We also know that LGBTQ+ youth historically experience more bullying, discrimination, lack of family or school support, and even physical harm. These additional factors place this already vulnerable population at greater risk of developing mental health issues and substance use disorders, particularly depression and suicidal ideation.
As a psychiatrist specializing in youth mental health, and leading the behavioral health clinical team for one of the country’s largest health organizations, it’s imperative that we address the unique barriers to care for these young people, bridge treatment gaps and improve care outcomes.
Unique barriers to care
In addition to the stigma and pressure to withhold their sexuality that surrounds LGBTQ+ youth, when these young people seek and receive behavioral health care, it’s too often inadequate. This is largely due to the limited number of culturally competent providers in the field.
While there are certainly mental health providers (like me) who specialize in youth, they tend to have limited training when it comes to LGBTQ+ adolescents and their family dynamics. Without proper training, providers may unknowingly provide inadequate care and even exhibit unconscious bias and discriminatory behavior toward young patients who are already at their most vulnerable.
In order to find someone to provide care with sensitivity to these specific needs, parents and their children may choose to seek treatment from a specialist that identifies with and is part of the LGBTQ+ community.
Additionally, physician shortages throughout the nation – including that of child and adolescent psychiatrists – are further complicated by socioeconomic and geographic factors. Therefore, finding the right therapist with the right experience and credentials in the right location at the right time all present real and significant challenges to delivering quality LGBTQ+ care.
Telebehavioral health helps fill the treatment gap
Telebehavioral health (TBH) is one option that can help address the provider shortage in many areas, and especially for LGBTQ+ patients. With limited in-person providers and clinics available in certain geographies, there are several advantages to TBH over in-person care:
- People with social anxiety or PTSD may feel more comfortable with TBH, experiencing easier communication and less stigma from the comfort of their own space.
- TBH also allows people to choose from a greater variety of providers – including those more experienced in treating LGBTQ+ patients – since geographic boundaries are not an issue.
- TBH can be more efficient for clinicians, and less costly for patients.
As with other treatment options, TBH comes with its own set of advantages and limitations. TBH offers privacy and comfort, and due to the variety of options available, an LGBTQ+ youth a greater chance of working with an experienced provider. However, some patients have difficulty accessing technology or have unreliable internet service. Some youth may feel the interactions with their provider are too impersonal, due to the lack of an in-person presence. Others may have privacy and confidentiality concerns, or fear of being overheard on a TBH session.
In TBH, therapists also risk missing patient mannerisms and body language. Simply by being in the same room and space as a patient, a therapist can provide in-person treatment that creates a stronger therapeutic alliance in ways that telehealth cannot.
While in-person therapy remains the gold standard for care (particularly for youth seeking treatment for the first time), TBH has been proven to increase patient compliance, as it is convenient, not limited by geographic location or time zone, and more providers are available to deliver mental health care virtually. Due to our experience with COVID, many providers today offer both options, and the combination of in-person and virtual care is a positive trend.
How to improve treatment outcomes
By raising awareness and educating the LGBTQ+ youth community on affirming in-person care and TBH treatment options as well as the benefits, mental health care providers can earn trust and provide better overall experiences for these vulnerable youth.
When providers receive training on LGBTQ+ youth, affirming care and cultural competency integrated with TBH, they can improve the quality of care they deliver – and ultimately improve patient outcomes.
Additionally, incorporating LGBTQ+-inclusive guidelines into treatment can help to elevate care systemwide. It’s why Carelon Behavioral Health is committed to working with policy makers and LGBTQ+ organizations to combat discrimination and marginalization, and improve care access.
Ultimately, everyone deserves access to quality mental health care. It’s our responsibility as mental health professionals to learn and grow with the changing needs of our communities and society. Together, we can substantially help to improve LGBTQ+ youth mental health overall.
James Polo, MD, is Chief Medical Officer at Carelon Behavioral Health
