Lesbian, gay and bisexual rural adults, who are nearly twice as likely to be diagnosed with depression or anxiety, report they have more challenges than their urban counterparts in accessing mental health care, a new study has found. 

The report from the University of Minnesota’s Rural Health Research Center found that lesbian, gay, and bisexual individuals are more likely to experience a mental health condition than their heterosexual counterparts. Looking at data from the 2019-2020 National Health Interview Survey, the researchers found that 38.6% of rural LGB adults reported a dual diagnosis of depression and anxiety disorders, compared to 11.4% of heterosexual rural adults, and 8.7% of urban heterosexual adults.

Rural LGBTQ adults were also less likely to report having a source of care and more likely to report not being able to afford medications to treat their mental illness. Nearly a third of rural LGBTQ adults diagnosed with depression or anxiety said they have gone without medications or delayed mental health care in the past year because of cost.

The group also reported other challenges to accessing care, including a lack of anonymity when seeking care, a shortage of available mental health professionals in their area, and a lack of transportation to mental health providers.

Although much has changed in the world since the data was collected, said Carrie Henning-Smith, lead researcher on the study, the information is an indication of what rural members of the LGBTQ community face.

“The past few years have made access to care for rural residents more urgent and more complicated,” she said in an email interview. 

“We’ve seen continued closures of rural hospitals and other health care facilities, coupled with serious shortages in the health care workforce, especially in the area of mental health. At the same time, the demand for mental health services has increased during the Covid-19 pandemic. Altogether, this might make the barriers to care that we found in this study even more pronounced for rural LGBTQ individuals today.”

One bright spot of the past few years, she said, was telehealth which has been able to provide more care to rural residents.

“In the midst of all of the access challenges we’ve seen during the Covid-19 pandemic, telehealth stands out as a potential good news story,” she said. “Expansion of telehealth services and reimbursement for those services during the pandemic made it possible for more people to access the care they need. For rural LGBTQ residents seeking mental health care, telehealth could offer easier access to LGBTQ-friendly providers, including those located in urban areas.”

For telehealth to really help members of the rural LGBTQ community, however, there needs to be a continued expansion of reimbursement for mental health services and a focus on addressing the workforce shortages and access to affordable, reliable broadband internet access, she said. 

Researchers recommended that addressing those workforce shortages, increasing reimbursement rates for mental health services and increased telehealth services would help bridge the access gap for LGBTQ adults in rural areas.

But, just as important is providing training and education on sexual orientation to entire health teams in rural clinics.

“Rural health care facilities, providers and staff should receive training or be offered continuing education on LGBTQ health vocabulary and topics to improve their comfortability with treating LGBTQ adults,” the study said. “Current provider education curriculum includes very little, if any, content on sexual orientation, let alone on the unique context for rural LGBTQ individuals.”

Moreover, Henning-Smith said, there needs to be community-wide efforts in rural areas to increase awareness and acceptance of LGBTQ residents to counter homophobia and interpersonal discrimination, as well as education in rural communities to remove the potential resistance to accessing mental health services.

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