Abstract
LGB people face worse mental health outcomes than heterosexual people (Bränström, 2017; Plöderl & Tremblay, 2015). LGB people have been demonstrated to access mental health services at an equivalent or higher rate than their heterosexual peers though report higher rates of dissatisfaction with mental health services (Dunbar et al., 2017; Kidd et al., 2016). Dissatisfaction can be explained by poor service provider cultural competence when working with LGB people (Simeonov et al., 2015; Sue et al., 1982). To investigate service provider cultural competence when working with LGB service users, three aims were developed. The first aim was to define what constitutes service provider cultural competence when working with LGB service users. The second aim was to explore whether mental health service providers were demonstrating cultural competence when working with LGB service users. The final aim was to develop a model that describes the components (attitudes, knowledge and skill) of cultural competence when working with LGB service users.Four studies were conducted to explore how service providers demonstrate cultural competence. Study one was a systematic review, which examined previous literature to identify practices that impact effective mental health service provision to LGB people. Study two and three involved semi-structured interviews with LGB service users (n=21) and service providers (n=10), respectively, to determine their perceptions of what constitutes cultural competence and whether this was being demonstrated by mental health service providers. Study four was a survey administered to a community sample of LGB people (n=274) to further examine perceptions of what constitutes cultural competence and whether these practices were being demonstrated with a wider cross-section of the LGB community.
All four studies provided clear evidence that demonstrating cultural competence comes from having affirming attitudes, adequate knowledge about LGB people and their experiences, and skills to provide inclusive service to LGB service users. Affirming attitudes involved holding positive attitudes towards LGB people, using inclusive language and reducing heterosexist assumptions. Being knowledgeable about LGB identities involved understanding the impacts of minority stress and having a wide knowledge about the issues impacting LGB people. Demonstrating skilful practice involved willingness to discuss LGB specific issues, if relevant during therapy, and use visual cues of affirmation to create a safe space for LGB people. Professional developments, graduate training and learning through lived experience were found to increase service provider cultural competence. Results provide support for a three-component model of cultural competence (attitudes, knowledge and skills.)
A service provider’s ability to demonstrate cultural competence when working with LGB service users was found to influence the therapeutic process. Results from this thesis showed that service providers who demonstrate cultural competence are more like to develop rapport, meet the treatment needs and increase therapeutic gains for LGB service users. Recommendations are provided for service providers seeking to demonstrate cultural competence when working with LGB people.
| Date of Award | 2024 |
|---|---|
| Original language | English |
| Supervisor | Dimity Crisp (Supervisor), Brett SCHOLZ (Supervisor) & Janie Busby Grant (Supervisor) |