Understanding the Barriers to Mental Health Services from a Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) Homeless Perspective

Aim: There is a lack of research into the barriers that Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ+) homeless people encounter when accessing mental health services, despite psychological distress being highly prevalent but service use remaining low. Unique mental health challenges are thought to exist, but in order to recognise needs and enable services to improve accessibility, service user perspectives must be recognised. This study aimed to address this by exploring the mental health needs of LGBTQ+ homeless adults, the role of services, the barriers that exist and improvements that could be made. Method: Semi-structured interviews were conducted with nine LGBTQ+ participants, who had experiences of past or present homelessness and self-identified mental health needs. Recruitment occurred via charities and social media. Thematic analysis was used to interpret the data. Results: The analysis revealed three main themes: (1) ‘Rejection of identity’ referred to experiences of LGBTQ+ discrimination which can impact wellbeing, and contribute to homelessness and a fear of sharing identity when seeking help, (2) ‘Homelessness can strip away personhood’ described the detrimental impact of homelessness, which can result in isolation and loneliness and exacerbate existing mental health difficulties, (3) ‘A lack of appropriate support’ highlighted some of the multi-faceted barriers to mental health services faced by this population. Conclusion: A range of mental health needs were identified in the research sample, including shame, hopelessness, low mood and a loss of self-worth. The role for services may include family interventions to address rejection, organisational work to reduce discrimination, and prevention of repeat homelessness through the provision of psychological support. A number of barriers were suggested, such as long waiting lists, limited awareness of services, and previous experiences of unhelpful interventions or being denied appropriate support. Services may increase flexibility in the type and delivery of intervention, address discrimination in practice, improve inclusivity and better account for social issues. The implications for recovery and prevention policy and future research have been discussed