(February 7, 2024) Black individuals who are a part of the LGBTQ+ community report higher levels of psychological distress than the general population. These higher levels of distress may be due to ‘minority stress’ or stress caused by the prejudice they experience due to their race, sexuality, and the intersection of these identities. Regardless, Black sexual minority adults often avoid or delay professional mental healthcare. A recent study published in "Psychiatric Services" explores why Black sexual minority adults may avoid professional mental healthcare and how these reasons may differ from those of white sexual minority adults. 

Methods 

Researchers collected data from an online survey of over 470 participants. Only participants who indicated that they were Black/African American or white and were a sexual minority were included in the study. Individuals were considered a sexual minority if they identified as asexual, bisexual, lesbian or gay, pansexual, queer, questioning, or same-gender loving.  

Key Findings 

Study data showed that 71% of white participants and 85% of Black participants reported avoiding or delaying professional mental healthcare. Overall, Black sexual minority participants were 2-2.7 times more likely to have postponed or avoided professional mental healthcare as compared to their white counterparts.  

Black participants were more likely than white participants to report avoiding or delaying care due to thinking people should work out issues by themselves, thinking they should work out issues with family or friends, and being refused by a provider. Black participants and white participants were equally likely to avoid or delay care because they could not afford care, lacked insurance, did not trust providers to help, were worried they would receive poor treatment, were embarrassed about their issues, or had previous negative experiences. More than half of all participants reported delaying or avoiding care because they could not afford it. 

Implications 

Nearly three-fourths of individuals included in this study indicated that they had postponed or avoided professional mental healthcare. This indicates that there is a significant avoidance of mental healthcare among LGBTQ+ individuals, and even more so among Black individuals. The findings in this study also align with previous research indicating that Black individuals are less likely than white individuals to engage in professional mental healthcare services. It is important to note that Black participants were not more likely than white participants to avoid care due to embarrassment; while there is extensive literature exploring stigma in the Black community, the data presented in this study indicates that the reasons for avoiding care may be more linked to medical distrust.  

The higher rate of providers refusing Black individuals may reflect institutional racism in mental healthcare. Additionally, the authors speculate that some Black sexual minority individuals may prefer to work on their issues on their own or with family and friends due to a lack of culturally competent care that meets the cultural needs of Black individuals and acknowledges the discrimination they face. While friends and family are an important source of support, it is important that Black individuals feel to seek professional care when symptoms can no longer be self-managed. This emphasizes the need for more cultural humility among mental health providers.  

Encouraging individuals not to postpone or avoid mental healthcare is critical for the treatment of severe mental illness. Long durations of untreated psychosis are associated with worse response to treatment, more severe symptoms, lower insight, and neurotoxicity. Addressing disparities in service use for racial and sexual minorities should be a priority among researchers, policy makers, and mental health providers. 

Reference 

Williams, N.D. et al. (January 2024). Black sexual minority adults’ avoidance of professional mental health care. Psychiatric Services.