title: Brief reports: Unequal treatment: mental health care for sexual and gender minority groups in a rural state.
abstract: OBJECTIVE
  This qualitative study examined the social dynamics of communities and clinic settings that impede the delivery of culturally relevant services to lesbian, gay, bisexual, and transgender (LGBT) people living in rural areas.
  
  
  METHODS
  Ethnographic interviews were conducted with 20 providers in rural areas to document their perceptions of LGBT mental health care.
  
  
  RESULTS
  A majority of rural providers claimed that there is no difference between working with LGBT clients and non-LGBT clients. This neutral therapeutic posture may be insufficient when working with rural LGBT clients. Despite providers' claims of acceptance, lack of education about LGBT mental health issues, and homophobia influenced services for rural LGBT people. LGBT clients had been denied services, discouraged from broaching sexuality and gender issues by providers, and secluded within residential treatment settings.
  
  
  CONCLUSIONS
  The challenges of ensuring access to quality care for this population are magnified by provider discourses of "therapeutic neutrality."
authors.affiliation: Behavioral Health Research Center of the Southwest, 612 Encino Place, N.E., Albuquerque, New Mexico 87102, USA. cwillging@bhrcs.org
authors.forename: Cathleen E
authors.initials: CE
authors.lastname: Willging
authors.forename: Melina
authors.initials: M
authors.lastname: Salvador
authors.forename: Miria
authors.initials: M
authors.lastname: Kano
mesh_terms: D001727:Bisexuality; D005783:Gender Identity; D006716:Homosexuality; D006801:Humans; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D008913:Minority Groups; D009516:New Mexico; D011787:Quality of Health Care / Q000592:standards*; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D012935:Social Justice; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014189:Transsexualism