Research Brief: Barriers to Crisis Utilization by LGBTQ+ Kansans

Authors

Megan S. Paceley, PhD, MSW; Michael Riquino, PhD, MSW; Liz Hamor, MS; Erica Molde, LSCSW; and Shana Green.

Background

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face high rates of stigma, oppression, and victimization, increasing their need for supportive mental health and crisis response services.^1,2 Simultaneously, LGBTQ+ people report barriers to accessing supportive and affirming crisis care.³ It is necessary to understand the specific barriers to crisis utilization by LGBTQ+ people in Kansas; doing so will help us work toward reducing and eliminating these barriers and promoting access to supportive mental healthcare for all Kansans.

The project

A team consisting of academic researchers, crisis counselors, LGBTQ+ Kansans, and community leaders advertised focus groups and interviews for 1) crisis providers in Kansas and 2) LGBTQ+ Kansans. A total of 64 people participated: 28 engaged in one of nine focus groups, 28 completed interviews, and an additional 8 completed an alternate anonymous survey. Of the 64 participants, 24 were crisis providers (11 of whom were LGBTQ+) and 40 were LGBTQ+ Kansans. Participants’ gender, sexual orientation, age, and race/ethnicity are shown below.

Anti-LGBTQ+ Barriers to Crisis Utilization

Many participants discussed anti-LGBTQ+ barriers to crisis utilization. Primarily, they discussed fear as a primary barrier to why they, or other LGBTQ+ people, were hesitant to utilize crisis services in Kansas. Fears were rooted in the stigma against LGBTQ+ communities, as well as fears of discrimination and violence based on their LGBTQ+ identity.

"I think from what I have observed, one of the biggest barriers is the stigma that they feel that they're being labeled. When you are not even comfortable sharing what part of the community you belong to or afraid of sharing who you are, how are you going to really open up and ask for help if that's what you need? I feel that's one of the biggest barrier that I have observed from my chat experience."

"I mean Kansas is really religious. Kansas is really conservative, and I would not feel safe, and I would feel like if I was in a mental health crisis that maybe the call line would exacerbate the problem rather than help the problem. So I do have some religious trauma. So so many people here are religious, I'd be afraid they'd bring something like that up. So I mean, really that's the biggest fear."

Sometimes participants’ fears were rooted in their past experiences, or the experiences of people close to them, with stigma, discrimination, and violence.

"It's mostly just word on the street. It's not safe and then if you have no choice, if you're in crisis, you don't always have the choice to not seek help. From what I've heard and observed…they are not set up with a mental health intake process and so they locked my friend in this room with no meds, no care, no treatment while they waited for a bed to come open somewhere. They just locked her in a room and she was there for over 24 hours, and no care to try to get her crisis managed while she was at a hospital."

Participants also discussed privacy concerns about other’s finding out about their LGBTQ+ identity via their engagement in crisis services. These fears were often rooted in anti-LGBTQ sentiment in their homes, communities, and religious institutions.

"Someone could be fearing for their privacy or their security. I think that's the only thing that can deter someone from using their services, because in some areas I think LGBTQ people face different difficulties like being discriminated, violence against them. I think they could be afraid for using the services because of the security and privacy."

"We live in small communities, so if you access crisis services or any mental health, there's the possibility that the people working those services are also your neighbors, or somebody working at your kids' school…and is going to spread your information around. So there's just a lot of privacy risks there, real or perceived, either way."

Fear of Police Involvement

Next, participants discussed a barrier to crisis utilization as a fear of police involvement. Participants discussed at length the historical power and violence used by police against LGBTQ+ communities and how this history made them fearful that police would be called if they called a crisis line.

"I feel like my initial response to calling a center or anything like that is, "Oh ..." If they're mandatory reporters, the scariest thing in the world to me is a health and wellness check. So I've kind of stayed away from actually calling. I usually directly contact my therapist through email, and as far as my friends go, pretty much everybody involved has stayed away from crisis lines and we've used ourselves as a community network."

"I think there's definitely fear of mistreatment both by health professionals and by law enforcement if it comes to that, in the form of refusal to accept your own proper pronouns and gender and presentation or to receive abuse, or to be placed in some holding capacity that doesn't match with your gender identity. And I think there's also a fear that if you do get placed somewhere that does match your gender identity, that you're then at risk for assault."

Lack of Options/Access

The next theme, lack of options/access, illustrated how sometimes LGBTQ+ Kansans did not have access to crisis services. Sometimes this lack of options were actual—in terms of a lack of transportation or accessibility.

"I think in smaller towns where, even though I'm starting to see some change, if they don't know or don't have access to something, I don't know the internet or if it's just not well known in an area, that's a big barrier."

"In our rural areas, we just don't have a lot of resources. It's just a very different culture. Our closest inpatient treatment facility is about a twohour drive."

Sometimes lack of access was specifically about a lack of LGBTQ+-affirming services.

"I can imagine there are institutional barriers to getting help too. One that I can speak to is a lot of people want an LGBTQ therapist and there are only a limited amount of them. There are already a limited amount of therapists, but finding someone who specifically understands what you're going through can be difficult"

"I think there's a lot of places, a lot of.... I would say it's more common in Western Kansas or southern Kansas even. There seems to be a much smaller variety of places that would be more affirming and a safe space for the LGBTQ community. I think certain mental health centers might not specialize in that or they might not have enough experience in that regard."

Another barrier that limited access or options to crisis services was economic barriers. Some participants discussed the lack of insurance, transportation, or other financial barriers to crisis services.

"Just considering that the LGBTQIA+ community is typically paid less than people who don't identify as part of that community…And if there've been problems at the job, they might not feel comfortable calling their EAP to get an appointment with a therapist. There's just so many financial barriers and a lot, I think probably the LGBTQIA+ community faces more financial barriers than those who aren't."

"I've noticed that access to funds is a huge one, because while crisis lines and some crisis response teams are free, other than those services, having the money to access other things is not as readily available or it's not made aware of the options for payment…And then the lack of transportation to be able to get to those places has been also a huge barrier, too."