Queer & Trans Mental Health Care Access

We deserve affirmative, affordable care.

There are no two ways about it: locating mental health care that is both affirmative and affordable poses a major challenge for many in our communities. As a queer clinician and community organizer with lived experience, I encounter countless requests for in-network LGBTQIA+ affirmative providers in my hometown of New York City--but fulfilling these requests is often impossible. The fact is that insurance company reimbursement rates can be dismal, and the bureaucratic requirements for private practitioners to become empaneled with health insurance companies are onerous, to put it mildly. So I often recommend that individuals look into requesting single case agreements (SCAs) from their insurance companies. SCAs, of which I'd never heard until I started working at a mental health clinic, are a well-kept secret that should not be so secretive! Meantime, LGBTQ health centers and public clinics tend to have long wait lists due to overwhelming demand--the pandemic hasn't helped in this regard.

Beyond this, though, LGBQ and/or TGNB people can face significant obstacles in simply locating affirmative care in the first place. Singh et al. (2017) explain how the deleterious effects of trauma are compounded for QTBIPOC who do not have access to the care they need. They provide the example of "LGBT people of color" who access mental health services via community centers not being able to find providers with training in addressing "significant and and multiple levels of racial/ethnic and gender trauma (e.g., lack of coverage of Eye Movement Desensitization and Reprocessing Therapy)" [EMDR] (Singh et al, 2017, p. 115). Lack of access to queer- and trans-affirmative health care and poor mental health outcomes are linked, per research;  being misgendered is also linked to negative mental health outcomes (Robertson et al., 2021).

In rural regions of the US, LGBTQ-specific mental health-related services generally are not offered, and rural individuals face numerous barriers to care including lack of health insurance along with concerns about confidentiality not being maintained (Willging et al., 2016). Isolation due to geographic location, too, may further complicate mental health care access; the Affirmative Couch (2020) describes how social isolation can have more of a detrimental impact on queer and trans individuals, particularly if they live with biological family and are unable to connect with friends and LGBTQIA+ community, let alone connect with affirming therapeutic services.