“…Many studies (e.g., Clements-Nolle, Marx, Guzman, & Katz, 2001;Hepp, Kraemer, Schynder, Miller, & Delsignore, 2005;Nuttbrock et al, 2010) report higher levels of mental distress in their trans samples than in the population generally and claim that these are likely to arise from such stress. Furthermore, in a study of LGBT people's experiences of mental health services, Adams et al (2013) found that cost, a lack of cultural safety (the ability to provide services that appropriately recognize diversity), and a lack of staff competence around LGBT issues to be substantive barriers to LGBT people accessing mental health services.…”