Poverty and Mental Health Needs Among Precariously Employed Gay, Bisexual, and Queer Men: A Narrative Inquiry

Background and purpose: Poverty, employment, and mental health are inextricably linked and altogether produce inequities across a variety of life domains, including access to stable housing, healthcare and social services, and recreation. Sexual and gender minorities experience disproportionate rates of poverty, low-wage and precarious employment, and poor mental health, but are often overlooked in the literatures that consider these intersections that commonly arise in mental health-focused social work settings. This study responds to the gap in literature and to sexual and gender minority community priorities by addressing the following research questions among gay, bisexual, and queer men: 1) How does mental health impact experiences of poverty and employment? 2) How do poverty and employment impact mental health? 3) How are these experiences shaped within contemporary socioeconomic and political structures including racism, xenophobia, classism, and ableism?

Methods: This community-based study employed a narrative inquiry methodology among 20 gay, bisexual, and queer men who were precariously employed in Toronto, Canada, in fall 2021. Drawing on a queer political economy of health and Polkinghorne’s narrative analysis, narratives were analyzed to uncover the production of economic and health inequities through structural systems of oppression, such as cisheteronormativity and capitalist modes of production. Plotlines, characters, temporal elements, and social contexts were identified through iterative processes of coding and writing to produce a layered story of participants’ accounts through a life-course perspective.

Results: The first layer of the story illustrates how participants’ mental health was shaped through experiences of sexual and gender minority-related invalidation and adversity in adolescence, such as being kicked out or financially cut off from their families. Economic insecurity resulted in barriers to participants completing university programs as expected, planning for their futures, and having resources to access mental healthcare or other health services. Upon entering the labour market, participants experienced various forms of economic insecurity that limited access to safe housing, mental health care, recreation, and opportunities to find more secure employment. The second layer of the story underscores the cyclical nature of mental health and poverty, whereby economic insecurity was a driver of poor mental health while also limiting the resources available to address mental health issues. Without mental health supports, participants’ employment was impacted and their financial stress worsened. The final layer identifies the ways that racism, xenophobia, and ableism impact the cyclical relationship between mental health and economic insecurity.

Conclusions and implications: Results highlight that the amelioration of disparities in sexual and gender minority people's mental health requires interventions that address the conditions that perpetuate inequities, including cisheteronormative environments that sexual and gender minority adolescents encounter that result in disproportionate rates of poverty, inadequate support from social welfare systems, discriminatory employment settings, and inaccessible mental healthcare. Social services need to consider socioeconomic (employment, income) conditions when addressing the mental health needs of marginalized groups. Addressing mental health at the individual level without consideration of the social conditions that structure sexual and gender minority people’s lives will be insufficient.