Health service experiences of LGBTQA plus adults in Australia with psychotic disorders, common mental disorders and physical health conditions: Findings from the Private Lives national survey

Background: Lesbian, gay, bisexual, transgender, queer or questioning, asexual or aromantic and more (LGBTQA+) populations face disparities in health outcomes, which are particularly pronounced in relation to mental health. While psychotic disorders are associated with added barriers to treatment, they are rarely included in conversations around improving healthcare for LGBTQA+ individuals. The present study compared the healthcare experiences reported by LGBTQA+ individuals with psychotic disorders, common mental disorders (anxiety and depressive disorders) and physical health conditions. Methods: A large online cross-sectional survey of LGBTQA+ adults in Australia was completed by 6835 individuals: 84 diagnosed with psychotic disorders, 521 diagnosed only with common mental disorders and 318 diagnosed only with common physical health conditions. Logistic regression analyses were used to investigate the association between diagnostic groups and health service access, service satisfaction and perceived respect for identity, and the importance of service LGBTQA+ inclusivity. Results: Compared to those with psychotic disorders and common mental disorders, participants with physical health conditions were more likely to access mainstream clinics that are not explicitly LGBTQA+ inclusive and demonstrated a trend towards lower importance of service LGBTQA+ inclusivity. Participants with psychosis reported lower levels of respect for gender identity in LGBTQA+ inclusive services than those with common mental disorders. Discussion: Differences in healthcare experiences between LGBTQA+ participants with physical health conditions, common mental disorders and psychotic disorders are present but not marked. Findings highlight a need for improved LGBTQA+ competencies in mainstream services and resource allocation to community-led services. Further research is needed to explore the factors contributing to worsened healthcare experiences for individuals with psychosis.