Health-care providers at sexual-health clinics in the Vancouver area are seeing a high number of requests for help with mental-health and substance-abuse issues and a researcher who has surveyed the clinics’ patients says those who identify as LGBTQ were particularly in need.
Travis Salway, a research fellow for the BC Centre for Disease Control, surveyed 1,115 clients in six clinics for sexually transmitted infections in Greater Vancouver. More than half were LGTBQ. He said the results of his nine-month study show there could be better health outcomes if STI clinics also offered mental-health services. LGBTQ patients would especially benefit because they are more comfortable opening up to health-care providers in STI clinics than they are in other health-care settings, said Mr. Salway.
“We really saw a lot of comfort and trust in the sexual-health providers,” said Mr. Salway, a social epidemiologist whose research focuses on health inequities experienced by lesbian, gay and bisexual people. “[Clients] have a little bit of an easier time coming in the door and feeling like they’re being seen and heard.”
The LGBTQ community has higher rates of suicidal thoughts, suicide attempts, depression, anxiety and substance abuse than heterosexual and cisgender individuals, said Mr. Salway.
His study found that 28 per cent of all respondents wanted to speak with a health-care provider about mental-health or substance-use concerns, but did not have the opportunity to do so. Eighty-five per cent reported being comfortable talking to a sexual-health clinician.
Mr. Salway said STI clinics are good places to reach sexual minorities because they are “low-barrier.” Clients do not need to get a referral from a doctor to go to an STI clinic. Most STI clinics are anonymous, meaning people can use any name they like to get tested. That helps create a feeling of privacy and protection, the researcher said.
Many STI clinics also have a history of working with sexual-minority communities due to the HIV epidemic. This can make individuals more willing to open up about another vulnerable topic, such as depression or anxiety.
Mr. Salway says he hopes that STI clinics will consider providing mental-health counselling in the same building. This approach is already being used at the Health Initiative for Men (HIM) in Vancouver.
HIM started in 2008 and a health centre – where mental-health counselling is provided – was opened in 2009. According to the program’s manager, Aaron Purdie, the organization originally began with two councillors and now works with 14.
Mr. Purdie said HIM is a comfortable, inclusive environment. Someone might visit the clinic for an STI test or medication and feel comfortable showing vulnerability to the health experts at the clinic.
“They might say, ‘Also, I’ve been feeling really freaked out lately, really anxious. Really stressed. Something in the bar happened to me last night. I was sexually assaulted and that’s why I’m actually here.”
Marianne Hunter, 32, is bisexual and immigrated to Canada from Rio de Janeiro 12 years ago. She has severe depression, anxiety, obsessive-compulsive disorder, borderline personality disorder and autism. Ms. Hunter, who now lives in New Westminster, B.C., has been under hospital care due to mental-health concerns in the past.
She says that when someone has severe anxiety, interacting with medical practitioners who assume they are heterosexual can exacerbate their anxiety.
“I do wish that they had had someone who had experience with the queer community. They asked, ‘What does your husband do?’ And I say, ‘I have a wife.’ And just having to explain that … it already puts me on the defensive,” said Ms. Hunter.
Mr. Purdie says that having councillors who understand the kind of anxiety and concerns the LGBTQ population often deal with is crucial to giving them the help they need.
“I think the first step would be recognizing that sexual-health outcomes are improved by positive mental health. … We can do better by having these bases co-located,” he said.