Reducing the Treatment Gap for LGBT Mental Health Needs: the Potential of Telepsychiatry


The high prevalence of psychiatric conditions and the concomitant increase in need for mental illness have posed a challenge across the USA. Patients continue to encounter many barriers to accessing care with only 43% receiving treatment. This situation is even more challenging for LGBT individuals, who experience higher rates of some mental health conditions, with an increased risk of suicidality, due to stressors such as discrimination and trauma. Simultaneously, LGBT individuals face specific barriers at the individual level, clinician level, and systemic level. Telepsychiatry has emerged as an approach that can help overcome some of the challenges faced by LGBT individuals when it comes to healthcare access. This paper examines the ways in which telepsychiatry can overcome the aforementioned barriers and provides recommendations to enhance the quality of telepsychiatry services for LGBT patients. Recommendations include improving medical education, enhancing health-force training on cultural competency, and expanding culturally affirming telehealth programs.

This is a preview of subscription content, log in to check access.


  1. 1.

    National Alliance on Mental Illness. Mental Health Conditions. Available online at Accessed June 1, 2019.

  2. 2.

    National Council Medical Director Institute. The Psychiatric Shortage: Causes and Solutions. Available online at Accessed June 1, 2019.

  3. 3.

    Mental Health America. Access to Care Data. Available online at Accessed June 1, 2019.

  4. 4.

    Ahrnsbrak R, Bose J, Hedden S, et al. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. See Accessed June 1, 2019.

  5. 5.

    National Institute of Mental Health. Mental Illness. Available online at Accessed June 1, 2019.

  6. 6.

    Redfern JS and Sinclair B. Improving Health Care Encounters and Communication with transgender patients. Journal of Health Communication. 2014;7(1):25-40.

    Google Scholar 

  7. 7.

    Institute of Medicine (US). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington: National Academies Press (US), 2011, p. 64-65.

    Google Scholar 

  8. 8.

    Romanelli M and Hudson KD. Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American Journal of Orthopsychiatry. 2017;87(6):714-728.

    PubMed  Google Scholar 

  9. 9.

    Kirby MJ, Keon WJ and Dinsdale HB. Out of the shadows at last: Transforming mental health, mental illness and addiction services in Canada. Report, The Standing Senate Committee on Social Affairs, Science and Technology, Canada, May 2006.

    Google Scholar 

  10. 10.

    Saeed SA and Anand V. Use of telepsychiatry in psychodynamic psychiatry. Psychodynamic Psychiatry. 2015;43(4):569-583.

    PubMed  Google Scholar 

  11. 11.

    Shore JH. Telepsyciatry: videoconferencing in the delivery of psychiatric care. American Journal of Psychiatry. 2013;170(3):256-262.

    PubMed  Google Scholar 

  12. 12.

    Bolle SR, Trodsen MV, Stensland GØ, et al. Usefulness of Videoconferencing in Psychiatric Emergencies—a qualitative study. Health and Technology 2018;8(1):111-117

    PubMed  Google Scholar 

  13. 13.

    Hilty DM, Ferrer DC, Parish MB, et al. The effectiveness of telemental health: a 2013 review. Telemedicine Journal and e-Health. 2013;19(6):444-454.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Yellowlees P, Burke MM, Marks SL, et al. Emergency telepsychiatry. Journal of Telemedicine and Telecare. 2008;14(6):277-281.

    PubMed  Google Scholar 

  15. 15.

    Hilty D, Yellowlees PM, Parrish MB, et al. Telepsychiatry: Effective, evidence-based, and at a tipping point in health care delivery? Psychiatric Clinics of North America. 2015;38(3):559.

    PubMed  Google Scholar 

  16. 16.

    U.S. Department of Health and Human Services. Lesbian, Gay, Bisexual and Transgender Health. Healthy People 2020, Available online at Accessed on June 1, 2019.

  17. 17.

    Roberts AL, Austin SB, Corliss HL et al. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health. 2010;100(12):2433-2441.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Veltman A and Chaimowitz G. (2014). Mental Health Care For People Who Identify As Lesbian, Gay, Bisexual, Transgender, And (Or) Queer. Canadian Journal of Psychiatry. 59(11):1.

    PubMed  Google Scholar 

  19. 19.

    Whitehead J, Shaver J and Stephenson R. Outness, stigma, and primary health care utilization among rural LGBT populations. Public Library of Science One. 2016;11(1).

  20. 20.

    Swank E, Fahs B and Frost DM. Region, social identities, and disclosure practices as predictors of heterosexist discrimination against sexual minorities in the United States. Sociological Inquiry. 2013;83(2):238-258.

    Google Scholar 

  21. 21.

    Ibañez GE, Purcell DW, Stall R, et al. Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS. 2005;19(suppl 1):49-55.

    Google Scholar 

  22. 22.

    Herek GM and Garnets LD. Sexual orientation and mental health. Annual Review of Clinical Psychology. 2007;3(1):353-375.

    PubMed  Google Scholar 

  23. 23.

    James SE, Herman JL, Rankin S et al. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey. Report, National Center for Transgender Equality, Washington, 2016.

    Google Scholar 

  24. 24.

    National Alliance on Mental Illness. LGBTQ. Available online at Accessed on June 1, 2019.

  25. 25.

    Uwakwe R, Jidda SM and Bährer-Kohler S. Access to Mental Health. In: Bährer-Kohler S and Carod-Artal FJ (eds) Global Mental Health. Gewerbestrasse: Springer Nature, 2017:21-31.

    Google Scholar 

  26. 26.

    Kidd SA, Veltman A, Gately C et al. Lesbian, gay, and transgender persons with severe mental illness: Negotiating wellness in the context of multiple sources of stigma. American Journal of Psychiatric Rehabilitation. 2011;14(1):13-39.

    Google Scholar 

  27. 27.

    Austin EL. Sexual orientation disclosure to health care providers among urban and non-urban southern lesbians. Women Health. 2013;53(1):41-55.

    PubMed  Google Scholar 

  28. 28.

    Bradford J, Reisner SL, Honnold JA and Xavier J. Experiences of transgender-related discrimination and implications for health: Results from the Virginia transgender health initiative study. American Journal of Public Health. 2013;103(10):1820-1829.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Durso LE and Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy. 2013;10(1):35-42.

    PubMed  Google Scholar 

  30. 30.

    Currin JM, Hubach RD, Crethar HC et al. Barriers to Accessing Mental Healthcare for Gay and Bisexual Men Living in Oklahoma. Sexuality Research and Social Policy. 2018:1-14.

  31. 31.

    Fisher CM, Irwin JA and Coleman JD. LGBT health in the midlands: A rural/urban comparison of basic health indicators. Journal of Homosexuality. 2013;61(8):1062–1090.

    Google Scholar 

  32. 32.

    Driskell JR, O'Cleirigh C, Covahey C et al. Building program acceptability: Perceptions of gay and bisexual men on peer or prevention case manager relationships in secondary HIV prevention counseling. Journal of Gay and Lesbian Social Services. 2010;22(3):269–286.

    PubMed  Google Scholar 

  33. 33.

    Hollander D. Men who do not disclose same-sex behavior may miss chances to get recommended care. Perspectives on Sexual and Reproductive Health. 2013;45(2):110–111.

    Google Scholar 

  34. 34.

    Clift, JB and Kirby J. Health care access and perceptions of provider care among individuals in same-sex couples: Findings from the medical expenditure panel survey (MEPS). Journal of Homosexuality. 2012;59(6):839-850.

    PubMed  Google Scholar 

  35. 35.

    Yarns BC, Abrams JM, Meeks TW et al. The mental health of older LGBT adults. Current Psychiatry Report. 2016;18(6):1-11.

    Google Scholar 

  36. 36.

    Boroughs MS, Bedoya CA, O’Cleirigh C and Safren SA. Toward defining, measuring, and evaluating LGBT cultural competence for psychologists. Clinical Psychology. 2015;22(2):151-171.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Bonvicini KA. LGBT healthcare disparities: What progress have we made? Patient Education and Counseling. 2017;100(12):2357-2361.

    PubMed  Google Scholar 

  38. 38.

    Price EG, Beach MC, Gary TL et al. A systematic review of the methodological rigor of studies evaluating cultural rigor of studies evaluating cultural competence training of health professionals. Academic Medicine Journal. 2005;80(6):578-586.

    Google Scholar 

  39. 39.

    Lyons HZ, Bieschke KJ, Dendy AK et al. Psychologists’ competence to treat lesbian, gay and bisexual clients: State of the field and strategies for improvement. Professional Psychology: Research and Practice. 2010;41(5):424–434.

    Google Scholar 

  40. 40.

    Beck A, Burdett M and Lewis H. The association between waiting for psychological therapy and therapy outcomes as measured by the CORE‐OM. British Journal of Clinical Psychology. 2015;54(2):233-248.

    PubMed  Google Scholar 

  41. 41.

    Williams ME, Latta J and Conversano P. Eliminating the wait for mental health services. Journal of Behavioral Health Services and Research. 2008;35(1):107-114. doi:

    Article  PubMed  Google Scholar 

  42. 42.

    Weng T, Geffen S and Cahill S. The current wave of anti-LGBT legislation: Historical context and implications for LGBT health. The Fenway Institute. 2016:1–21.

  43. 43.

    Malhotra S, Chakrabarti S and Shah R. Telepsychiatry: Promise, potential, and challenges. Indian Journal of Psychiatry. 2013;55(1):3.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    The Department of Health and Human Services, Office of the Press Secretary. HHS Announces Final Conscience Rule Protecting Health Entities and Individuals [Press release]. Retrieved from Accessed on June 1, 2019.

  45. 45.

    Shore JH. What is Telepsychiatry? American Psychiatric Association. Available online at Accessed on June 1, 2018

  46. 46.

    Waugh M, Voyles D and Thomas MR. Telepsychiatry: Benefits and costs in a changing health-care environment. International Review of Psychiatry. 2015; 27(6): 558-568.

    PubMed  Google Scholar 

  47. 47.

    García-Lizana F and Muñoz-Mayorga I. What about telepsychiatry? A systematic review. Primary Care Companion to the Journal of Clinical Psychiatry 2010; 12(2).

  48. 48.

    Shore JH. Telepsyciatry: videoconferencing in the delivery of psychiatric care. American Journal of Psychiatry 2013; 170(3): 256-262.

    PubMed  Google Scholar 

  49. 49.

    Levin A. Report details national shortage of psychiatrists and possible solutions. Psychiatrics News,2017;52(8), Accessed June 1, 2019.

  50. 50.

    Farrell SP and McKinnon CR. Technology and rural mental health. Archives of Psychiatric Nursing 2003; 17(1): 20-26.

    PubMed  Google Scholar 

  51. 51.

    Simms DC, Gibson K and O’Donnel S. To use or not to use: clinicians’ perceptions of telemental health. Canadian Journal of Psychology 2011; 52(1): 41-51.

    Google Scholar 

  52. 52.

    Chan S, Parish M and Yellowlees P. Telepsychiatry today. Current Psychiatry Reports 2015; 17(11): 1-9.

    Google Scholar 

  53. 53.

    Mucic D. Cross-Cultural Telepsychiatry: An Innovative Approach to Assess and Treat Ethnic Minorities with Limited Language Proficiency. Innovation in Medicine and Healthcare 2016; 60: 49-58.

    Google Scholar 

  54. 54.

    Shore JH, Savin DM, Novins D and Manson SM. Cultural aspects of telepsychiatry. Journal of Telemedicine and Telecare 2006; 12(3), 116-121.

    PubMed  Google Scholar 

  55. 55.

    Greenberg PE, Fournier AA, Sisitsky T et al. Insurance status, use of mental health services, and depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry 2015; 76(2): 155-162.

    PubMed  Google Scholar 

  56. 56.

    Yellowlees PM, Odor A, Iosif A, et al. Transcultural Psychiatry Made Simple—Asynchronous Telepsychiatry as an Approach to Providing Culturally Relevant Care. Telemedicine and e-Health 2013; 19(4): 259-264.

    PubMed  Google Scholar 

  57. 57.

    Yellowlees PM, Odor A, Parish MB, et al. A Feasibility Study of the Use of Asynchronous Telepsychiatry for Psychiatric Consultations. Psychiatric Services 2010; 61(8): 838-840.

    PubMed  Google Scholar 

  58. 58.

    Marziali E and Garcia LJ. Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs. American Journal of Alzheimer’s Disease & Other Dementias 2011; 26(1): 36-43.

    Google Scholar 

  59. 59.

    Archibald D, Stratton J, Liddy C, et al. Evaluation of an electronic consultation service in psychiatry for primary care providers. BMC Psychiatry 2018; 18:119.

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    The American Psychological Association. Best Practices for Mental Health Facilities Working With LGBT Clients. The American Psychological Association. Available at Accessed June 1, 2019.

  61. 61.

    How To Find An LGBTQ-Friendly Rehab and Mental Health Treatment Center. Mission Harbor Behavioral Health. Available online at . Accessed June 1, 2019.

Download references

Author information



Corresponding author

Correspondence to Emily L. Vogt.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Whaibeh, E., Mahmoud, H. & Vogt, E.L. Reducing the Treatment Gap for LGBT Mental Health Needs: the Potential of Telepsychiatry. J Behav Health Serv Res 47, 424–431 (2020).

Download citation