4 - (OP15) Accessing Evidence-based Care: Barriers to Mental Health Treatment Among LGBTQ+ Veterans at Risk for Suicide

Background: While elevated suicide risk among LGBTQ+ veterans is well-documented, less is known about barriers to accessing and engaging in mental health care for LGBTQ+ veterans, particularly among those not engaged in Department of Veterans Affairs (VA) mental health services. Understanding unmet need and barriers to care is essential for ensuring that evidence-based treatments, including cognitive behavioral therapies, are affirming, equitable, and accessible. This study examined unmet mental health need, barriers to care, and perceived importance of LGBTQ+-specific attributes among LGBTQ+ veterans with recent suicidal ideation and/or behavior, comparing those engaged and not engaged in VA mental services.

Methods: A national sample of 98 LGBTQ+ veterans in the United States with past-year suicidal ideation and/or behavior was recruited via social media (26.5% not engaged in VA mental health services in the past year; 49.5% transgender/gender diverse; 84.7% White). Participants completed an online survey assessing participation in mental healthcare, barriers to VA mental health care (i.e., benefits, fitting in, sensitivity, quality, availability of care, availability of LGBTQ+ care, logistics), and LGBTQ+-specific attributes that may be important to include in care. Descriptive statistics summarized key variables. Independent t-tests with Benjamini-Hochberg correction compared VA-engaged and non-VA engaged veterans.

Results: Overall, 61.4% of veterans reported unmet mental health need in the past 12 months. Among the full sample, the highest rated barrier domain was in availability of LGBTQ+ services, whereas logistics was the lowest-rated barrier. At the item level, the top three greatest barriers were perceptions that VA is mainly for heterosexual, non-transgender veterans (48.2% of veterans endorsed at least moderately); lack of sensitivity to LGBTQ+ issues (49.1%); and inability to access an LGBTQ+-specific service (38.4%). The most highly valued LGBTQ+-affirming care attributes included intolerance of anti-LGBTQ+ remarks from patients and staff (89.3%), provider training in LGBTQ+ health issues (86.6%), and integration of LGBTQ+-specific issues into treatment (77.7%). Compared to VA-engaged veterans, non-VA engaged veterans were significantly more likely to report having insurance that covers healthcare outside VA (t = -4.31, p < .001) and placed greater importance on intake forms including questions about sexual orientation and gender identity (t = -2.21, p = .03). The two groups did not significantly differ on unmet needs or domain-level barrier scores.

Conclusions: Most LGBTQ+ veterans with recent suicidal ideation and/or behavior experience unmet mental health needs. Findings suggest that perceptions of exclusion and limited access to LGBTQ+-affirming services may hinder engagement in VA mental health care. While VA is a leader in innovating and delivering evidence-based CBT, these findings underscore the importance of implementing these interventions within inclusive and equitable systems of care in which all veterans feel welcomed and valued.