Mental and Behavioral Healthcare is Top LGBTQ Healthcare Need

“The survey findings are especially relevant considering today’s Supreme Court ruling overturning Roe V. Wade, which puts the state of LGBTQ health in a precarious position in many ways, including through restricted access to reproductive and other essential healthcare services, and increased mental health stressors driven by a lack of access to and inequities in healthcare,” said the Coalition’s Executive Director Brian Hujdich. “The data from this report can help inform how we navigate this new reality, which undoubtedly will heavily impact sexual and gender diverse racial and ethnic minorities and youth who are already disproportionately affected by HIV, COVID-19, and other infectious and non-infectious diseases, and are more likely to face barriers to care stemming from lack of housing, low socio economic status, and complex care needs.”

The Coalition surveyed more than 2,300 clinicians and other healthcare providers who identified mental health, stigma and discrimination, and transgender and gender affirming care as the key healthcare issues in LGBTQ+ communities in 2022. Providers also noted widespread workforce issues directly impacting their ability to care for these communities, including staff shortages, burnout, and retention issues. An extensive report on the State of LGBTQ Health™ survey findings is available at HealthLGBT.org/HealthSurvey.

• LGBTQ+ providers are experiencing staff shortage, burnout, and retention: LGBTQ+ providers reported significant burnout, staff shortage, and retention issues. They are requesting support to address this, including expanded training on LGBTQ+ care, more LGBTQ+ focused medical providers, and increased staff support to provide wraparound services.
• Mental and behavioral health is the most significant need for the LGBTQ+ community: Mental and behavioral health needs were cited as the number one issue for LGBTQ+ communities—71% of providers reported this as a key issue. Integrating mental and behavioral health services into primary care can work to offset those risks.
• Numerous factors impact taking sexual health histories: Taking a sexual history is an important element of LGBTQ+ health. The findings demonstrate that most (89%) providers feel comfortable taking a sexual history, and 76% report taking them with LGBTQ+ patients/clients. However, providers reported that they do not discuss sexual practices with their clients due to patient flow, knowledge, and accreditation factors.
• Need to expand sexual orientation and gender identity supports: The majority of providers reported that they incorporated a number of sexual orientation and gender identity (SOGI) supports such as gender identity, sex at birth, and sexual orientation questions on intake forms. However, they were less likely to incorporate pronouns and providing LGBTQ+ materials in the waiting room areas.
• LGBTQ+ providers are experiencing challenges with insurance and pre-authorizations for sexual health services: Providers indicated that employee sponsored insurance, private insurance, and Medicaid are more likely to require the most time for pre-authorizations for  PrEP, HCV Direct Acting Agents, hormone replacement therapy, and anti-HIV medications.
• COVID-19 impacts LGBTQ+ services: Respondents reported that the services most impacted by COVID-19 were linkage to care, HIV testing, and case management. A variety of reasons were provided including workforce shortages, clinic closures, and client disengagement.

The State of LGBTQ Health™ National Survey identified needs and gaps in the healthcare delivery system and the provision of optimal care to LGBTQ communities, including improved sexual orientation and gender identity data collection, expanded access to care, and enhanced sexual health services.

“COVID-19 has exacerbated these needs, resulting in a depleted and overextended workforce, care interruptions, and heightened inequities”, said Hujdich. “Meeting the healthcare needs of LGBTQ communities requires a workforce that is well-supported and trained in LGBTQ culturally-affirming healthcare.”

“Even as Pride Month is recognized, more than 320 anti-LGBTQ bills have been introduced in state legislatures across the country—bills that either restrict participation in activities or access to medical care services based on identity and orientation,” said the Coalition’s Director of Advocacy Scott D. Bertani. “These types of constant—persistent and routine—minority stressors are impact drivers on our mental health and quality of life, with particular weight placed on LGBTQ+ youth, persons of color, and transgender people. This survey reflects that reality. In fact, 71% of providers reported mental health as their key unmet need for this community.”

The Coalition administered its Inaugural State of LGBTQ Health™ National Survey to identify the “state of” healthcare needs for LGBTQ+ communities. The survey’s insights will be used to optimize the education and training of the LGBTQ healthcare workforce, and to better inform LGBTQ+ health advocacy, education, research, and training activities.

Visit the National Coalition for LGBTQ Health at HealthLGBT.org to learn about education, training, and advocacy resources and to stay up to date on important healthcare issues for LGBTQ communities and the providers who serve them.