Rainbow experiences of accessing mental health support in Aotearoa New Zealand: A community-based mixed methods study
While we know that rainbow people in Aotearoa New Zealand (that is, people of diverse sexualities, genders, and sex characteristics) experience high rates of adverse mental health outcomes, we know much less about the extent to which Aotearoa’s rainbow community members are receiving the mental health support they need. To address this gap I used mixed methods and a reflexive community-based approach to extend current understandings of rainbow mental health support experiences, and to explore how the provision of mental health care can be improved for rainbow people in New Zealand. I first conducted interviews with 34 rainbow community young adults about their experiences of accessing mental health support. My thematic analysis showed that rainbow people across New Zealand faced significant structural barriers to accessing mental health support. Participants understood mental health settings as embedded within a heteronormative and cisnormative societal context, rather than as a safe place outside this context. This, together with a widespread silence from mental health professionals around rainbow identity, meant that participants actively negotiated coming out in mental health settings. Participants shared a variety of perspectives as to whether it should be standard practice for mental health professionals to ask about rainbow identities, but agreed on a number of subtle acts that could communicate a professional or service is rainbow-friendly. Knowledge about sexuality, gender, and sex characteristic diversity, together with clinical skills of empathy, validation, and affirmation, were described as key components for the provision of effective mental health support. I conducted a second thematic analysis of data from a subset of the initial interviews, in which 13 participants discussed their experiences of accessing gender-affirming healthcare. Participants reported a lack of funding for gender-affirming healthcare in New Zealand, and described its provision a “postcode lottery”; the care available was largely dependent on the region participants were living in. Mental health assessments for accessing gender-affirming care were often described as tests of whether participants were “really” transgender, and participants discussed the need to express their gender in a particular way in order to access the healthcare they needed. Thematic analyses of interview data informed the development of an online survey about rainbow peoples’ experiences of accessing mental health support and gender-affirming healthcare in New Zealand (n = 1575). Survey results closely reflected interview findings, indicating that rainbow people have mixed experiences in New Zealand’s mental health settings, and that accessing gender-affirming healthcare is a lengthy and convoluted process. Finally, interview and survey data were used to develop a resource for mental health professionals, to guide their work with rainbow clients. I sought and incorporated feedback from key stakeholders (n = 108) during resource development. I then distributed the resource to mental health professionals around New Zealand, both in print and online. Overall, my research shows that widespread knowledge gaps compromise the ability of New Zealand’s mental health professionals to provide culturally competent support to rainbow clients. Knowledge from this thesis can be used to increase awareness of rainbow community members’ mental health support needs, and to inform mental health professionals’ training and self-reflection around sexuality, gender, and sex characteristic diversity.