For our second virtual journal club “meeting,” I chose the following article.  Unfortunately, what I do not have is a live link for this one.  I’m hoping that many here will have access through their academic or clinical institutions.

MacKay, J., Robinson, M., Pinder, S., & Ross, L. E. (2017). A grounded theory of bisexual individuals’ experiences of help seeking. American Journal Of Orthopsychiatry, 87(1), 52-61. doi:10.1037/ort0000184

As any work using grounded theory would, this has a lot to dig our teeth into!  I’ll give a bit of a summary here for those not able to access the full article.

The authors start with a discussion of mental health disparities of bisexual-identified individuals as compared with both heterosexual- and gay- or lesbian-identified individuals.  While acknowledging that the data are not as robust as might be ideal, the authors feel confident that this population’s experiences are distinct enough to merit exploration.  The authors also expressed a hope that, while the population chosen was bisexual people, that this could serve as a more general case study of help-seeking by a group impacted by minority stress (p. 52).

In their breakdown of participant demographics, the authors note that the orientation identities covered include, bisexual, fluid, pansexual, queer, and two-spirited (p. 54, table 1).  It’s interesting to note that while 20% of participants identified as First Nations, only 10% identified as two-spirited, an identity specific to First Nations and Native American people.

The authors framed help-seeking as a process, with the stages being “Consideration of Services,” “Finding Services,” and “Accessing Services” (pp. 55-56).  They then went on to analyze themes that emerged around factors that influenced participants’ choices and actions during these stages.

Many of the barriers to access discussed were general, such as the fact that non-biomedical care (i.e. therapy other than medication) required out-of-pocket payment and that the overall Mental Health Services (MHS) in Canada tend to treat medication as first-line treatment.  Finding practitioners with positive and accepting attitudes towards lesbian, gay, and bisexual (LGB) people was also identified as a barrier.  More bisexual-specific barriers included history of poor experiences with providers around their identity such as being told bisexuality does not exist (p. 56).

Facilitators to access also emerged, such as socioeconomic privilege, self-advocacy, and the existence of some resources specifically for locating affirming practitioners (pp. 57-58).  Unfortunately, these facilitators for some imply some of the same barriers for others (finances, availability of information on which practitioners are bisexual-accepting).

The authors acknowledge that negative anecdotes were prevalent in their findings.  For example, they note that the financial barriers led to delaying care until the symptoms being experienced became urgent.  They also noted the importance of social networks in facilitating locating LGB-positive providers.  Many participants reported their first experiences with MHS had been at university, where care was freely available, and the authors include in their implications a recommendation that Ontario MHS look at replicating that model to facilitate wider access (pp. 59-60).

Another implication and recommendation that will surprise no one here is to improve the curricula of mental health providers.  One sentence here stuck out to me in particular:  “It is important for service providers, even those that are affirming of nonheteronormative relationships, to be competent at working with individuals whose experiences and identities are difficult to categorize in binary terms” (p. 60).  In the previous article discussed, the focus was on people whose gender identity does not fit into “neat” binary categories.  Selecting these two articles back-to-back as both focusing on non-binary identities wasn’t planned, but is a happy coincidence.

What are your thoughts?  Do you find the process model of help-seeking the authors used to be helpful, or would you have taken a different approach?  What do you think of their idea that this (or any) specific minority group could be seen as a case study for minority groups in general?  What would you think are the key take-aways for nurses whose primary practice area is mental health, whether in Ontario where the study was or elsewhere?