‘You Get the Feeling That They Don’t Really Get it’: LGBTQ+ Young People's Experiences with Mental Health Services

Although the heightened risk of LGBTQ+ young people encountering mental health challenges has been demonstrated in various studies (Rees et al., 2021), relatively few have qualitatively explored their experiences with mental health services (MHS). Furthermore, while minority stress theory (Meyer, 2003) is widely used as a framework for making sense of the nature and depth of LGBTQ+ young people's mental distress, its application is not always accompanied by theoretical engagement with underlying macro-level systems of oppression. This reflects the relative lack of engagement in queer psychology with decolonial and intersectional perspectives, as seen in extant studies’ continued emphasis on data and narratives about Western, White, cisgender, LGB, middle- or upper to middle-class, highly educated, nondisabled people (Freeman-Coppadge & Langroudi, 2021).

In this article, we build on and contribute to recent efforts in critical psychology (e.g., Ferguson, 2021; Metzger et al., 2023) to understand the interlinkages between experiences of mental distress and discrimination in MHS among minoritised people, and structural inequalities shaped by the sociopolitical context. We complement minority stress theory with insights from intersectional theorisation to analyse LGBTQ+ young people's experiences with MHS, aiming to shed light on current challenges and discriminatory patterns in MHS provision, as well as opportunities to develop such services to better cater to the needs of minoritised young people.

Experiences of LGBTQ+ Young People With MHS, Minority Stress and Intersectionality

As mentioned above, qualitative research on the experiences of LGBTQ+ young people with MHS is fairly sparse, reflecting a wider gap in studies on LGBTQ+ young people's own views and experiences (Metzger et al., 2023). In a study focusing specifically on LGBTQ+ young people and MHS in the UK, McDermott et al. (2024) showed that they often refrain from using MHS due to poor previous experiences, including a lack of understanding of intersectionality in LGBTQ+ lives. A review of qualitative studies by Rees et al. (2021; not focused solely on young people), conducted to identify mental health needs in LGBTQ+ communities and their experiences of accessing mental healthcare, corroborated these findings. The review showed that LGBTQ+ clients had not only been pathologised and undertreated for their primary mental health problems, resulting in experiences of helplessness and vulnerability, but they also felt that practitioners imposed their knowledge during these encounters. Quantitative and mixed methods studies with adults (e.g., McCann & Sharek, 2014) and youth (Fraser et al., 2022) have supported these findings by showing that LGBTQ+ people highlight practitioners’ lack of knowledge, and thus the need for increased education across varied geographical locations.

Our study makes a valuable contribution to this underresearched field by shedding light on LGBTQ+ young people's experiences with MHS through qualitative, collaboratively produced focus group discussions, which provided in-depth knowledge of the lived inequalities that shape LGBTQ+ young people's MHS encounters. Theoretically, our work has been guided, firstly, by the conceptualisation of cisheteronormativity. Stemming from queer theory, cisheteronormativity enables an understanding of how bodies become intelligible only in relation to a set of norms that favour an idealised White, cisheterosexual, middle-class, young, able and successful body (Riggs & Treharne, 2017). Secondly, we draw on minority stress theory, a widely used conceptual framework designed to explain mental health differences between LGBTQ+ and heterosexual people, later extended to understanding differences between transgender and cisgender people (Meyer, 2003; Velez et al., 2021). Minority stress theory operates on two foundational principles: it acknowledges that prejudice and stigma targeted at LGBTQ+ individuals create distinct stressors, and recognises that these stressors contribute to negative health consequences, encompassing both mental and physical distress (Frost et al., 2015). Therefore, the minority stress model elucidates how environmental factors, particularly those linked to stigma and prejudice, can generate stressors that persist throughout the lives of LGBTQ+ individuals and thus contribute to the higher prevalence of mental health issues among LGBTQ+ individuals compared to heterosexual and cisgender people (Meyer, 2015; Velez et al., 2021).

Meyer (2003) outlined four processes of minority stress: (a) experiences of discrimination, including differential treatment, derogation, harassment or victimisation based on one's sexual or gender minority identity; (b) anticipation of rejection, where individuals expect to encounter discrimination, leading to heightened vigilance; (c) internalised heterosexism or transphobia, referring to the acceptance of negative attitudes or beliefs about LGBTQ+ identities; and (d) identity concealment, which involves the stress associated with deciding whether to reveal one's sexual or gender identity. Integral to the minority stress model is the idea that these processes shape each other cyclically. Therefore, the theory illuminates how cumulative negative experiences with mental health and other services can have increasingly dire consequences, including deepened mental distress and potentially a pattern of refraining from help-seeking.

While the minority stress model is crucial for understanding the specific stressors faced by gender- and sexuality-minoritised people, it must be complemented with an intersectional lens to fully grasp their life experiences and to more robustly consider the structural determinants of discrimination experiences, including within mental health counselling contexts (McDermott et al., 2024; Moradi & Grzanka, 2017; Tan et al., 2020). Intersectional theorisation originates from Black feminists’ efforts to understand the particularities of Black women's experiences in the United States (US) at the intersections of racism and sexism (e.g., Crenshaw, 1989). It has since expanded into a variety of applications, with different emphases in different geographical locations. Intersectionality is a theoretical framework, perspective and praxis that shifts the focus away from ‘single axis’ thinking (such as attending exclusively to race, gender or sexuality) towards a ‘matrix’ perspective that underscores the inseparability of systems of oppression and privilege – such as cisheterosexism, racism and capitalism – in shaping people's possibilities in life (Collins, 2019).

As intersectionality is increasingly applied to an ever-expanding array of intersections and in studies with broadly varied background assumptions, concerns have been raised that such applications may erase its rootedness in Black women's experiences. Bilge (2020), for instance, has emphasised the importance of ensuring that intersectionality travels ‘with Black women’, and has contended that ‘a racialized habitus is not an optional but a constitutive component of intersectionality’ (2020, p. 2310). Others, such as Jennifer Nash (2019), have emphasised the benefits of intersectionality's expanding usage, suggesting that it should ‘move with figures beyond “Black woman”’ (2019, p. 104). Regardless of differences in viewpoints, there is broad agreement on the risks of erasing the experiences and viewpoints of Black women as the basis for intersectional theorisation. Therefore, as White, highly educated researchers residing in a Western European country, we find it important to reflect on how to draw on intersectionality in a responsible manner that seeks to avoid its negligent appropriation and distortion (Moradi & Grzanka, 2017). In this article, using data from focus groups with LGBTQ+ young people, we foreground cisheteronormativity while paying somewhat less attention to other systems of oppression such as racism. However, our analysis shows that cisheteronormativity does not shape our participants’ experiences in isolation from other systems of oppression, but rather co-operates with them in creating a sense of otherness and exclusion. Furthermore, the analysis shows that intersectionality served as an important tool for participants to make sense of their experiences of discrimination and of services’ lack of attentiveness to structural inequalities and lived differences.

Patricia Hill Collin's (2019) intersectional theorisation on the interlinkages between experience, knowledge and social action holds particular significance for us, also regarding the epistemological and ontological assumptions that drive our inquiry. Collins (2019) has foregrounded the importance of both experience and social action for critical theorising and, by extension, for epistemology. As she states, since ‘experiences occur in the social world, they are windows to that world’ (2019, p. 13). Oppositional knowledge based on experiences of oppression is central in Collins's thought for achieving social change. For us, these notions form an important basis for attending to minoritised young people's own understandings of MHS and the best ways to make them more inclusive. More specifically, they help us consider how young people's resistant knowledge can disrupt patterns of minoritisation in MHS and the knowledge practices of practitioners. Accordingly, our analysis seeks to answer these research questions: 1. How do LGBTQ+ young people make sense of their experiences with MHS? 2. What kind of patterns of exclusion do they identify? 3. How do they envision inclusivity in these services?

Materials and Methods

Analysis

The themes are presented in Table 1 along with their corresponding subthemes. We discuss each theme in a separate subsection.

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Table 1.

Themes and Subthemes.

Themes	Subthemes
Expectations: Minority stress and (in)accessibility	Knowledge hierarchies Uncertainty due to inequalities
Experiences: MHS are incompetent for minoritised people	The discriminatory burden of ignorance Stigmatisation due to insensitivity
Outcomes: MHS generate counterproductive outcomes	Deepened distress Harmful coping mechanisms
Demands: With collective care towards safer spaces	Validation (as the bare minimum) Valuing diversity

Note. MHS = mental health services.

Demands: Collective Care Towards Safer Spaces

The participants repeatedly emphasised the urgent need for systemic change within MHS to address intersecting forms of discrimination and to provide equitable and inclusive care. They did so in an assured manner that stressed the LGBTQ+ community's right to care that meets their needs. Hence, we labelled our fourth theme ‘Demands: Collective care towards safer spaces’. Actions aimed at resisting and challenging oppression have been identified in previous research as effective strategies for coping with minority stress. For instance, sexually diverse individuals who recognise that they are not solely responsible for dismantling oppression tend to cope better with minority stress, suggesting the importance of self-care (Noyola et al., 2020). Self-care can also be understood as an element of collective care, as recognising and communicating one's needs enables communicative relationships that help healing (Tervalon & Murray-García, 1998). We therefore interpret the participants’ demands for systemic transformation as expressions of both self-care and collective care, each of which plays a crucial role in helping to maintain individual and collective mental well-being.

The emphasis on the collective dimension of mental well-being became evident in the importance participants placed on supportive peer networks for preserving mental well-being. They highlighted the unique advantages of peer-led support groups, contrasting them favourably with interventions led by adults, who were characterised as ‘moralising’ and out of touch with young people's experiences in their efforts to ‘talk to young people about young people's issues’ (P3, FG2). As in the ‘Expectations’ theme, an intersectional divide connecting age with queerness and mental health was also clearly present here. For the participants, peer-led support groups offered an antidote to older practitioners’ ignorance and the knowledge hierarchies they perpetuated. However, despite the emphasis on peer support as a means of being understood and heard, participants also acknowledged that simply by actively listening and respecting clients’ experiences and identities, practitioners can also create affirming and supportive spaces in one-on-one encounters.

The first subtheme of the ‘Demands’ theme is ‘Validation (as the bare minimum)’, which is based on participants’ emphasis on practitioners’ capacity to listen respectfully and thus validate LGBTQ+ young people's experiences. Queer and trans people often experience challenges in having their distress acknowledged, resulting in invalidation of both their distress and their identity (Cowie & Braun, 2022). For the participants in our study, validation did not necessarily require much: they discussed incorporating safer space principles, putting effort into building trust or simply refraining from voicing prejudiced assumptions:

P3: Yeah, but overall, if a therapist doesn’t know much about a topic, especially if the patient belongs to a minority, I don’t think they should be like, ‘Well, I can’t help you’, but rather, they could do a little work, like googling. Because, you know, they don’t need to know everything right away when listening. Listening with acceptance is already a good start, and not many people necessarily know how to do that.

Participants discussed this need for investment with an intersectional sensitivity to diversity in experiences shaped by multiple forms of discrimination and marginalisation. For instance, in FG1, P4 stated that an intersectional approach to interventions is ‘really important’ because mental health interventions are too often ‘focused on the resources of the individual’. Here, intersectionality signifies a departure from individualism towards an awareness of lived differences and inequalities.

In calling for intersectional sensitivity, participants underscored the importance of therapists possessing cultural competence, particularly regarding marginalisation shaped by racialisation and cisheteronormativity. Their suggested approach is akin to what has been termed cultural humility, wherein mental health practitioners adopt an ‘other-oriented interpersonal stance’ to avoid making assumptions about clients’ cultural identities and their significance (Hook et al., 2013). Embracing cultural humility entails a commitment to continuous learning, self-reflection and the mitigation of traditional power differentials between therapists, clients, colleagues and communities (Metzger et al., 2023).

This connects to participants’ argument that the therapist's primary goal should be to offer support, rather than to assume an authoritarian stance of knowing everything and unilaterally providing solutions. To this end, they advocated a more collaborative and connected approach between therapist and client, where the therapist acknowledges their own fallibility and works alongside the client towards shared goals. Valuing diversity appears integral to this perspective. For instance, P1 stated that, in the end, people want to be seen and heard, and framed this as a basic need of all human beings. Their accompanying suggestion is that the diversity of human beings should be a factor in enabling people to get the help they need:

Yeah, and then there's the fact that, in all their diversity, people are ultimately the same; in the end, everyone just wants to be seen and heard and so on, so ignoring differences somehow removes a basic human dimension. So that's what I think we should ultimately aim for, to ensure that the differences don’t prevent you from getting help, but maybe even become an enabling factor [in getting help]. (P1, FG1)

Conclusions

Our analysis demonstrated that the experiences of LGBTQ+ young people with MHS in Finland reveal several shortcomings in the services’ ability to meet their needs. Similar to previous research (McDermott et al., 2024; Rees et al., 2021), the analysis shed light on the vicious cycle of minority stress and how previous bad experiences with MHS may result in a reluctance to seek help and thereby exacerbate LGBTQ+ youth's mental health concerns. Minority stress theory thus serves as a helpful tool for understanding the connections between participants’ previous experiences, expectations and the outcomes of poor encounters with MHS. Furthermore, our analysis shows the entanglement of intersecting societal, systemic issues with individual everyday experiences. The influence of cisheteronormativity and other intersecting systems of oppression such as racism (see also e.g., Metzger et al., 2023) turns MHS encounters into poor ones through discriminatory and stigmatising preassumptions, a lack of knowledge, the discrediting of minoritised knowledge and a lack of respect for diversity.

What our study specifically adds to existing literature is a close consideration of youth's voices and the critique of MHS they formulated in their own terms. This critique had a hopeful and agentic tone: far from seeing successful mental health encounters as an impossibility, they suggested various measures to enhance the capacity of MHS to meet the needs of LGBTQ+ young people. In alignment with recommendations made in previous studies (e.g., Czimbalmos & Rask, 2022; McDermott et al., 2024), participants specifically highlighted the importance of reflexive attentiveness to minoritised youth's own concerns and self-definitions, and pointed out that by simply listening and adopting a humble and respectful attitude, practitioners can go a long way in providing LGBTQ+ youth with validation. The participants’ recommendations also extended to addressing the structural inequalities and inadequate resourcing of MHS. Here, in particular, the conceptual tools guiding our inquiry as researchers, such as intersectionality and cisheteronormativity, also emerged as tools for the participants themselves, helping to bridge potential differences in our viewpoints. Our peer-led focus group design allowed us to ground the use of these tools in participants’ lived experiences, thereby ensuring a close fit between the conceptual tools and the participants' lived experiences and viewpoints.

While our study is limited in scope, it yielded rich data that offer valuable insights into LGBTQ+ young people's experiences with MHS in Finland. The so-called youth mental health crisis in Finland has not been adequately addressed with due consideration of systemic inequalities in service accessibility or the impact of austerity and mental health policies on health disparities (Kurki & Rask, 2025). This is despite the increasing recognition in recent years of health disparities and the impact of systemic discrimination on mental health service provision. For example, in 2023, the Finnish Ministry of Social Affairs and Health published recommendations for identifying and reducing stigma and discrimination related to mental health, along with substance abuse problems and addiction, with the overarching aims of ensuring equal access to public services and fostering cultural diversity (Strand et al., 2023). Our findings suggest that further efforts are needed to enhance inclusivity in MHS, with specific attention paid to the perspectives and needs of LGBTQ+ young people.

It is worth noting that our participants constitute a rather select group of LGBTQ+ young people – those who were comfortable speaking in a group about sensitive issues such as mental health, well-versed in queer feminism and intersectional perspectives and highly educated. While participants’ LGBTQ+ identities were somewhat diverse, none identified as gay boy, for instance. Therefore, various intersectional experiences and perspectives may be missing from our study, including those of young people for whom talking about MHS is too difficult, and for whom the services might appear even less accessible. Had their perspectives been included, the picture painted by the findings on MHS and youth mental health might have been even bleaker.

Our analysis provides further support for the claim made in previous literature (e.g., McDermott et al., 2024; Noyola et al., 2020) that intersectional sensitivity is a key route to considering the specific features of LGBTQ+ young people's experiences and circumstances. Such an approach enables a move beyond surface-level treatments to address the underlying issues that contribute to mental health challenges (Cowie & Braun, 2022). While MHS play a crucial role in alleviating the mental distress of LGBTQ+ young people, they are no substitute for a structural transformation that challenges cisheteronormativity, racism and ableism, among other systems of inequality, on a broader scale (Mereish & Taylor, 2021; Stojanovski et al., 2022). The issues we have identified are rooted in societal inequalities perpetuated by inadequate social policies, cuts to social and healthcare funding and gaps in legislation. A sustainable transformation therefore requires addressing harmful patterns at various levels, from societal discourse and policies to the education of future practitioners. In sum, our analysis suggests the need to (a) develop practitioner training in gender, sexual and cultural diversity and antiracism, (b) address implicit biases and enhance reflexivity to improve the therapeutic alliance and (c) cultivate collective care practices in mental health interventions.