LGBT-specific Mental Health Treatment in the United States

This week we will be discussing an article published in the Journal of Health Services Research titled, “The availability of LGBT-specific mental health and substance abuse treatment in the United States”, written by authors Williams and Fish. The authors examine the presence of LGBT-specific treatment programs in the United States, as well as predictive facility  characteristics that may be associated with providing LGBT-specific intervention programs.

Why did they do it?

According to the authors, individuals in the LGBT+ community are at a particularly elevated risk for experiencing mental health disorders, substance abuse problems, and overall psychiatric comorbidity relative to heterosexual and cisgender peers. Specifically, LGBT+ individuals are between 1.6 and 3.1 times more likely to experience a substance use disorder compared to heterosexual peers, and are also significantly more likely to meet criteria for clinical depression and/or anxiety. As the authors explain, the lack of adequate mental health care services that are sensitive to LGBT+ individuals is driving this population-level inequity, and LGBT-specific treatment should be considered a necessary means of providing culturally competent care. 

How did they do it?

This study utilized data from three primary sources: information about treatment facilities comes from the 2016 National Survey of Substance Abuse Treatment

Services (N-SSATS) and the 2016 National Mental Health Services Survey (N-MHSS). State-level LGBT population density data come from the Gallup Daily Tracking Survey. These surveys are primarily designed to collect information on the location, characteristics, and the use of outpatient, residential, and hospital inpatient programs throughout the United States. The authors aimed to assess how many mental health and substance abuse facilities offer LGBT-specific programs, the characteristics (e.g., treatment type, ownership and funding, capacity, and payment types) of mental health and substance abuse facilities that offer LGBT-specific programs, and the association between state-specific density of LGBT+ people and the number of facilities that offer LGBT-specific mental health and substance abuse programs in each state.

What did they find?

Broadly, 18% of state-owned substance abuse facilities and 12.6% of mental health facilities reported offering programs specifically tailored for LGBT+ individuals. The authors found several statistically significant associations between facility characteristics and the offering of LGBT-specific programs. For example, facilities offering outpatient treatment (12.7%) and residential care (13.6%) were more likely to offer LGBT-specific programs compared to those not offering these types of care. Conversely, facilities offering inpatient care were less likely to offer LGBT-specific programs. Additionally, facilities that were not religiously affiliated were more likely to offer LGBT-specific programs relative to those with some religious affiliation. Lastly, substance use facilities located in hospitals were less likely than those outside of hospital locations to offer LGBT-specific programs.

The authors were also interested in examining whether states that had a greater proportion of LGBT+ individuals might be more likely to have state-approved facilities that offer LGBT-specific programs. While the authors did find that state-level LGBT+ population density was associated with the availability of LGBT-specific mental health treatment programs, this was not the case for substance abuse treatment programs. 

What does it all mean (our take)?

All in all, the authors were able to provide a great deal of in-depth information related to the availability of intervention specifically aimed toward supporting the LGBT+ population. Their findings, however, highlight the unfortunate reality that the national prevalence of LGBT-specific mental health and substance abuse treatment programs is alarmingly low.  As a field, we must continue to work diligently to develop and deliver idiographic interventions that support any and every person experiencing difficulties with mental health or substance abuse. 

We suspect that as more great research articles are published, such as the article reviewed here, the push to develop LGBT+ specific treatment programs will continue to spread. We thank the authors for their work and look forward to continuing to read articles reviewing similar, extremely important, topics in our field.