Background LGBTQ+ young adults experience disproportionately higher rates of mental health disorders and homelessness related to family and community rejection. A nonprofit organization providing emergency shelter for LGBTQ+ individuals aged 18-24 was partnered with, to address mental health literacy through educational interventions. The objective of this study was to assess mental health and barriers to accessing mental health care to better understand and meet the mental health needs of this population.

Methods Four LGBTQ+ identifying individuals experiencing homelessness were interviewed after participating in a single-session mental health education intervention. Interviewees were asked a series of open-ended questions regarding their mental health experiences, their LGBTQ+ identity, and their healthcare experiences. All interviews were recorded, transcribed, and coded individually using RAPID Analysis Process. Codes were analyzed as a group using a grounded theory approach.

Results Participants cited that their mental health was impacted by their situation, the people around them, and a lack of access to healthcare. Participants stated that their LGBTQ+ identity contributed to feelings of isolation, difficulty trusting others, sexualization and sexual assault, and poor mental health due to interpersonal and systemic homophobia and transphobia. Three participants stated that they found it difficult to discuss their mental health with others. When asked about their relationship with healthcare systems, participants discussed cultural stigma against LGBTQ+ individuals in healthcare settings, a desire for gender-affirming interactions in healthcare, and a hope for a change in perspective amongst a new generation of healthcare providers. Participants stated that the mental health interventions provided tools in mindfulness, communication, and emotional regulation, and fostered community with their peers.

Conclusion Investigating the intersection of mental health and LGBTQ+ identity showed that personal discrimination from family and friends, systemic transphobia, isolation, and sexualization and sexual assault due to gender identity all contributed negatively to participants’ mental health. Participants’ lack of comfort with reaching out to others for help with their mental health puts this community in a dangerous intersection of heightened mental health stressors and decreased social support. Additionally, participants’ responses indicate a lack of access to general, mental, and gender-affirming healthcare for this community. Increasing access to affordable and consistent care, as well as ensuring gender-affirming and culturally competent interactions in healthcare settings, will help this population better meet their health needs. Conducting interactive mental health educational interventions may further help this population connect with potential support systems and learn tools for managing mental wellness.