Research Brief:
LGBTQ+ Kansans’ Experiences with Crisis Services
Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face high rates of stigma, oppression, and victimization, increasing their need for supportive mental health and crisis response services.1,2 Simultaneously, LGBTQ+ people report barriers to accessing supportive and affirming crisis care.3 Little research has explored the specific experiences of LGBTQ+ people when accessing crisis services, especially in Midwestern and predominantly rural states like Kansas. With the goal of improving crisis services for all Kansans, it is necessary to understand the experiences of groups who face increased marginalization and oppression in crisis services. Therefore, this project explored the experiences of LGBTQ+ Kansans with crisis services across the state.
The Project: A team consisting of academic researchers, crisis counselors, LGBTQ+ Kansans, and community leaders advertised focus groups and interviews for 1) crisis providers in Kansas and 2) LGBTQ+ Kansans. A total of 64 people participated: 28 engaged in one of nine focus groups, 28 completed interviews, and an additional 8 completed an alternate anonymous survey. Of the 64 participants, 24 were crisis providers (11 of whom were LGBTQ+) and 40 were LGBTQ+ Kansans. Participants’ gender, sexual orientation, age, and race/ethnicity are shown below.
Participants were spread throughout the state with 64% in the Northeast, 23% in the Southeast, 11% in the Middle, and 2% in the Southwest regions. About 16% lived and/or worked in rural communities. LGBTQ+ participants answered questions about their experiences with crisis services. Their answers were analyzed by the research team to better understand their experiences with crisis and mental health services. Participants described both positive and negative experiences, many of which related to their identities as LGBTQ+ people.
Positive Experiences with Crisis Services
About half of LGBTQ+ participants described positive experiences with both crisis providers and mental health providers more broadly. Specifically, they identified positive experiences as 1) having their gender and/or sexuality affirmed by providers, 2) receiving support from providers, and 3) accessing LGBTQ+ providers.
Having Gender and/or Sexuality Affirmed
One primary positive experience that participants discussed was being affirmed as LGBTQ+ people by crisis or mental health providers. When providers validated LGBTQ+ participants’ identities as normal, valid, and deserving of care and respect, it either helped to alleviate their crisis experience or not exacerbate it.
“I was having a particularly bad fight with my mom at one point in my life, and it was all about my identity and how she was not accepting of it at all…having another person there to be like, ‘You’re not doing anything wrong by being who you are, and you’re not doing anything wrong by standing your ground and standing with your identity.’ And so that’s one of the biggest affirming things, and it makes you feel a little bit less crazy when you’ve got someone to talk to about it.”
“I have several nonbinary friends, and I think just having workers get their pronouns right, being very good about getting pronouns and preferred names right goes a long, long way, especially when you’re still discovering your own gender identity, having someone say that thing out loud to you, when maybe their families or friends don’t or don’t take it seriously.”
Receiving Support from Providers
In addition to affirming their identities, participants discussed receiving support from their providers as a positive experience with crisis services. They shared these supportive experiences as going beyond, or sometimes not related to, their sexual or gender identities.
“But when I did use the (Crisis Organization) services, ’cause I was in their day program for a little bit, my worker, she was very supportive of me and it was never about anything LBGTQ. She treated me as a person, just like she would want to be treated. So that’s what I’ve got to help me through that stuff.”
“Yeah, she treats me like who I am. I mean, really that’s about it. And she definitely gets to see all of my insecurities, even about myself questioning, and she just is supportive of that and helps me kind of introspect and find my legs again.”
“So just seeing that there are crisis providers, crisis services that go out of their way to say that they’re queer-friendly and show it by having a diverse staff is really, really important. And it makes me feel more comfortable that they’re going to meet my needs and hear my needs and make me feel safe, ’cause that’s the whole point of crisis work, is making someone feel safe and comfortable.”
“It was great for me to be able to find a Latinx female therapist in (City), she’s been phenomenal. And I have been able to talk about things that I have never been able to talk about in therapy because I just didn’t feel comfortable enough to, or felt like they would understand. So, definitely more representation in services would be phenomenal because it has helped me exponentially.”
Accessing LGBTQ+ Providers
Finally, LGBTQ+ participants in this study expressed positive experiences with finding and accessing LGBTQ+ providers and/or providers with intersectional identities that reflected their own. Having providers who shared LGBTQ+ and/or racial/ethnic identities with their own allowed participants to avoid having to educate their providers about their own identities and promoted more engagement in their work to manage their own crises.
Negative Experiences with Crisis Services
While some participants shared positive experiences with crisis services, about half of LGBTQ+ participants also shared negative experiences. Some participants shared their worries about engaging with crisis services as LGBTQ+ individuals, while others reported avoiding crisis services altogether. For those who did engage with crisis services, negative experiences included 1) being dismissed, 2) having to educate their providers, and 3) experiencing misgendering.
Worrying About and/or Avoiding Crisis
Some participants discussed that, even prior to engaging in crisis services, they went through an internal process of trying to decide if they felt safe enough as LGBTQ+ people to do so. While some ultimately decided to reach out for support or help, others chose to avoid it because of the possibility of negative experiences.
“One of the major concerns during the crisis, in the back of the person’s mind, is should I tell the crisis workers that I am part of the (LGBTQ+) community? And if so, what ramifications would happen if I do and that would the status of my care change?”
“I haven’t experienced discrimination while receiving crisis services specifically…Because I avoided crisis services.”
Being Dismissed
One common negative experience that LGBTQ+ participants discussed was being dismissed by crisis or mental health providers. This dismissal often directly related to their LGBTQ+ identities, such that they were denied access to engage in discussions about it or were treated poorly in response.
“I just feel like as far as things that haven’t been affirming, as a person assigned female at birth, I feel like there’s just been a lot of misogyny in my care, a lot of feeling dismissed and minimized, and as though I couldn’t intelligently speak to my experience because I’m not a psychiatrist. And I just think that that’s really harmful.”
“There have been situations where I’ve been in crisis where I did not have a therapist and if I mentioned my sexuality, it was either kind of swept under the rug like, ‘Okay, well, we’re not going to deal with that.”
Educating Providers
LGBTQ+ participants also described having to educator their crisis or mental health providers about their own identities or experiences, which they perceived as negative. Having to educate providers, particularly in the midst of a crisis, shifted the focus away from their own needs and put the focus on their providers’ lack of knowledge.
“Well, I had a therapist that didn’t know what polyamory was, and that’s about it. I just had to explain how it worked…it’s hard to … I don’t know. Especially when you’re in a place of really bad mental health and it’s tied up with polyamory, having to take the time to explain it, even when you’re not necessarily feeling it can be kind of difficult. You know?”
“I have had therapists that I’ve had to explain it to, and that can be exhausting when you’re trying to explain issues that you’re having within that, and they’re like, ‘I don’t understand this at all.”
Misgendering
Finally, some LGBTQ+ participants shared experiences of being misgendered when accessing crisis or mental health support. Misgendering includes actions such as using pronouns that do not align with a person’s gender identity or the pronouns they have shared for themselves and using names assigned at birth rather than chosen names (i.e., “deadnaming”). Misgendering served to exacerbate crisis situations rather than support individuals.
“Well, I had a therapist that didn’t know what polyamory was, and that’s about it. I just had to explain how it worked…it’s hard to … I don’t know. Especially when you’re in a place of really bad mental health and it’s tied up with polyamory, having to take the time to explain it, even when you’re not necessarily feeling it can be kind of difficult. You know?”
“I got dead named and it ruined my day. It happened when I was vulnerable in a time where I was extremely vulnerable, and it just really sucked, and it set me back. It set my healing back.”
Recommendations
● It is important that crisis service organizations and associated state organizations become aware of the positive and negative experiences LGBTQ+ Kansans have when accessing crisis services in the state.
● Crisis service organizations should ensure their staff and volunteers are trained in LGBTQ+-culturally responsive crisis intervention on an annual and ongoing basis.
● When trained in LGBTQ+-culturally responsive crisis intervention, crisis service organizations should advertise their LGBTQ+-inclusivity through their websites and marketing materials.
● Crisis service organizations should adopt policies that mandate the use of all employee and client chosen names and pronouns regardless of legal name or insurance.
Authors: Megan S. Paceley, PhD, MSW; Michael Riquino, PhD, MSW; Liz Hamor, MS; and Shana Green.
1. Gower, A.L., Valdez, C.A.B., Watson, R.J., Eisenberg, M.E., Mehus, C.J., Saewyc, E.M., Corliss, H.L., Sullivan, R., & Porta, C.M. (2019). First- and second-hand experiences of enacted stigma among LGBTQ youth. The Journal of School Nursing, 37(3). https://doi.org/10.1177/1059840519863094
2. Katz-Wise, S.L. & Hyde, J.S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. The Journal of Sex Research, 49(2-3), 142-167. https://doi.org/10.1080/00224499.2011.637247
3. White, B.P., & Fontenot, H.B. (2019). Transgender and non-conforming persons’ mental healthcare experiences: An integrative review. Archives of psychiatric nursing, 33(2), 203-210. http://doi.org/10.1016/j.apnu.2019.01.005
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