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Gay and bisexual men across the U.S. face complex, often discouraging barriers when trying to find affordable, LGBTQ‑affirming mental health care, according to a new study by CUNY SPH researchers.
For this qualitative study, doctoral alumna Alexa D’Angelo, MPH alumna Rifa Ehsan, Associate Professor Emma Tsui, former Assistant Professor Naomi Zewde, and Distinguished Professor Christian Grov drew on in‑depth interviews with 24 gay and bisexual men from the national Together 5,000 cohort.
Participants described navigating insurance networks and provider directories as confusing, inaccurate, and emotionally draining, with long lists of “in‑network” therapists who were inaccurately listed or not accepting new patients.
Individuals also reported seeking LGBTQ-affirming care from therapists from the LGBTQ+ community, and from those who shared their racial or ethnic background—a challenge made more difficult by limited in-network options. Some even recounted harmful experiences with non‑affirming providers, including religious condemnation for being gay.
High copays, deductibles, and self‑pay fees led some men to reduce their frequency of care, or stop therapy altogether, even when care was still needed.
“Improving the accuracy and breadth of insurer directories and networks, funding LGBTQ‑affirming training, and expanding online matching tools for identity‑concordant providers could meaningfully increase access,” says Dr. D’Angelo.
The authors also recommend reducing treatment limits on talk therapy and scaling up integrated and campus‑based models that deliver culturally appropriate, affirming care for LGBTQ communities, particularly in a political climate marked by rising anti‑LGBTQ hostility.
