Mental healthcare providers’ thoughts on system barriers for LGBT people

Lesbian, gay, bisexual and transgender (LGBT) people report poorer mental health outcomes than do heterosexual, non-trans people. But little is known about their experiences with mental health services. In this study, mental health providers talk about the system-level barriers that LGBT people face, and provide recommendations to address them. System-level barriers are challenges that a person faces when dealing with a system, due to the system’s very nature rather than the people within it.

Ontario researchers conducted interviews with eight mental health professionals from the Greater Toronto Area (GTA). They were asked questions about their experiences providing services for the LGBT community, and were asked to suggest recommendations on how to improve the mental health system.

EENet is pleased to feature a Research Snapshot on the article, “Systems-level Barriers in Accessing Supportive Mental Health Services for Sexual and Gender Minorities: Insights from the Provider’s Perspective,” by John McIntyre, Andrea Daley, Kimberly Rutherford, and Lori E. Ross. The article appeared in the Canadian Journal of Community Mental Health, vol. 30, no. 2 (2011).

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

Read it below or download the PDF.

What you need to know

There are 3 key barriers that LGBT people face in the mental healthcare system: the standardized nature of the system, the limited LGBT-positive services, and stressful working conditions for practitioners. The researchers make three recommendations: adopting an anti-oppression approach, expanding OHIP coverage, and incentivizing LGBT-positive mental health providers.

What is this research about?

Lesbian, gay, bisexual and transgender (LGBT) people report poorer mental health outcomes than do heterosexual, non-trans people. But little is known about their experiences with mental health services. In this study, mental health providers talk about the system-level barriers that LGBT people face, and provide recommendations to address them. System-level barriers are challenges that a person faces when dealing with a system, due to the system’s very nature rather than the people within it.

What did the researchers do?

Ontario researchers conducted interviews with eight mental health professionals from the Greater Toronto Area (GTA). They had all worked with sexual and gender minorities for at least two years. They were asked questions about their experiences providing services for the LGBT community, and were asked to suggest recommendations on how to improve the mental health system.

What did the researchers find?

The researchers found 3 major systems-level barriers:

  • Standardized Mental Healthcare Since generalizations are often made about the cause and effect of mental illness, the medical system overlooks the unique social context of LGBT people.
  • Availability of Services The amount of LGBT-specific services is minimal. This leads to very long waitlists and less effective service. This is directly linked to the amount of funding given to public mental healthcare.
  • Stressful work conditions LGBT-positive mental health providers are overworked due to limited funding. This pushes LGBT-positive clinicians away from working in the public mental healthcare sector.

Practitioners make three recommendations:

  • Anti-oppression approach The medical system should address social and structural issues faced by LGBT people through a person-centred approach.
  • Expand OHIP coverage Psychiatry is often the only mental health service covered under the Ontario Health Insurance Plan (OHIP). However, other services often fit an LGBT person’s mental healthcare needs better. OHIP should cover other services like social work or community-based programs.
  • Incentives for LGBT-positive mental health providers Creating new opportunities for those seeking careers in LGBT mental healthcare, like peer supervision groups, can reduce the pressures that providers face.

How can you use this research?

This study may interest policy makers and practitioners by identifying system-level barriers that LGBT community members face, and providing recommendations for improvement. Further research may consider interviewing practitioners from a more diverse ethnic and gender/sexual background or from outside the GTA. Future studies may also include other service providers like nurses or in-patient psychiatrists.

About the researchers

John McIntyre is a student at Queen’s University Faculty of Law in Kingston, Ontario. Andrea Daley is an Assistant Professor in the Faculty of Social Work at York University, Toronto, Ontario. Kimberly Rutherford is a family physician practicing in Vancouver, British Columbia. Lori E. Ross is a Senior Scientist in the Social and Epidemiological Research Department at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario. She is also the leader of the Researching for LGBTQ Health Team at CAMH and an Associate Professor in the Department of Psychiatry, Dalla Lana School of Public Health, and Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto in Toronto, Ontario. mcintj4 [at] gmail [dot] com

This Research Snapshot is based on their article “Systems-level Barriers in Accessing Supportive Mental Health Services for Sexual and Gender Minorities: Insights from the Provider’s Perspective,” which was published in the Canadian Journal of Community Mental Health, vol. 30, no. 2 (2011): 173-86.


Lesbian/gay/bisexual/transgender, mental health services, systems-level barriers, medical model, anti-oppression approach

This Research Snapshot is based on an article that has been critically appraised for quality and susceptibility to bias.

EENet has partnered with the Knowledge Mobilization Unit at York University to produce Research Snapshots in the field of mental health and addictions in Ontario. This summary was written by Maia Miller.