Maintaining mental health can be challenging for all rural folks, but especially for members of the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) community. One in five LGBTQ+ adults in the United States call a rural place home; one in ten in Canada. It is critical that as we work to address mental health challenges for rural residents, we pay special attention to those who identify as LGBTQ+. Resources to support these individuals should be accessible in all rural communities.
Our team at the University of Minnesota Rural Health Research Center wanted to understand more about the landscape of health – both physical and mental – for LGBTQ+ people in rural areas across the United States. Initially, we did this by exploring large national health datasets that contained measures of sexual orientation and gender identity as well as rurality. We examined several health outcomes, including depression and anxiety, and access to mental health care.
We found that rural lesbian, gay, and bisexual (LGB) adults had the highest rates of depression and anxiety compared to urban LGB adults and rural and urban heterosexual adults. They also had the highest rates of depressed feelings. These troubling findings are coupled with delays in access to mental health care for LGB adults. We also found that both rural and urban adults were more likely to have delayed mental health care in the past year due to cost.
In light of these bleak findings, it seemed more important than ever that rural LGBTQ+ residents get the help they need to maintain mental health and overall well-being. We hoped to learn more about how rural communities were supporting their LGBTQ+ residents, so we spoke with representatives of a range of organizations doing this work, highlighting success stories in a series of four different case studies.
One great example of this comes from rural Virginia, where the Pride of Rural Virginia aims to destigmatize the experience of health care for LGBTQ+ patients. They are doing this by providing an education and cultural humility training model for rural health care providers and clinic staff across the commonwealth. Access to high quality, inclusive, and affirming health care is important for everyone. Rural LGBTQ+ residents face additional barriers to accessing such care, and the more we improve access to it, the better the outcomes.
Another rural organization we learned was working to support local LGBTQ+ residents is Olympic Pride. Based in Port Townsend, Washington, Olympic Pride focuses on supporting LGBTQ+ youth mental health and well-being. They host a drop-by center that serves as an inclusive safe space for LGBTQ+ youth, and they recently helped local youth establish a gender spectrum club at the local high school. Rural organizations like these, even if they serve a small population, can have a tremendous impact in reducing stigma around the overlapping issues of mental health and sexual orientation/gender identity in rural areas.
LGBTQ+ rights and equality have increasingly taken center stage in both policy discussion and public discourse. This is a critically important step toward progress, but in order to meaningfully improve life for LGBTQ+ residents of rural communities, these conversations must be accompanied by community resources and policies that center rural LGBTQ+ individuals.
To accomplish this, data collection needs to encompass the intersections of identities – in other words, the multiple layers that make up who a person is. Data that measures rurality, sexual orientation, and gender identity at the same time is essential for further research and health policy intervention for this large, growing, and diverse population. In addition, policy that explicitly supports rural, LGBTQ+ communities is vital to curbing the homophobic and transphobic legislation increasingly being introduced and adopted across the United States. This type of legislation is limiting healthcare access for transgender individuals and discussion of sexual orientation in classrooms, both of which are already a challenge for LGBTQ+ populations.
Public policy must also be used to promote health and access to care for all rural individuals, especially given the growing inequities in health outcomes in the wake of the COVID-19 pandemic. Because rural and LGBTQ+ individuals are over-represented among uninsured/underinsured and Medicaid populations, polices that provide subsidies for rural health care providers and expand Medicaid in states that have not yet expanded eligibility could be particularly helpful. In addition, it is critical that policymakers enact non-discrimination protections for LGBTQ+ people and codify marriage equality into federal law. These actions will begin to address the mental and physical health disparities experienced by rural LGBTQ+ individuals.
Improving physical health, mental health, and overall well-being among LGBTQ+ individuals who live in rural communities is critical. Our research revealed the extent of the challenges faced by rural LGBTQ+ folks. The story it tells us is both disheartening and simultaneously full of encouragement. We found rural places across the entire United States full of affirming, open-hearted people supporting LGBTQ+ members within their local community in creative and powerful ways. We hope to see more rural communities seize opportunities to offer stigma-free support for LGBTQ+ individuals who call their community home.
Authors: Mariana Tuttle, Robert Libal, and Courtney Sarkin