title: A lesbian, gay, bisexual and transgender dedicated inpatient psychiatric unit in rural New England: a descriptive analysis in demographics, service utilisation and needs.
abstract: OBJECTIVE
  To develop an understanding of lesbian-, gay-, bisexual-, transgender-specific mental health and substance abuse needs in rural populations and to improve data about sexual orientation and gender identity.
  
  
  BACKGROUND
  Existing literature on mental health needs for lesbian, gay, bisexual and transgender populations has continued to reveal higher levels of need. Research has also demonstrated that few mental health providers have expertise or comfort in treating lesbian, gay, bisexual and transgender clients.
  
  
  METHODS
  Descriptive correlational study.
  
  
  METHODS
  A sample (n = 456) of patient records admitted to a rural lesbian, gay, bisexual and transgender inpatient psychiatric clinic over 12 months were examined using descriptive statistics. Patient zip code information was used to determine the levels of rurality. Chi-square analysis was used to determine relationships between sexual orientation, rural/urban distinctions and concomitant drug use.
  
  
  RESULTS
  Unexpectedly, those who identified as heterosexual were significantly more likely to concomitantly abuse alcohol and heroin than those who identified as lesbian, gay, bisexual and transgender. Patients residing in small or isolated rural areas were more likely to abuse alcohol or synthetics than those residing in urban or micropolitan areas.
  
  
  CONCLUSIONS
  Results of this study concerning substance abuse among lesbian, gay, bisexual and transgender individuals are not reflective of prior studies. LGBT patients did not demonstrate a higher proportion of substance abuse compared with those identifying as heterosexual. Increased substance abuse among those from rural isolated areas does support prior studies. The context of gathering demographic information on sexual orientation was thought by staff to increase the number of those identifying as heterosexual.
  
  
  CONCLUSIONS
  Context in which sensitive questions are asked may affect the accuracy of demographic data. Lack of information regarding patients' sexual orientation or gender identity may impact perceived need for culturally competent care. Results suggest the need for efforts to provide training for mental health specialists in rural areas to provide sensitive care.
authors.affiliation: University of Massachusetts, Boston, MA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Klotzbaugh
authors.affiliation: University of Massachusetts, Boston, MA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Glover
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005783:Gender Identity; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009511:New England; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D000072339:Sexual and Gender Minorities / Q000523:psychology* / Q000706:statistics & numerical data; D019529:Sexuality / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*; D055815:Young Adult
keywords: bisexual; gay; lesbian; mental health; minority stress; rural; substance abuse; transgender