Beyond ‘Help-Seeking,’ toward ‘Engagement’: Understanding Barriers to Mental Health Equity among Sexual Minority Individuals

The finding that 57.4% of adults living in the United States with a diagnosable mental health disorder do not receive mental health care (Substance Abuse and Mental Health Services Administration, 2018) opens important questions as to what structural and individual factors contribute to this “treatment gap” and individuals’ willingness and/or ability to seek out traditional mental health care. Sexual minority (SM) individuals experience inequitable mental health outcomes and report more unmet mental health needs and more barriers to health care than heterosexual individuals. Thus, there is a need to understand the process of mental health care engagement (MHCE) for SM individuals in order to ensure accessible, affirmative, and effective treatment. MHCE is purposefully used as mental health reflects a complex, intertwined process of engagement between individual-, community-, and macro-level factors. A sample of 398 SM individuals completed an online, anonymous survey on Amazon Mechanical Turk. Informed by the theory of planned behavior (Ajzen, 1985), Network-Episode Model (Pescosolido & Boyer, 2010), and the threat-to-self-esteem model (Nadler & Fisher, 1986), a structural equation model with adequate model fit found intentions to seek out traditional mental health care dynamically shift across the trajectory of psychological distress in relation to Theory of Planned Behavior moderators (e.g., attitudes towards mental health care professionals, mental health stigma, structural barriers) and other variables (e.g., self-concealment, social support) commonly used in previous help-seeking studies. A substantial amount of the sample reported unmet mental health needs, engagement with alternative mental health care, and experiences with sexual orientation change efforts. The implications foreground the importance of structural vulnerability throughout the process of MHCE in terms of theory, practice, advocacy, education, training, and research.