The Influence of Psychiatric Hospitalization on Mental Health Help-Seeking for LGBTQ People of Color

Abstract

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) may be uniquely impacted by psychiatric hospitalization and at greater risk of reporting perceived coercion, which is associated with increase suicide risk. This study examined the prevalence of perceived coercion in a sample of 133 LGBTQ POC who were psychiatrically hospitalized for suicidality and investigated whether perceived coercion predicts traumatic impact and future help-seeking intent using hierarchical linear regression models. Seventy-one percent of the sample reported perceived coercion and 29% of the sample reported no perceived coercion. Transgender and gender expansive (TGE) participants reported higher levels of perceived coercion than men. Perceived coercion independently significantly predicted traumatic impact and future help-seeking intent. Needs satisfaction and institutional betrayal each significantly predicted traumatic impact and future help-seeking intent when controlling for perceived coercion. Twenty-seven percent of participants encountered police involvement on their journey to hospitalization, 74% of whom reported a negative experience with the police. Clients who experienced police involvement were more likely to report lower needs satisfaction, greater institutional betrayal, greater traumatic impact, and lower future help-seeking intent. Medical and mental health providers, as well as administrators and staff, in inpatient psychiatric units can promote needs satisfaction through prioritizing patient autonomy, affirming patients’ strengths, demonstrating care and friendliness toward all patients, and cultivating social connection and peer support among patients. Institutions can prevent betrayal through LGBTQ+ affirming care practices and cultural competency training to avoid incidents of bias and discrimination. Prevention also includes publicizing patients’ rights, posting guidelines for behavior to promote an inclusive climate, and having highly visible methods to report bias and dissatisfaction with care. Institutions can also work to repair betrayal by incentivizing providers to solicit patient input in treatment, listen to patient feedback with empathy, apologize for missteps, and share additional steps patients can take for the institutions to address their grievances. Future research should investigate alternatives to hospitalization including non-police models of crisis response. Keywords: Inpatient Hospitalization, Perceived Coercion, LGBTQ, People of Color, Help-Seeking, Traumatic Impact, Institutional Betrayal, Needs Satisfaction, Police