LGBTQ+ experiences of accessing NHS adult mental health services during COVID-19 in an area of North West England: a qualitative interview study

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people have a higher prevalence of mental health conditions than heterosexual and cisgender people, and report poor experiences of accessing mental health services. The COVID-19 pandemic may have had detrimental impacts on socially disadvantaged groups, such as LGBTQ+ people, and their mental healthcare access. This study aimed to understand LGBTQ+ experiences of mental health and accessing mental health services during the COVID-19 pandemic. METHODS: Topic-guided qualitative interviews were conducted with twelve LGBTQ+ people who accessed or tried to access NHS mental health services in an area of North West England between March 2020 and February 2022. Levesque’s Conceptual Framework for Healthcare Access was used as a framework to code the qualitative data. Reflexive thematic analysis was adopted to analyse the qualitative data from a critical realist perspective. Researchers with lived experience of being LGBTQ+ and accessing mental health services were embedded as part of the research team. RESULTS: Eight themes across five domains of the framework were identified from the qualitative data. LGBTQ+ participants shared the negative impacts the pandemic had on their mental health (e.g., worsening existing mental health conditions, experiences of isolation, a loss of social connectedness with the LGBTQ+ community). LGBTQ+ participants experienced significant challenges accessing mental health services during COVID-19, associated with experiences of stigma and discrimination, concerns about disclosing their LGBTQ+ identity, living in unsupportive environments, and being unable to access mental health support remotely. Where positive experiences were identified, these highlighted important opportunities for change. CONCLUSIONS: This study suggests that LGBTQ+ people may have been adversely impacted by the COVID-19 pandemic, with an increased risk of mental ill health and isolation, and poor experiences of accessing mental health services. Opportunities to maximise protective factors and improve timely access to mental health support are needed to mitigate these effects for LGBTQ+ people in the future. Recommendations to improve LGBTQ+ service inclusivity include implementing self-referral options, being more visibly LGBTQ+ inclusive, and improving staff knowledge and training on supporting LGBTQ+ service users.