Health Provider and Sexual and Gender Minority Service User Perspectives on Provision of Mental Health Services During the Early Phase of the COVID-19 Pandemic in British Columbia, Canada

Abstract

While the COVID-19 pandemic impacted everyone, social determinants of health and structural inequities have had compounding effects that shaped the experiences of some sub-populations during the pandemic. Stigmatization, discrimination, and exclusion contribute to a disproportionately high burden of mental health concerns among sexual minority (i.e., lesbian, gay, bisexual, queer, and other sexually-diverse) and gender minority people. Pre-pandemic, these health inequities are exacerbated by barriers to adequate mental health services including cost, waitlists, and experiences of sexual and gender minority stigma when accessing providers. During the COVID-19 pandemic, these barriers were further complicated by drastic changes in service delivery and access during the pandemic (i.e., a shift to online/virtual provision of care to reduce risk of COVID-19 transmission). To better understand the experiences of sexual and gender minority people accessing mental health services during the first three to nine months of the COVID-19 pandemic, we conducted semi-structured interviews with a purposive sample of 15 health care providers and administrators (summer 2020) and 14 sexual and gender minority individuals interested in accessing mental health services (fall 2020) in British Columbia, Canada. We used interpretive description to inductively analyze interview data. Triangulating between the provider and service user datasets, we examined changes in mental health and coping during the COVID-19 pandemic. We recorded increases in isolation and lack of identity affirmation; inequities in accessing mental health services during the pandemic, perceived opportunities for mental health support, and avenues for reducing mental health inequities through system-level changes that deserve particular attention during the pandemic.

‘It’s not as good as the face‐to‐face contact’: A sociomaterialist analysis of the use of virtual care among Canadian gay, bisexual and queer men during the COVID‐19 pandemic

“…Social distancing increased mental distress and exacerbated social isolation among many GBQM (Gaspar et al., 2022; Philpot et al., 2021). Some GBQM were also forced to return to live with families of origin, leading to an increased risk of violence and abuse, which can further amplify physical and mental health concerns (Kennedy et al., 2022; Salerno et al., 2020). The lack of safe or private spaces for GBQM living at home with homophobic families also prevented some from engaging in virtual mental health services due to fear of family members overhearing conversations/disclosures (Fish et al., 2020).…”

“…The lack of safe or private spaces for GBQM living at home with homophobic families also prevented some from engaging in virtual mental health services due to fear of family members overhearing conversations/disclosures (Fish et al., 2020). However, the shift to remote mental health services did increase service access for some GBQM, particularly those living in rural settings and those who were otherwise physically or mentally unable to attend in‐person therapy (Kennedy et al., 2022). Moreover, while the closure of sexual health services exacerbated poor access to sexual health testing and treatment, there was an increased demand for alternate models for delivering sexual health services, such as online testing, reinforcing the importance of virtual care (Gilbert et al., 2022).…”