While mental health and sexual health services are often separated, new research suggests it could be valuable to combine them, particularly for sexual and gender minorities. The lesbian, gay, bisexual, transgender and queer (LGBTQ) population tends to experience higher levels of mental health struggles than the heterosexual and cisgender (meaning people whose gender identity matches their sex at birth) population. Yet, LGBTQ people are more likely to face barriers in accessing health care services. In this Q&A, Travis Salway, a postdoctoral fellow with the BCCDC, explains the recent findings of a new study in the Journal of Public Health Management and Practice.

We surveyed 1,115 clients in six STI clinics in Greater Vancouver and found that 28 per cent wanted to talk with a health care provider about a mental health or substance use concern but had not had the opportunity to do so. The most common mental health-related needs were anxiety, depression, drug or alcohol use, and thoughts of suicide. Just over half of the clients surveyed were LGBTQ, and these clients were more likely than heterosexual and cisgender clients to report facing a barrier to accessing mental health services. Many LGBTQ people continue to feel a stigma related to their sexuality or gender and in some cases this may make it harder for them to open up about their health needs, especially for another stigmatized topic like mental health.

Integration of mental and sexual health services has been explored in other places, including at San Francisco’s Strut and the Health Initiative for Men (HIM) in Vancouver, both organizations that promote health and wellness for gay men. The findings from our study and others suggest LGBTQ-tailored services, like those of Strut and HIM, can help address these needs.

In this survey, clients reported delaying or avoiding access to mental health care because of cost and shame or embarrassment. Other research has also found that many LGBTQ people avoid accessing health care or are selective in the providers they talk to because they fear judgment. This means we need solutions to address the needs of the LGBTQ population and create an environment where they feel included and recognized for their sexual orientation and gender identity. Health care settings can create such environments by providing staff with training to understand LGBTQ-specific issues when they arise. They can also create policies and practices that ensure clinics are non-discriminatory settings by, for example, taking care to use patients’ preferred pronouns. 

We also asked clients about their comfort in talking about mental health and found they were more comfortable talking to nurses and doctors in the STI clinic than they were in talking to their family doctor, friends or family. For these reasons, we think there is a good opportunity to reach those in need of mental health supports when they come into the STI clinic. In fact, 42 per cent of the clients we surveyed did not have a regular health care provider or family doctor so the STI clinic may be their only contact with health care.

We are currently working with STI clinic providers throughout the province to better understand how they currently address their clients’ mental health-related needs. What we have learned so far is that mental health concerns often go hand-in-hand with sexual health concerns and STI clinic providers are prepared to hear about those issues from their clients. As a next step, we will be exploring different models for how this could work. These models could include co-locating mental and sexual health services or strengthening the connections between providers. This could be one of a growing number of initiatives in British Columbia to address the mental-health needs of the LGBTQ community.