Patient Access to Mental Healthcare Challenging for 60% of LGBTQ Kids

Patient access to mental healthcare is still out-of-reach for most LGBTQ youth, with more than half saying they wanted or needed mental healthcare in the past year but were not able to access it, according to figures from the Trevor Project.

That includes nearly three in five transgender or nonbinary youth and more than three in five cisgender youth, the survey showed.

These finding double down on the serious mental healthcare access problems LGBTQ youth have long faced. Stigma, limited provider options, and other social determinants of health, like transportation barriers, have contributed to mental healthcare access barriers.

Nevertheless, mental healthcare access is a significant need across the LGBTQ youth population. The Trevor Project found that 82 percent of LGBTQ kids wanted or needed mental healthcare. Only 40 percent of those kids said they were able to get the mental healthcare they desired.

Of the 60 percent who weren’t able to get mental healthcare, many (48 percent) cited fear of discussing their mental health needs. This was the most commonly cited barrier to mental healthcare, although other structural and SDOH barriers emerged.

For example, 45 percent of LGBTQ kids said they were concerned they wouldn’t get permission from their parents or guardians and 20 percent said they were completely denied that permission. About a quarter (23 percent) said they were worried about using telehealth at home.

Others cited more logistical barriers. About one in five kids who were not able to access mental healthcare said they had transportation barriers, while 41 percent said mental healthcare was not affordable.

Meanwhile, fears about discussing identity with a mental healthcare provider were significant. Just over a quarter of respondents said they were worried their identity might be misunderstood, 29 percent feared being outed, and 43 percent were worried they would not be taken seriously. Thirty-four percent of LGBTQ kids said they were worried mental healthcare would not work to address their mental health needs.

Moreover, there were serious cultural identity concerns among LGBTQ youth, particularly that their mental healthcare provider may not understand their culture or ethnicity. This concern was most common among Asian American/Pacific Islander (18 percent) and Middle Eastern/Northern African youth (21 percent).

Thirteen percent of Black kids, 9 percent of Hispanic kids, 9 percent of Native/Indigenous kids, and 8 percent of multiracial kids also held this fear.

Meanwhile, cultural concerns were rare among White kids, with only 2 percent saying they were worried their mental healthcare providers might not understand their culture or ethnicity.

LGBTQ youth fear that these care access problems will continue, particularly due to institutional barriers. Ninety-three percent of transgender and nonbinary kids told the Trevor Project they have worried about transgender people being denied access to gender-affirming care due to state or local laws.

Factors like being able to call home or school a safe or affirming space, seeing LGBTQ advocacy and representation, community acceptance, and support from parents or guardians have all been identified as key to assuring better mental health outcomes for LGBTQ kids, the researchers pointed out.

The number of kids who have access to those social safety nets is growing, the report indicated, although there is room to grow.

Importantly, the healthcare industry needs to cultivate a more diverse clinical workforce to assure LGBTQ youth—and adults—have access to providers who understand their unique needs.

In March 2022, researchers from the Regenstrief Institute, Indiana University School of Medicine, and Eskenazi Health reported that access to a transgender clinic can help improve care access and quality for transgender people, but those clinics are few and far between.

In turn, geographic barriers and long wait times are getting in the way of access to culturally responsive care, patients told the researchers.

“When we spoke to these patients, many described difficulties in being able to find a provider that could or would treat them. Some traveled for hours just so they could be seen in an affirming setting with providers knowledgeable about transgender health,” Joy L. Lee, PhD, MS, a research scientist at Regenstrief Institute and assistant professor of medicine at IU School of Medicine, said in a public statement.

“These interviews speak to the need for more primary care providers who can treat transgender patients and highlight the need to create healthcare spaces that feel safe for transgender individuals,” added Lee, who was also the first author of the study.