Abstract
Lesbian, gay, bisexual, trans, and/or queer (LGBTQ) people face barriers to accessing mental health care; however, we know little about service experiences of low income LGBTQ people. In this qualitatively-driven mixed methods study, over 700 women and/or trans people completed an internet survey, of whom 12 LGBTQ individuals living in poverty participated in interviews. Low income LGBTQ respondents saw more mental health professionals and had more unmet need for care than all other LGBTQ/income groups. Narrative analysis illustrated the work required to take care of oneself in the context of extreme financial constraints. These findings highlight the mechanisms through which inadequate public sector mental health services can serve to reproduce and sustain both poverty and health inequities.
Highlights
Lesbian, gay, bisexual, trans, and queer (LGBTQ) populations, relative to non-LGBTQ populations, experience significant health disparities [1] in relation to mental health
We worked in collaboration with LGBTQ community members and agencies towards addressing inequities experienced by LGBTQ people in their attempts to access mental health care [13]; the present analysis focuses on inequities experienced by LGBTQ people living in poverty
The reuse of data described in this manuscript is a qualitatively-driven mixed methods analysis [22], where we used an iterative approach to re-examine both the qualitative and quantitative data with new research questions about mental health service experiences for LGBTQ people living in poverty
Summary
Gay, bisexual, trans, and queer (LGBTQ) populations, relative to non-LGBTQ populations, experience significant health disparities [1] in relation to mental health. Fewer data are available regarding trans mental health, as a result of the invisibility of gender identity in most population-based surveys, available evidence suggests that mental health disparities are even more pronounced for trans people relative to cisgender (non-trans) people [4]. There are important economic disparities associated with sexual orientation and gender identity. Badgett and colleagues [5] examined data from three different US population-based surveys, and found a consistent pattern of elevated poverty rates among sexual and gender minority people. These findings align with data from other countries, including Canada [6] and the United Kingdom [7], which have identified disparities associated with
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