LGBQ+ adults' experiences of Improving Access to Psychological Therapies and primary care counselling services: informing clinical practice and service delivery

摘要

Lesbian, gay, bisexual, queer and other sexual minority (LGBQ+) people experience higher levels of psychological difficulties than heterosexual people. Evidence suggests that LGBQ+ treatment outcomes within England's Improving Access to Psychological Therapies (IAPT) services are worse than the outcomes for heterosexuals, especially for bisexual people and sexual minority women. IAPT services provide evidence-based treatments like cognitive behavioural therapy (CBT), typically for anxiety or depression. This study explored LGBQ+ adults' experiences with IAPT services and/or primary care counselling. LGBQ+ adults (n = 136) answered an online questionnaire (fixed-response and optional open-ended questions) about their access and treatment experiences. Descriptive statistics summarized multiple-choice responses. Qualitative data were analysed through thematic analysis. Before access, 41.9% of participants were concerned about experiencing LGBQ+ stigma/discrimination within psychological services. Only 13.2% of participants thought their sexuality negatively impacted their treatment, although prejudice/ discrimination may be underestimated as 33.6% participants did not disclose their sexuality to practitioners and sexuality was not discussed in treatment for 44.0% of participants. Bisexual clients were significantly less likely to disclose their sexuality. The barriers LGBQ+ people described within IAPT or primary care services included: feared or experienced stigma in the services; reluctance to disclose sexuality; inconsistent discussion of sexuality in treatment; a lack of awareness and understanding towards LGBQ+ identities and community-specific challenges; and distrust, disillusionment and exclusion resultantly. Overall, 52.2% thought services could be improved for LGBQ+ individuals. This study identified multiple issues to be addressed in therapist training and service development.