The Provider Perspective on Behavioral Health Care for Transgender and Gender Nonconforming Individuals in the Central Great Plains: A Qualitative Study of Approaches and Needs

Transgender and gender nonconforming (TGNC) individuals interact with mental health care systems at high rates and experience substantial barriers to care. Rural TGNC individuals face additional disparities in accessing appropriate mental health services. Little research has focused on the mental health care providers who work with TGNC individuals in underserved areas. The current study sought to describe the mental health care services delivered by providers perceived as affirming by TGNC community members in the Central Great Plains. We conducted qualitative interviews with 10 providers to understand how providers seek cultural competency and conceptualize and work with their TGNC clients given the barriers to care. Providers held diverse theoretical orientations and described challenges to working with TGNC clients, including the impact of stigma and marginalization and financial and structural barriers to care. Emphasis was placed on individualizing care, helping clients to manage stigma and build resiliency, connecting clients to resources (when available) and support systems, and navigating the intersections of physical health care and mental health care, such as writing letters for medical transition. Providers largely educated themselves on TGNC topics and had previous experience working with marginalized populations. Overall, the providers' approaches to working with TGNC clients mapped onto models of cultural competency, but few providers described their work in the context of an evidence-based model. Implications for increasing the quality and availability of mental health care services for TGNC individuals in underserved areas are discussed.