International Journal of Health Science & Biomedicine

Abstract 

In 2020, the COVID-19 pandemic devasted health outcomes and economies globally. As a result, many suffered financial hardships, childcare challenges, and poor mental health due to the pandemic’s negative effects. Young people were particularly affected by the pandemic as it pertained to education, social isolation, and access to essential resources and services. Additionally, the U.S. experienced a rise in anti-LGBTQ+ proposals and laws were introduced or passed in various states across the country, particularly in the South. LGBTQ+ youth and young adults are more likely to experience and report poor mental health compared to their straight counterparts. As a result, my two research collaborators (Dr. Gayle Beck and Phillis Lewis) and I proposed to examine the perceptions of mental health services, access, and availability among the LGBTQ+ student community and LGBTQ+ identifying faculty and staff on the University of Memphis campus. As a result of the pending or enacted anti-LGBTQ+ legislation and the effects of the pandemic, a needs assessment was conducted. Three methodological approaches were used to capture student, faculty, and staff insights; an online survey, focus groups, and interviews. The results of the needs assessment suggest that efforts could be used to improve access and reduce barriers for LGBTQ+ students on campus to improve overall mental health by facilitating the provision of counseling services, improving the campus atmosphere for students via training, and supporting LGBTQ mental health on campus.

Introduction

In 2021 as a new assistant professor at the University of Memphis College of Health Sciences, I applied for and was awarded a Campus Community grant, titled Perceptions of Mental Health in the LGBTQ+ Student Community: Needs, Barriers, and Access. As the principal investigator [1], I collaborated with Phillis Lewis, executive director of Love Doesn’t Hurt (LGBTQ IPV non-profit) and Dr. Gayle Beck on this project. This report summarizes the findings of this grant, which was intended to conduct of a needs assessment at the University of Memphis (UoM) related to the perception of mental health services, access, and availability among the LGBTQ+ student community. Over the past decade, the University of Memphis has become more LGBTQ+ inclusive and affirming due to its policies, training, education, and other equitable measures that both protect and include LGBTQ+ staff, faculty, and students. Despite the advancements in LGBTQ+ equity on campus [2], likely, the LGBTQ+ campus community may still face some challenges related to prejudice, discrimination, violence, or safety concerns which could inadvertently have an impact on mental health. This grant intended to assess current perceptions of needs, barriers, and access to services designed to improve the mental health and well- being of students within the LGBTQ+ community. 

On-line Student Survey

All respondents were asked to answer a set of on-line questions. The number of responses varied by question, perhaps reflecting survey fatigue:

• Key demographics: 63 students responded to the survey with a majority being undergraduate students.

  - 18–24-year-old.
  - 54% White, 27% Black, 6.68% Multi-Racial, Latinx 8.47%, 3.38% Asian/Pacific Islander.
  - 52.54% Women, 22.03% Men, 10% Non-Binary/Third Gender, 6.78 Transwoman, 6.78% Other, and 1.69% Transman.

• How helpful are Perception of mental health services on campus: 36.21% Neutral, 24.14% Somewhat Helpful, 18.97% Somewhat Not Helpful, 12% Very Helpful [3], 8.62% Not Helpful 

  - Neutral may indicate uncertainty or a lack of interaction with services on campus; other results related to perceptions of services are both helpful and not helpful.

• Access to mental health services on campus: 37.76% Neither Easy Nor Difficult, 25.86% Somewhat Easy, 24.14% Somewhat Difficult, 12% Extremely Easy, 5.17% Extremely Difficult.

  - Respondents reported more of a mixture of easy and difficult overall which indicates access could be improved.

• Availability of mental health services on campus: 39.29% Neutral, 28.57% Somewhat Available, 17.86% Mostly Available, 7.14% Always Available, 7.14% Never Available [4]. 

  - Majority of respondents reported that mental health services on campus were available to them; availability refers to mere presence of services on campus versus having access is related to the navigation process and potential barriers.

• Mental health services locations: The counseling center (Wilder) was the most common response for respondents; thus, this suggests that increased outreach efforts with the Student Counseling Center could be helpful being that most survey respondents reported they would go to the Counseling Center to seek mental health services.
   

• LGBTQ+ students and unique mental health needs: 65.71% reported that LGBTQ+ students have unique mental health needs, 20% Maybe, 14.29% No [5]

  - In line with previous research studies pertaining to LGBTQ+ mental health (higher levels of substance use, depression, anxiety, suicidal ideation/attempts), majority of respondents reported that students of this population have more unique mental health needs.

  - Considerations: Identify more protective factors for LGBTQ+ students such as; affirming faculty staff, supportive and affirming RSOs, awareness/campaigns, and mental health staff who are more experienced working with LGBTQ+ community.

• How does UoM address the unique needs of the LGBTQ+ student community: 29% Moderately Well, 29% Slightly Well, 26% Not Well At All, 9% Very Well, and 6% Extremely Well.

  - Responses indicate that the UoM needs to do more to address this area of need (as various groups or other populations need tailored approaches or programming).

• Additional mental health support for LGBTQ+ students were: Social/support groups, skilled mental health staff, coming out resources, and increased promotion and marketing.

  - Respondents identified desired mental health resources which serve as protective factors that are essential to positive mental health for this vulnerable population. Identifying and increasing the visibility of these resources is paramount.

• On campus barriers to mental health services: Respondents reported that stigma, discrimination, and fear were the largest barriers; due to minority stress, LGBTQ+ individuals are more likely to experience such prejudices and negative experiences due to their sexual orientation and or gender identity compared to straight counterparts. 

  - These barriers were somewhat expected being that LGBTQ+ individuals face many of these issues at a societal level, thus most of these perceived barriers would also be present on college campuses too.

• Self or other student having difficulty finding competent, LGBTQ+ mental health professionals: 42.86% Reported having NO difficulties finding a competent, LGBTQ+ mental health professional, 40% Reported Maybe, and 17.14% Reported Yes. 

  - Compared to previous reporting on other questions, this item indicates perhaps some success finding competent mental health professionals but some uncertainties and reservations for others.
  - Most important characteristics of a counselor: The following characteristics were the most reported by respondents: Caring, supportive, knowledgeable about LGBTQ+ affirming practices, open minded, great listener, trauma informed, and non-judgmental.

• Perception of a need for more LGBTQ+sensitive mental health professionals on campus: 47% reported YES to a need of more LGBTQ+ sensitive mental health professionals, 35.29% Reported MAYBE, and 17.65% Reported N. 

  - This prompt aligns with previous areas that there is a need for more LGBTQ+ affirming and sensitive mental health professionals on campus. 
  - Considerations: specific trainings or counseling techniques working with the LGBTQ+ community; collaboration with Counseling Center.

• Familiar mental health resources on Campus: 41.18% Counseling Center, 26.47% Relaxation Zone, 11.76% Psychological Services, 9% Mindfulness Support, 9% Victims Services Referral, 3% Other. 

  - As reported in the previous “mental health location” question, due to the high percentage of responses related to the Counseling Center, it is essential that more resources and or training are put in the Counseling Center since it is the most familiar mental health resource on campus.

• Effectiveness for mental health resources on campus for LGBTQ+ students: 47% Reported Moderately Effective, 35% Slightly Effective, and 17.65% Not Effective At All. 

  - Responses suggest that the mental health services/resources are not perceived to be of high effectiveness and could be significantly improved.

• How can the campus improve mental health resources: 19.67% More Diverse Representation of Mental Health Professionals, 19.67% LGBTQ+ specific training, 18% Improve Marketing/Promotional efforts, 14.75% Mental Health (Awareness Days and Months) Activities/Programming, 13.11% Train Student Leaders, Faculty, and Staff to be Mental Health Advocates, 10% Increase Mental Health Seminars and Workshops on Campus. 

  - The responses provided for this final question sums up the NEEDS for the student, LGBTQ+ population on campus. This is where capacity building is needed, and knowledge could be shared to improve the needs of this population.

Summary 

- Needs: Counselors who are diverse, trained, and skilled to work with LGBTQ+ clients. Also, counselors must be caring, supportive, knowledgeable about LGBTQ+ affirming practices, open minded, great listener, trauma informed, and non judgmental. 
- Social/support groups, skilled mental health staff, coming out resources, and increased promotion and marketing serving as protective factors to positive mental health. 

- Access: Improvements could be made per increased marketing and promotional efforts to mental health resources in general and specifically LGBTQ+ specific targeted messaging. Note: availability is not the same as access. 

- Barriers: Stigma, discrimination, prejudice, and fear were some of the common challenges that prevented or is a concern for seeking mental health services on campus. Although society is changing pertaining to mental health awareness, barriers still exist especially for members of the LGBTQ+ community. Hence, working with various departments on campus such as the Counseling Center, Marketing, and the Student Equity Office are pivotal to improving mental health service/resource efforts on campus. 

Focus groups/interviews 

Standardized prompts were used with these face-to-face interviews. Interviews with students were conducted in small groups of 3-7 individuals. A total of 12 staff and faculty were interviewed individually. Confidentiality was assured. All interviews were audiotapes and transcribed by an outside company. Themes were extracted across interviews by the research team, to deepen understanding provided in the on-line survey information. 

Perceptions of available mental health resources for LBGTQ+ students 

With respect to LGBTQ+ mental health resources on campus, opinions varied. Some faculty/staff think positively of the counseling center or have heard of students with positive experiences at the counseling center, while other faculty/staff think the counseling center can be improved overall or have heard negative experiences from students. This diversity of opinion was also reflected in the student focus groups. 

Supports/affirming spaces 

Affirming spaces and people were reported to be the following:

• Stonewall Tigers

• College of Arts department and staff

• Psychology department and staff

• Pride Equity and Alliance

• LGBTQ+ counseling group

• Office of Multicultural Affairs

• Select professors, staff, deans, advisors

Summary 

Needs Many of the perceived needs centered on the Counseling Center, the primary source of mental health services available to students on campus. Many individuals mentioned the need for improved counseling center marketing/promotion in general, specifically targeting the campus LGBTQ+ community. A stronger external referral system and process for Counseling Center staff were recognized as a need, to promote improved continuity of services for LGBTQ+ students. The intake process at the Counseling Center was also discussed by students as a need. Specific improvements include greater recognition of the unique needs of this student sector. Additionally, a need for the Counseling Center to recruit more LGBTQ+ identifying counselors and/or counselors who specialize in LGBTQ+ issues and comorbidities was discussed, to improve services. Finally, increased efforts to promote the LGBTQ+ counseling group to students and faculty/staff were identified as a need. Some of the perceived needs centered on faculty and staff. Overall, faculty and staff could benefit from Safe Zone or other LGBTQ+-related training. Students noted that it would be helpful to identify more LGBTQ+- affirming and supportive faculty and staff on campus and to increase faculty/staff knowledge of affirming spaces/staff for LGBTQ+ students. Housing was also mentioned as a need. Improved housing support for LGBTQ+ students was mentioned by numerous individuals, particularly during semester breaks, when family rejection precludes housing at home. Improved atmosphere in on-campus housing during the semester would be beneficial. Lastly, the LGBTQ+ student body collaborates more effectively with the Counseling Center, Pride Equity and Alliance, and the Office of Multicultural Affairs. 

Access 

Improved access was recognized. In particular, many felt that access to the Counseling Center could be improved, particularly concerning the number of available treatment sessions. Provision of support for external counseling was a common theme, to improve mental health services for LGBTQ+ students. Additionally, many felt that access to several resources on campus could be improved, particularly Stonewall Tigers, the Pride and Equity Alliance, and the Office of Multicultural Affairs. A closer collaboration with OUT Memphis was also suggested, to improve access. 

Barriers

Although resources exist on campus for LGBTQ+ students, several perceived barriers were noted. Concerning the general atmosphere on campus, LGBTQ+ students noted a general lack of acceptance among professors and counselors at the Counseling Center. Coupled with the cultural/religious environment in the South, recognition of this barrier was notable. Additional barriers centered on the Counseling Center’s services. These included the limited number of counseling sessions provided for students, the limited number of Non-LGBTQ+ identifying counselors and counselors who have limited or no LGBTQ+ specific counseling training, and the intake process at the Counseling Center. Each of these perceived barriers at the Counseling Center could be improved with the provision of greater resources for this facility. We hope that the results of these efforts can be used to improve access and reduce barriers forLGBTQ+ students on campus to improve overall mental health and particularly, facilitate the provision of counseling services,improve the campus atmosphere for students, and support positive mental health.

References

1. Bell I, Nicholas J, Broomhall A, Bailey E (2023) The impact of COVID-19 on youth mental health: Amixedmethodssurvey. Psych Res.

2. Dietzelm C, Bello B, O’Shea B, Cullum J (2023) Mental health of LGBTQ+ people during the Covid-19 pandemic:Ascoping review. Advances in Mental Health.

3. Horne S, Maroney M, McGinley M, Yel N (2022) The stench of bathroom bills and anti-transgender legislation: Anxietyand depression among transgender, nonbinary, and cisgender LGBQ people during a state referendum. J Couns Psychol 69.

4. Lawrence SE, Hanna-Walker V, Lefkowitz ES (2024) Sexual orientation and gender identity expression, internalizedstigma, andmental health during the COVID-19 pandemic. J of LGBT Youth 1-19.

5. Lesbian, Gay, and Bisexual Behavioral Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health(2023). US Department of Health and Human Services Substance Abuse and Mental Health Services Administration.