Mental Health Care Needs and Experiences Among LGBT+ People

Key Findings

There has been rising attention to the scope of mental health challenges in the United States, including a desire to better understand the experiences and needs of those who may be most heavily impacted. The LGBT+ community is one such group, having faced lifelong mental health challenges beginning in adolescence and persisting through adulthood. While in some cases, LGBT+ people are accessing mental health care more frequently than non-LGBT+ people, their need for services is greater, and gaps remain. Today, policies seeking to curtail access and rights of LGBT+ people threaten to worsen these disparities, and continuing to monitor the wellbeing of the community will be important.

With this report, we examine LGBT+ people’s needs for and experiences accessing mental health care by analyzing data from a nationally representative 2022 KFF survey with a large sample of LGBT+ adults. Key findings include:

• Two-thirds of LGBT+ people (67%) reported needing a mental health service over the past two years, a considerably higher share than for non-LGBT+ people (39%).
• Yet, only about half of LGBT+ people with a reported need sought and received mental health services (similar to the share among non-LGBT+ people).
• Barriers to care can include:
  • Wait times: Four-in-ten LGBT+ people reported having to wait at least a month for services.
  • Insurance: One-quarter of privately insured LGBT+ people who received mental health services said their provider did not take their insurance.

Introduction

There has been rising attention to the depth and breadth of mental health challenges in the United States, including a desire to better understand the experiences and needs of those most heavily impacted. A recent KFF/CNN poll found that nearly all (90%) Americans believe there is a mental health crisis today and that LGBT+ adults consistently reported poorer mental health outcomes on almost all measures throughout the survey.

Indeed, the LGBT+ community has faced lifelong mental health challenges beginning in adolescence and persisting through adulthood at higher rates compared to non-LGBT+ people. Additionally, while in some cases, LGBT+ people are accessing mental health care more frequently than non-LGBT+ people, their need for services is greater and gaps remain. Addressing systemic factors that drive stigma and discrimination within the community could play a key role in mitigating these challenges alongside improving access more generally.

With this report, we provide an update on LGBT+ people’s needs for and experiences of accessing mental health care by analyzing data from a nationally-representative 2022 KFF survey of 6,442 adults ages 18 to 64, including 958 LGBT+ people, conducted primarily online from May 10, 2022, to June 7, 2022. For this survey, LGBT+ people include those who identified their sexual orientation as lesbian, gay, bisexual, or “something else,” and those who identified their gender as transgender, non-binary, “other,” or whose reported gender does not correspond to their reported sex assigned at birth. (See the Methodology for additional detail.) Beyond issues related to mental health and access to care, the survey collected data on a range of demographic characteristics and issues from general well-being to experiences engaging in the health system, use of preventive services including HIV and STI testing, and reproductive health. A separate companion issue brief, LGBT+ People’s Health Status and Experiences Accessing to Care, provides these additional findings.

Findings

Experiences with Mental Health Problems

Surveys regularly find that LGBT+ people face greater mental health challenges than non-LGBT+ people, including for common conditions like depression and anxiety, as found in a recent KFF/CNN poll.

Here we find that two-thirds of LGBT+ people (67%) reported needing a mental health service over the past two years, a considerably higher share than the one-in-four non-LGBT+ people (39%). Self-reported need for mental health care was highest among younger LGBT+ people under age 35 (77%) and for women, nearly three-quarters of whom (73%) reported the need for mental health care (Figure 1).

Accessing Mental Health Care

The higher rates of stigma, discrimination, and violence experienced by LGBT+ populations can translate into mental health and substance use challenges. For many who are part of this community, these challenges highlight the need for behavioral health care.

While reported need for mental health services was high among LGBT+ people, not all of those with a need for services sought or received them. Notably, a higher share of LGBT+ people have both a need for mental health service than non-LGBT+ people, and higher shares sought and received mental health services than their non-LGBT+ counterparts. Yet, unmet need persisted for many in both groups.

Two-thirds (65%) of LGBT+ people who reported needing a mental health service sought one, compared to 58% of non-LGBT+ people, still leaving many without desired services (Figure 2). There were no statistical differences in the share that sought services by age, race/ethnicity, or insurance status among LGBT+ people. Limited uptake could be due to being a lower-income group, having lower rates of private coverage, or experience of stigma, discrimination shame and trauma, including within medical settings. See the issue brief LGBT+ People’s Health Status and Experiences Accessing to Care for more details.

Only about half of LGBT+ people (55%) and non-LGBT+ people (49%) who reported a need for mental health services over the past two years received care, pointing to substantial unmet need in this area regardless of gender identity or sexual orientation. One-in-ten (10%) LGBT+ who reported a need for these services said they tried to get but did not receive care, also similar to non-LGBT+ people. One-third (35%) with a need did not try to get mental health care (Figure 3). A smaller share of LGBT+ individuals with a need did not try to get mental health care compared to non-LGBT+ individuals (35% vs. 42%).

Since the COVID-19 pandemic, telehealth has emerged as an important avenue for people to access health care, including mental health services. Almost two-thirds of LGBT+ people (63%) reported having had a telehealth visit in the last year and mental health services was the leading reason for their most recent telehealth visit – 28% received mental health services, followed by an annual check-up or well-visit (21%). Telehealth can increase access to mental health services, including for those who might not otherwise get or want in-person care (data not shown in figure).

Barriers to Mental Health Care

Among LGBT+ people who were able to get a mental health appointment, about six-in-ten (58%) were able to get one in less than a month, but four-in-ten (42%) had to wait one month or more, with 16% waiting more than two months. These were similar to the shares among non-LGBT+ people. Such delays can be a barrier to getting people into care, particularly when those who have to wait may end up not seeking care at all if that wait is for a substantial period. These delays can prolong suffering and lead to worsening of symptoms (Figure 4).

Seven-in-ten (69%) privately insured LGBT+ people reported their mental health provider accepted their insurance plan, but 27% said they did not, and 4% didn’t know, shares similar to privately insured non-LGBT+ people (Figure 5).

Conclusion

LGBT+ people experience significantly higher rates of mental health challenges and need for mental health services than non-LGBT+ people, as well as higher rates of health care discrimination. While they also reported accessing mental health care at slightly higher rates than non-LGBT+ people, nearly half who said they could benefit from such services went without. The findings presented here suggest that in addition to inability to secure appointments, wait times may also be a barrier to care. A facilitator to mental health care appears to be telehealth, with more than one-quarter of LGBT+ people accessing telehealth care doing so for mental health services.

The reasons that LGBT+ people are more likely to face mental health challenges are complex and may relate, in part, to widespread experiences of stigma and discrimination. Current attempts to institute anti-LGBTQ policies in many states and communities may contribute to poor mental health outcomes and increase the need for care. Targeted and culturally appropriate policy solutions aimed at improving the well-being of the LGBT+ community and addressing their access challenges to mental health care could help to meet their mental health care needs, as would efforts to address systemic factors that drive stigma and discrimination within the community.