Health, Mental Health, and Barriers to Care for the LGBTQ Population

LGBTQ Community Health

The health and mental health of lesbian, gay, transgender, and queer/questioning (LGBTQ) populations is affected by multiple factors, many of which being unique to this population. The number of LGBTQ persons in America is found to be between 2-3% of the total population (Romanelli & Hudson, 2017); however, this population remains underserved or ill served by the healthcare industry (Romanelli & Hudson, 2017). The causes for these health disparities are numerous and ever changing as research delves deeper into specific health concerns and causality.

Access to physical and mental health requires opportunities to seek out and reach needed services and to be offered appropriate care when provided (Romanelli & Hudson, 2017). LGBTQ persons already accessing primary or mental health services come upon specific and unique barriers to quality care compared to the care received by the heterosexual cisgender population even though they are more likely to seek treatment (Williams & Fish, 2020). These include both individual and system-level barriers, both having effects on LGBTQ health outcomes.

Mental Health Among LGBTQ Populations

Metal health among LGBTQ populations often go hand-in-hand with physical health and health outcomes; therefore, an overview of mental health issues is in order. The LGBTQ population is riddled with unique societal and personal stressors that contribute to their overall mental health. Some of the most prevalent stressors include social stigma, prejudice, discrimination, victimization, homophobia, internalized homophobia, family dynamics, and denial of civil rights (Fulginiti et al., 2021; Whaibeh, 2019; Yolaç &Meriç, 2020).

These influences often cause members of the LGBTQ community to develop mental health problems at a high rate. The most common mental health conditions seen among the population include depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorders, job discrimination, and alcohol use as well as feelings of helplessness (Macbeth et al., 2021; Whaibeh, 2019; Yolaç &Meriç, 2020). Each of these mental health conditions are represented among the LGBTQ population at higher rates than their heterosexual cisgender peers. These mental health conditions also often correlate with general poor health outcomes.

Physical Health Among LGBTQ Populations

Physical health among the LGBTQ populations can be divided among genders or represented as a whole; however, due to the diversity of the population certain numbers may be an under- or overestimation of physical conditions. Physical conditions range from early predictors of future disease to acquired fatal diseases.

First, members of the LGBTQ community are less likely to have a primary care provider (PCP) (Cigna, 2022). Not having a reliable provider to create a report with can lead to a host of problems when accessing primary care. Even when a PCP has been established LGBTQ persons have reported dissatisfaction with treatment autonomy, equity, and overall clinical outcomes (Whaibeh et al. 2019). Members of the LGBT community have higher rates of HPV infections and are at a higher risk for alcohol, substance, and tobacco use (Cigna, 2022; Shaver et al., 2019).

Women identifying as lesbian or bisexual have higher rates of elevated weight and a decreased likelihood of attending regular yearly pap smears (Shaver et al., 2019). Women identifying as lesbian or bisexual also have higher rates of breast cancer than thier heterosexual, cisgender peers (Cigna, 2022). Regular avoidance of annual checkups puts women identifying as lesbian or bisexual at greater risk of developing undiagnosed diseases and/or diseases caught at later stages of development.

Men who identify as gay or bisexual have higher markers for cardiovascular stress and higher rates of eating disorders proportionally (Shaver et al., 2019). Transgender men also have a higher rate of depression than heterosexual cisgender men or other subcategories within the LGBTQ community (Shaver et al., 2019).

Violence Among LGBTQ Populations

Violence among LGBTQ population members is higher than that of the general population and includes physical and sexual assault, verbal assault, interpersonal trauma, harassment, and bullying (Kassing et al., 2021). Violence at any age can have repercussions on one’s mental and physical health even if the violence happened years in the past. The number of violent cases is highest in rural areas and other areas without specific legislation for LGBTQ protection (Backhaus et al., 2019).

Sexual assault rates are reported as high as 10% within the LGBTQ community with an average of 2% of those identifying as heterosexual (Kassing et al., 2021) and an average of 30% reporting being threatened or physically attacked (Kassing et al., 2021). These types of discriminatory actions are associated with poor mental and physical health outcomes as well as side effects such as decreased energy levels, concentration difficulties, and lower levels of job retention and earning potential (Backhaus et al., 2019).

There are some methods shown to buffer the effects of violence among LGBTQ college students. Those who felt a sense of belonging, group cohesiveness, and community connectedness showed fewer long-term effects from discriminatory violence than those who felt isolated or excluded (Backhaus et al., 2019). This may also be true for those who feel a sense of belonging or community connectedness in other age ranges.

Suicidality in LGBT Populations

Suicidal ideation and attempts are very high in the LGBTQ population compared to heterosexual cisgender peers. Suicide is already the second leading cause of death among youth aged 10-24 (Fulginti et al., 2021), so increased ideation and attempts among this population make them especially vulnerable. Stigma, prejudice, discrimination, and victimization are reported as the leading factors related to LGBTQ suicidality (Fulginti et al., 2021).

In the general population it is estimated that 12% of adolescents contemplate suicide (Russon et al., 2021). It is reported that suicidality among LGBTQ youth are around 1.6-2.63 times that of the general population (Backhaus et al., 2019). The attributed factors for this include parent-adolescent relationship, family rejection of sexuality, negative familial events, and extrafamilial victimization (Russon et al., 2021). The largest disparity between suicidality in the general population and the LGBTQ population is that of actual suicide attempts (Fulginti et al., 2021).

Transgender male adolescents reported the highest rate of suicidality followed by transgender female adolescents (Fulginti et al., 2021). The rate of suicidal ideation and attempts by members of the LGBTQ population is alarming and warrants research for interventions specific to this population.

LGBTQ Health and Family Dynamics

Family dynamics can play a large role in either exacerbating or buffering symptoms associated with mental health disparities for the LGBTQ community. Some of the largest factors attributed to family dynamics and their effect on the LGBTQ community include rejection of one’s sexuality, inclusivity, acceptance, and religiosity.

Religiosity is often seen as a protective factor that buffers the effects of everyday life for the general population, but this is not always the case for members of the LGBTQ community (Macbeth et al., 2021). Religiosity may be one of the main variables attributed to familial acceptance or exclusion of family members based on sexual orientation. Therefore, it is reasonable to look at it as a marker of future mental health outcomes for LGBTQ members.

Religiosity is seen as the degree to which an individual, or family, hold religious beliefs (Macbeth et al., 2021). Traditionally religiosity has led to members of the LGBTQ community felling excluded and unwelcome as homosexuality has historically been prohibited (Dyer, J.,2021). A family’s religiosity, therefore, can indicate problems among family members’ acceptance of non-heterosexual orientations. Rejection by family members has been associated with increased suicide attempts and higher rates of anxiety and depression (Macbeth et al., 2021).

Barriers to Accessing Quality Care

The barriers to accessing quality care are numerous among the LGBTQ community and are attributed to both individual and systematic barriers. The main barriers include discrimination, poor treatment, insensitivity, geographical availability, appropriateness of service, and competence among providers (Romanelli & Hudson, 2017). Other barriers include lack of self-advocacy, embarrassment, and false expectations by the individual care-seeker (Romanelli & Hudson, 2017).

Often, LGBTQ members believe providers hold negative predispositions toward them, lack competency in their unique care, and are overall less satisfied with treatment (Williams & Fish, 2020). Although some of these may be misconceptions by the care-seeker the reality is that it is enough for them to either delay care or forfeit care altogether. A universal system for teaching LGBTQ care is needed in medical programs.

Some recent suggestions to increase care quality among providers is the idea of culturally responsive care as well as care via telemedicine. Currently 1 in 6 adults is lives with a mental illness, and this number is higher for the LGBTQ population (Waihbeh et al., 2019). Telehealth seems to be a major advantage in meeting the needs of mental and physical care for all populations across geographical and socioeconomic status (Waibeh et al., 2019). Although promising, more needs to be done to meet the unique needs of the LGBTQ population.

Conclusion

The LGBTQ population makes up a large community who have trouble accessing quality physical and mental health services. Much of the problem regarding access has to do with societal discrimination and/or perceptions of such. Little research has been done to identify specific, effective interventions within the LGBTQ populations for both mental and physical health even though these members of the community are at a much higher risk for certain mental and physical health conditions.

Universal teaching practices as well as on-site training specific of the population in the geographic area is warranted and necessary. To provide the best available care for the LGBTQ community, members of the community and providers should tailor care to meet the needs of this population and self-advocacy skills should be taught regarding one’s own health. A multi-faceted approach should be taken to ensure the health and wellbeing of the LGBTQ population. Research should continue to delve into appropriate care interventions for both mental and physical health of the LGBTQ population as well as how to reduce stress factors and societal barriers to appropriate care.

References:

Backhaus, I., Lipson, S., Fisher, L., Kawachi, I., & Padrelli, P. (2021). Sexual assault, sense of belonging, depression and suicidality among LGBQ and heterosexual college students. Journal of American College Health, 69(4), 404-412. https://doi.org/10.1080/07448481.2019.1679155

Cinga. (2022). LQBTQ+ health disparities. Retrieved from https://www.cigna.com/knowledge-center/lgbtdisparities#:~:text=LGBTQ%2B%20people%20are%20less%20likely%20to%20have%20a%20regular%20health%20care%20provider.&text=Lesbian%20and%20bisexual%20women%20have,women%20are%20at%20greater%20risk.&text=LGBTQ%2B%20people%20have%20higher%20rates,related%20cervical%20or%20anal%20cancers.

Dyer, Justin. (2021). Refining research on the intersection between sexual orientation, suicide, and religiosity. American Psychological Association, 24(2), 179-188. https://doi.org/10.1037/rel0000451

Fulginiti, A., Rhoades, H., Mamey, M., Klemmer, C., Srivastana, A., Weskamp, G., & Goldbach, J. (2021). Sexual minority stress, mental health symptoms, and suicidality among LGBTQ youth accessing crisis services. Journal of Youth and Adolescents, 2021(50), 893-905. https://doi.org/10.1007/s10964-020-01354-3

Kassing., F., Casanova, T., Griffin, J., Wood, E., & Stepleman, L. (2021). The effects of polyvictimization on mental and physical health outcomes in an LGBTQ sample. Journal of Traumatic Stress, 2021(34), 161-171. https://doi.org/10.1002/jts.22579

Macbeth, A., Vidales, C., & Vogel, D. (2021). Perceived parental religiosity as a predictor of depression and substance use among LGBTQ+ individuals: The mediating role of perceived familial stigma. American Psychological Association, 14(1), 140-147. https://doi.org/10.1037/rel0000411

Romanelli, M. & Hudson, K. (2017). Individual and systematic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American Journal of Orthopsychiatry, 87(6),714-728. https://dx.doi.org/10.1037/ort0000306

Russon, J., Morrissey, J., Dellinger, J., Jin, B., & Diamond, G. (2021). Implementing attachment-based family therapy for depressed and suicidal adolescents and young adults in LGBTQ+ services. Crisis. https://doi.org/10.1027/0227-5910/a000821

Shaver, J., Sharma, A., & Stephenson, R. (2019). Rural primary care providers’ experiences and knowledge regarding LGBTQ health in a midwestern state. The Journal of Rural Health, 2019(35), 362-373. https://doi.org/10.1111/jrh.12322

Whaibeh, E., Mahmoud, H., & Vogt, E. (2019). Reducing the treatment gap for LGBT mental health needs: The potential of telepsychiatry. Journal of Behavioral Health Services and Research, 47(3), 424-431. https://doi.org/10.1007/s11414-019-09677-1

Williams, N. & Fish J. (2020). The availability of LGBT-specific mental health and substance abuse treatment in the united states. Health Services Research, 2020(55), 932-943. https://doi.org/10.1111/1475-6773.13559

Yolaç, E. & Meriç, M. (2020). Internalized homophobia and depression levels in LGBT individuals. Perpectives in Psychiatric Care, 2019(57), 304-310. https://doi.org/10.1111/ppc.12564

Testimonials

“As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.”
Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

“The DBH represents something that I've always embraced in my professional career. And that's collaboration and working across a lot of different disciplines to make sure you’re delivering the best care for the patient. Everything is about being patient centered about finding innovative ways and creative ways to collaborate with other professionals.”
CDR Sean K. Bennett, LCSW, MSWAC, BCDDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - October 10, 2023

“This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.”
Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

“The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.”
Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

“The DBH program has been a pivotal turning point in my understanding and application of behavioral health principles. Recently, the concept of ‘whole person health’ has gained widespread attention in healthcare circles, becoming somewhat of a buzzword. Like many others, I embraced this term, believing in my capacity to deliver comprehensive care.

Prior to my engagement with the program, my approach, albeit well-intentioned, lacked an appreciation for the intricate interplay between physical and mental health. More importantly, the role of unmet social needs as a catalyst for health disparities was a dimension I had not fully integrated into my practice. The DBH program illuminated these connections, offering me a robust framework to understand and address the multifaceted needs of individuals, especially within marginalized communities.

Additionally, the confidence I have gained through the DBH program extends beyond theoretical knowledge. My role as a connector and advocate for these individuals has become more pronounced, driven by a deep-seated commitment to fostering accessibility, equity, and comprehensiveness in care.”
Michelle Stroebel MA, NCC, LCMHC, NADD-CCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - June 12, 2024

“I have worked in behavioral health for the entirety of my professional career starting with college internships up to my current role as Deputy Executive Commissioner of Behavioral Health for the Texas Health and Human Services Commission. While I have years of experience in the field, the DBH program at Cummings has framed my perspective as leveraging therapy as a first line of intervention. As a public servant, much of the work I do is usually in the aftermath of crises or when the system is being forced to respond to a service gap. However, the DBH program takes a much more proactive and integrative approach to health. This perspective/approach has the potential to positively shape policy in Texas in my role as a public servant charged with addressing the safety net needs of the most vulnerable constituents in Texas.”
Trina K. Ita, MA, LPCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - July 10, 2024

“CGI feels like a community of long-lost cousins that finally met as adults and we realized that we share the same goals. The support from the faculty and classmates have been nothing short of amazing. I can reach out to my advisor at any given time to discuss course work, career endeavors, or to just vent about life. There is a feeling of closeness and belongingness at CGI that is just unmatched. I am very happy to be a member of the family and will continue to spread the word of how great this DBH program is.”
Michelle Francis, LCSW/LICSW-QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 10, 2024

“The DBH program’s mission, purpose, and objective say it all: We strive for intentional care outcome improvement practices that exemplify whole person-centered integrated healthcare advanced competency. The program of study drives insights and awareness of the ever-changing patient population and multidisciplinary practice environments to change how the world experiences healthcare. This is further reinforced by the pillars of medical literacy, integrated behavioral health intervention, and entrepreneurship skills and expertise. Development growth is needed to prepare the aspiring DBH for the future of the shifting healthcare marketplace through international networking in a growing community of disruptive innovators and an evolving movement toward systemic healthcare change. I feel that I will be positioned alongside a fellowship of like-minded professionals trying to improve the quality of healthcare service delivery value and outcome sustainability.”
Jose Mathew, LCSW, LAC, ACS, EMDR-T, CCTP-IIDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - October 8, 2024

“The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.”
Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

“By becoming a DBH, I have found that I am able to have different conversations with different people. Before having my doctorate degree, I was able to speak to certain items in behavioral health, but was only seen as a licensed therapist where as a doctor, I am able to speak to the changemakers and policy makers in a more collaborative manner which then allows us as a group to enhance the services we are providing. I also found that as a DBH, my confidence in the treatment room has improved immensely and cases that may have been more difficult for me before are no longer as difficult due to the training I have received in the program.”
Dr. Allison Earl, DBH, LPC-SDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - November 13, 2024

“I think the DBH is quite groundbreaking, it allows you to study from anywhere in the world. The support is fantastic, and you can make out of the DBH what you want. Unlike standard professional doctorates, the DBH was trying to break new ground, not trying to go over just old ground. It greatly encourages its students to be those people who break new ground.

As a person who actually has a disability, I found CGI staff to be very supportive, very accommodating. If I need extensions, they are always there. In fact the staff will reach out and check on you, if they haven’t heard from you in a very short period of time. Which I have never had from any other university.

I find the community of fellow DBH students absolutely wonderful, we reach out across numerous social media platforms, we email each other. Doesn’t matter where I am in the world or where they are in the world, everyone is supportive. Its support, support and encouragement with the DBH.”
Jason P. Sargent, B Policing, GDip Psych, MSW, JPDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - December 10, 2024

“Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.”
Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

“I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.”
Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

“Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.”
Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

“Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.”
Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

“The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.”
Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

“The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.”
DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

“The DBH program has been integral in preparing me for leadership roles by providing a solid foundation in both the theoretical and practical aspects of leadership within the behavioral health sector. Through coursework, case studies, and hands-on experiences, I have learned to lead with empathy, data-driven decision-making, and strategic planning. The program has also honed my skills in organizational development, communication, and policy advocacy, equipping me to effectively lead teams, drive impactful change, and foster environments that promote positive behavioral health outcomes. With this training, I am confident in my ability to lead initiatives that address systemic barriers and improve care delivery.”
Dr. Jerrika Henderson, DBH, CMHCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - March 18, 2025