Experiences of Lesbian, Gay, Bisexual, Transgender, and Queer, People of Color in Mental Health Services and Substances Abuse Services: A Systematic Review

Background and Purpose: Lesbian, Gay, Bisexual, and Transgender/Gender nonconforming, People of Color (LGBTQ+ POC) face a myriad of challenges due to inhabiting multiple discriminated identities. These challenges are compounded by multiple systems of oppression related to their racial, gender, and/or sexual minority statuses, which contribute to poor mental health outcomes: mood disorders, anxiety disorders, suicidal thoughts, and substance use disorders. Recent scholarship seeks to develop responsive social work interventions to alleviate these burdensome processes. In order to develop responsive interventions, we must first identify and describe the range of barriers, critical treatment processes, and treatment outcomes related to LGBTQ+ POC receiving mental health and substance abuse treatment. Therefore, this systematic review seeks to answer the following question: What are the positive, negative, and/or neutral experiences of LGBTQ+ POC in seeking and receiving mental health/substance abuse treatment services?

Methods: The authors followed the PRISMA standards to complete this review. Studies were included in if they collected data from LGBTQ+ POC (over the age of 15) relating to their experiences in seeking and receiving mental health/substance abuse treatment and were completed since January 1, 1990. Searches were performed in 6 databases: CINAHL, PsychInfo, Social Services Abstracts, ProQuest Dissertations & Theses Global, PubMed, and Sociological Abstracts, with an expert-informed search string. Following duplicate removal, double-independent screening, and reference harvesting, 18 studies were included in the review. Relevant data were extracted from the studies, which was then synthesized using narrative thematic analysis.

Results: Studies varied regarding study design, methods, and outcomes. However, common patterns were identified. The patterns amongst the studies were grouped under treatment phases: pre-treatment, treatment, and post-treatment. Pre-treatment themes included identity and culturally specific presenting problems, access and barriers (e.g., mistrust, costs, geographical location), and determinates of help-seeking. Treatment foci for LGBTQ+ POC consisted of client attributions (e.g., culturally specific mental wellness practices, presenting problems), provider/agency attribution (e.g., cultural competence and humility), and characteristics of the client-provider relationship (e.g., goodness of fit). Post-treatment fluctuated from negative (e.g., pre-mature dropout) to positive experiences (e.g., self-integration, increased social connection). Overall, the findings underscored the importance of examining the treatment experiences of this population to develop culturally responsive interventions.

Conclusions and Implications: Common themes were identified across treatment phases. Examining LGBTQ+ POCs’ mental health and substance abuse treatment experiences has implications for improving the service delivery for this vulnerable population, in addition to training/education of future and current social workers. Future research should consider intergroup comparisons and employ more rigorous methods with larger sample sizes.