UCLA

Although there are population-based studies that find that sexual minorities are at increased risk for psychological distress and mental health disorders compared to heterosexuals, there have been few studies examining the way sexual minorities utilize mental health services within the U.S. health care system. With the reversal of the Defense of Marriage Act (DOMA) in 2013 and the Patient Protection and Affordable Care Act (PPACA), sexual minorities will have unprecedented access to health insurance coverage. The impact of this expanded coverage on mental health service utilization and cost is not known.

This dissertation examines sexual minority mental health service utilization over three studies and two data sets. The first two studies examined sexual minority mental health service utilization using two different national data sets over several years: the National Health and Nutrition Examination Surveys (NHANES) from 2001-2010 and the Medical Expenditure Panel Surveys (MEPS) from 1996-2010. The third study used the MEPS to examine differences in out-of-pocket and total expenditures between individuals in same-sex couples compared to individuals in different-sex couples.

This research found that sexual minorities were more likely to use mental health services compared to heterosexuals. In particular, sexual minorities were found to be primarily accessing this care in office-based visits and through psychopharmaceutical prescriptions. Despite this increase in access, sexual minorities were not more likely to receive minimally adequate care after initiating mental health services compared to heterosexuals. This increased utilization of care did translate into increased out-of-pocket mental health care expenditures and total mental health care expenditures for individuals in same-sex couples as compared to individuals in different-sex couples.

This dissertation found that sexual minorities are accessing and using mental health services differently than heterosexuals. With the enactment of PPACA and the reversal of DOMA, sexual minorities should have unprecedented access to mental health services. Due to the limited research in this area, it remains unclear if there will be enough access to culturally competent mental health providers and how this access will impact overall access to already-scarce mental health services. Sexual minority and health policy researchers will need to seek novel data sets to examine the impact of this increased utilization on both mental health outcomes as well as health care expenditures.