A decade of studies confirm that lesbian, gay, bisexual, and transgender (LGBT) people suffer disproportionately from mental health and substance use problems in comparison to their heterosexual counterparts. The higher prevalence of disorders within this population is most reasonably explained by minority stress, referring here to stigma, prejudice, discrimination, and violence toward socially disadvantaged groups. Our previous formative research in the rural and multi-ethnic state of New Mexico suggests that professional providers frequently fail to recognize how the experience of minority stress affects rural LGBT people and are often ill-prepared to provide quality services to this population. Rural LGBT people, particularly those who are isolated from supportive social networks, have few LGBT-specific resources to draw from when in need of assistance for mental health and substance use problems. We propose the use of well-trained peer advocates as a creative response to this situation. The advocates will perform several vital functions in rural areas: reduction of social contextual factors associated with minority stress that can adversely affect wellbeing and service utilization among LGBT people;outreach to professional providers and others;and cultivation of LGBT social support. The day-to-day work of the advocates will be informed by an empowerment protocol that specifies the general range of community-based activities they will engage in to provide assistance to rural LGBT help seekers. To obtain the knowledge and skills needed to effectively implement this protocol, peer advocates will take part in didactic and interactive training exercises that are to be evaluated and refined in the course of this research. This study has three aims: (1) Develop the empowerment protocol, coaching manual, and peer advocate support system;(2) Design and implement a training curriculum to prepare individuals to serve as peer advocates;(3) Conduct a pilot test of the empowerment protocol that will yield preliminary qualitative and quantitative data on feasibility, acceptability, and impacts on treatment access and utilization and social support for LGBT help seekers. In pursuit of all three aims, we will evaluate procedures to recruit and retain peer advocates and LGBT help seekers both members of a widely dispersed, rural population in intervention research. Data generated from this multi-method study will also be used to improve utility of the protocol and refine the training curriculum. Most importantly, these essential data will comprise the groundwork for a broader scale effectiveness trial of a promising intervention for an underserved and understudied population. To our knowledge, there are no similar interventions tailored for rural sexual and gender minorities, even though such individuals face significant mental health disparities.

Public Health Relevance

Lesbian, gay, bisexual, and transgender (LGBT) persons living in rural areas of the U.S. face tremendous challenges in accessing appropriate treatment and social support for mental illness and substance use disorders. Building upon our formative research, we will design, implement, and evaluate a data- and theory driven intervention that will address these challenges within the predominantly rural state of New Mexico. This will be accomplished by developing an educational curriculum to educate peer advocates in LGBT mental health and substance use issues, who will then help empower LGBT people in rural communities to proactively address social contextual factors that affect their use of LGBT-affirmative treatment and social support.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Mental Health Services in Non-Specialty Settings (SRNS)
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Juliano-Bult, Denise M
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Pacific Institute for Research and Evaluation
United States
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Willging, Cathleen E; Harkness, Audrey; Israel, Tania et al. (2018) A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities. Community Ment Health J 54:395-409
Israel, Tania; Willging, Cathleen; Ley, David (2016) Development and Evaluation of Training for Rural LGBTQ Mental Health Peer Advocates. Rural Ment Health 40:40-62
Willging, Cathleen E; Israel, Tania; Ley, David et al. (2016) Coaching mental health peer advocates for rural LGBTQ people. J Gay Lesbian Ment Health 20:214-236