LGBQ+ adults’ experiences of Improving Access to Psychological Therapies and primary care counselling services: informing clinical practice and service delivery

Abstract

Lesbian, gay, bisexual, queer and other sexual minority (LGBQ+) people experience higher levels of psychological difficulties than heterosexual people. Evidence suggests that LGBQ+ treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse than the outcomes for heterosexuals, especially for bisexual people and sexual minority women. IAPT services provide evidence-based treatments like cognitive behavioural therapy (CBT), typically for anxiety or depression. This study explored LGBQ+ adults’ experiences with IAPT services and/or primary care counselling. LGBQ+ adults (n = 136) answered an online questionnaire (fixed-response and optional open-ended questions) about their access and treatment experiences. Descriptive statistics summarized multiple-choice responses. Qualitative data were analysed through thematic analysis. Before access, 41.9% of participants were concerned about experiencing LGBQ+ stigma/discrimination within psychological services. Only 13.2% of participants thought their sexuality negatively impacted their treatment, although prejudice/discrimination may be underestimated as 33.6% participants did not disclose their sexuality to practitioners and sexuality was not discussed in treatment for 44.0% of participants. Bisexual clients were significantly less likely to disclose their sexuality. The barriers LGBQ+ people described within IAPT or primary care services included: feared or experienced stigma in the services; reluctance to disclose sexuality; inconsistent discussion of sexuality in treatment; a lack of awareness and understanding towards LGBQ+ identities and community-specific challenges; and distrust, disillusionment and exclusion resultantly. Overall, 52.2% thought services could be improved for LGBQ+ individuals. This study identified multiple issues to be addressed in therapist training and service development.Key learning aims (1)The unique needs/experiences that LGBQ+ people bring to therapy, such as the need to disclose their sexuality and past experiences of stigma/discrimination, including how this differs within the community (e.g. bisexual people or LGBQ+ Black and minority ethnic people).(2)How these needs/experiences can result in barriers that make their treatment experience distinct from heterosexuals and influence their treatment outcomes.(3)What steps should be taken in future research and clinical practice to ensure improvements in the psychological treatment experiences of LGBQ+ people, including in relation to therapist understanding and training in LGBQ+-related issues.

LGBQ adults’ experiences of a CBT wellbeing group for anxiety and depression in an Improving Access to Psychological Therapies Service: a qualitative service evaluation

“…There is stronger evidence that members of the LGBQ community report feeling disconnected from and mistreated by health services when they do engage. Specifically, services may be perceived as discriminatory and as failing to address the specific needs of LGBQ people (Foy et al ., 2019; Hudson-Sharp and Metcalf, 2016; King et al ., 2007). LGBQ individuals report that clinicians in health care settings often use heteronormative language which locates heterosexuality as the norm, and that many clinicians lack particular sensitivity to issues that sexual minority communities may face.…”

“…In their mixed methods survey study exploring LGBQ adults’ experiences of IAPT and primary care counselling services, Foy et al . (2019) found that 41.9% of participants were concerned about experiencing stigma/discrimination in relation to their sexuality within psychological therapy services. This arguably hindered engagement with therapeutic interventions and may have deterred further help-seeking from mental health services.…”

“…Given the disparities in satisfaction and symptom improvement that exist between LGBQ and heterosexual populations accessing IAPT services, as well as the particular community-specific stressors that LGBQ populations face in relation to their mental health, and barriers in accessing mental health treatment (Foy et al ., 2019), a novel CBT group intervention was developed specifically for LGBQ service users in a London-based IAPT service. The group aimed to offer a LGBQ affirmative space through which attendees could learn more about CBT principles as applied to overcoming stress, anxiety and depression, whilst also attempting to address how to cope with some of the specific minority stressors that this group are exposed to (e.g.…”

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review

“…The review yielded 42 studies relating to LGBT+ mental health. Of these included papers, 10 were qualitative papers [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], 22 were quantitative papers [ 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ], 6 were review papers [ 97 , 98 , 99 , 100 , 101 , 102 ], and 4 were mixed-methods papers [ 103 , 104 , 105 , 106 ]. Broadly, these papers were thematically divided across three areas.…”

“…Secondly, 22 papers were concerned with the incidence of mental health problems, and the risk factors associated with the elevated rates of mental health problems within LGBT+ populations [ 75 , 76 , 78 , 79 , 80 , 81 , 83 , 84 , 85 , 86 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 100 , 101 , 102 , 106 ]. Thirdly, 14 papers were concerned with LGBT+ people’s experiences of having mental health problems and treatment, and explaining the factors contributing to their poor mental health [ 65 , 66 , 67 , 68 , 69 , 71 , 72 , 73 , 74 , 88 , 89 , 103 , 104 , 105 ].…”