A Systematic Review and Lived Experience-Informed Thematic Synthesis of Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences in Mental Health and Substance Use Services

High rates of co-occurring mental health and substance use issues in the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) population are well documented; yet, no reviews exist that investigate LGBTQ+ peoples' heterogeneous and intersectional experiences in mental health and substance use services. To address this gap, this lived experience-informed systematic review examines the experiences, including intersectional experiences, of LGBTQ+ people in mental health and substance use services. A search of MEDLINE, CINAHL, PsycINFO, Scopus, Sociological Abstracts, and Embase was completed, and a thematic synthesis of 35 qualitative and mixed-methods studies was undertaken in partnership with LGBTQ+ people with a lived experience of mental health and/or substance use issues. Included studies highlighted inconsistent and negative experiences of LGBTQ+ people in mental health and/or substance use services. Negative experiences included general service stressors, which occurred irrespective of participants gender or sexuality; minority service stressors that were specific to LGBTQ+ people; and intersectional service stressors related to intersections of gender and sexuality with other social structures, including race and class. Review data also indicated that experiences in mental health and substance use services could have an ameliorating or exacerbating impact on mental health and substance use issues. Drawing on the analytical themes of the review, as well as existing research and intersectional minority stress theory, we propose a model of the impacts of societal and service stressors on LGBTQ+ people's mental health and substance use, which may serve as a framework for future research.