Functional, communicative, and hybrid barriers to accessing mental health care in LGBTQ+ communities

Understanding how LGBTQ+ populations experience common mental health care barriers reveals uncommon ways these barriers interact, layer, and compound to increase health disparities. This mixed methods study organised 250 open ended responses into 30 codes situated along a functional to communicative spectrum. The codes revealed sub-categories and relationships between barrier groupings which highlight ways mental health care obstacles for sexual and gender minorities span categories and are operationalised in unique ways that compound constraints. Organizing LGBTQ+ mental health care access obstacles along a continuum that spans functional barriers (i.e. time, money, transportation) to communicative ones (i.e. stigma, trust) revealed a hybrid category (i.e. providers, bureaucracy) where functional and communicative barriers overlap, mesh and operate simultaneously. Lack of access to trained mental health care providers who offer affirming, appropriate care sits at the centre of this web of constraints and as such is influential in a wide array of mental health care issues. Prioritising mental health care workforce training in LGBTQ+ specific competencies has the potential to create a 'ripple effect' that mitigates interconnected mental health care barriers throughout this spectrum.