barriers, including stigma associated with mental health symptoms and sexuality, ambivalence about the e cacy of treatment, and lack of family support due to family's previous negative experiences with mental health interventions (Moore, Lopez, Camacho, & Munson, 2020).…”

Australian Mental Health Consumers’ Experiences of Service Engagement and Disengagement: A Descriptive Study

“…Specific ethnic, cultural, and sexual minority populations were also under-represented, and their reasons for engagement and disengagement may vary. Moore et al’s US study of engagement among Black and Hispanic LGB young adults [ 32 ], for example, found stigma related to sexual orientation and cultural attitudes, ambivalence about treatment efficacy, lack of family support, and difficulty finding suitable and affordable care were important barriers.…”

Mental health provider training to improve LGBTQ competence and reduce implicit and explicit bias: A randomized controlled trial of online and in-person delivery.

“…provider mistrust (Ferlatte et al, 2019;Moore et al, 2020) and other barriers to accessing LGBTQ-affirmative services (Veltman & Chaimowitz, 2014). LGBTQ individuals' negative interactions with providers have been associated with reduced health care engagement (James et al, 2016;Li et al, 2015), while lack of LGBTQ-specific or affirming expertise often results in inadequate and/or withheld treatment (Calabrese et al, 2018;James et al, 2016).…”

“…Stigma generates excess stress and depletes coping abilities for lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals worldwide (Mays & Cochran, 2001; Meyer et al, 2008) and is associated with adverse physical (Kecojevic et al, 2012; Poteat et al, 2018) and mental health (Ferlatte et al, 2019; Shipherd et al, 2010; Wilton et al, 2018). In mental health care contexts, stigma generates provider mistrust (Ferlatte et al, 2019; Moore et al, 2020) and other barriers to accessing LGBTQ-affirmative services (Veltman & Chaimowitz, 2014). LGBTQ individuals’ negative interactions with providers have been associated with reduced health care engagement (James et al, 2016; Li et al, 2015), while lack of LGBTQ-specific or affirming expertise often results in inadequate and/or withheld treatment (Calabrese et al, 2018; James et al, 2016).…”