Contextualising the guidance within contemporary empirical evidence

The unique mental health needs of LGBTQIA+ individuals emphasised within the Mental Health Commission guidance document is well supported by contemporary Irish research (Mental Health Commission 2025). The 2024 national study Being LGBTQI+ in Ireland (Higgins et al. Reference Higgins, Downes, O’Sullivan, de Vries, Molloy, Monahan, Keogh, Doyle, Begley and Corcoran2024) not only highlight rates of suicidality (self-harm, suicide thoughts, and suicide attempt) but reports escalation of mental health psychopathology within Irish LGBTQIA+ cohorts, with increases of 17% in reported symptoms of severe/extremely severe depression and 30% higher prevalence of severe/extremely severe symptoms of anxiety, compared to 2016 data. Notably, 60% had sought professional help for mental health problems, with many respondents in Being LGBTQI+ in Ireland identifying challenges in accessing timely mental health supports as well as expressed dissatisfaction with the hetero and cis-normative culture that permeates some mental health services. This may be understood to illustrate several issues-substantial gaps in service delivery, the heightened vulnerability of this population cohort, and the need for further guidance as services learn more about these concerns and lean into this disparity.

The 2022 Mental Health Reform publication, My LGBTI+ Voice Matters considered the experience of a substantial LGBTI+ cohort in Ireland: 22% reported experiencing a lack of adequate support from psychiatrists, with only 31% reporting experiencing treatment with dignity and respect in community mental health team settings (Mental Health Reform 2022). Whilst trends based on convenience samples warrant judicious interpretation and subgroups may be driving differential experiences within LGBTQIA+ it is noteworthy that Ireland lacks census-level national data on sexual orientation and gender identity. These collective reports, albeit with acknowledged methodological limitations, are in alignment with international literature, highlighting systemic challenges experienced by LGBTQIA+ people in accessing and receiving quality mental health care (Clark et al. Reference Clark, Jewell, Sherman, Balthazar, Murray and Bosse2021; Gonçalves et al. Reference Gonçalves, Waters, Quirk, Haddad, Lin, Williams and Yung2024). At a time when LGBTQI+ people’s rights are increasingly under threat internationally (Alibudbud Reference Alibudbud2025), the MHC guidelines embodies a rigorous, evidence-informed foundation for enhancing mental health service provision to LGBTQIA+ populations in Ireland in 2025.

Cultural competence and cultural humility

The MHC guidance appropriately focusses on interpersonal interactions, emphasising the importance of avoiding assumption and validating service users’ gender identities and sexual orientations through respectful use of names, pronouns, and identity acknowledgement. Affirming and inclusive care, is healthcare that holistically addresses the social, psychological, and physical health and well-being needs of LGBTQIA+ people, while respectfully affirming their sexual orientation and gender identity. It is an approach that calls upon healthcare providers and systems to incorporate expansive ways of thinking about sexual orientation and gender so that those who identify outside of heterosexual and cisgender normative scripts are not excluded from accessing appropriate healthcare. Voluminous research reports affirmative and inclusive practice as fundamental to facilitating therapeutic alliance, with the result of improving mental health outcomes (Meyer Reference Meyer2003; Pachankis Reference Pachankis2015). Affirmative practice is also a crucial component of trauma-informed care, as the invisibility or erasure of people’s identities can deeply harm self-esteem and make it difficult for individuals to feel safe or to trust practitioners or colleagues who fail to acknowledge their existence (Murphy and Higgins Reference Murphy, Higgins, Higgins, Kilkku and Kristofersson2022).

The suggestion of embedded ongoing cultural competence training that is underpinned by a cultural humility may be seen as a critical intervention point. Competence training must transcending superficial awareness, to engage deeply with the structural, cultural, and interpersonal barriers, including stigma, that shape the experience LGBTQIA+ individuals in accessing and receiving equitable mental health care (Yu et al. Reference Yu, Flores, Bonett and Bauermeister2023). This requires acknowledging the long and troubled history of LGBTQIA+ identities being pathologised in psychiatry, a legacy that continues to cast a shadow (Higgins et al. Reference Higgins, Downes, Murphy, Sharek, Begley, McCann, Sheerin, Smyth, De Vries and Doyle2021). While competence emphasises the acquisition of knowledge and skill, cultural humility shifts the focus towards ongoing reflection – moving from simply ‘knowing about the other’ towards understanding how our own sexual and gender identity and theoretical positions shape our assumptions, interactions and the practitioner client relationship.

Institutional policy and structural inclusion

The path to equitable mental health care not only rests on the individual practitioner awareness but must be embrace wider organisational reform The Guidance’s clear recommendation on LGBTQIA+ inclusive policies suggests an understanding of the need for systemic reforms. Anti-discrimination policies, confidentiality safeguards, and ongoing education, including the inclusive of non-clinical personnel in education programmes may be foundational to transforming services into affirming and inclusive environments. These suggested structural interventions align with frameworks advocating for inclusive and trauma-informed care approaches to eliminate structural stigma for LGBTQIA+ individuals accessing mental health services (Hatzenbuehler Reference Hatzenbuehler2014).

Community engagement and participatory approaches

In line with recovery approaches the MHC Guidance document notably highlights the significance of meaningful engagement with LGBTQIA+ communities to design, deliver, implement, and subsequently evaluate services and care. Again, this is consistent with international recommendations and with HSE policy in relation to co-production (Health Service Executive 2018). The need for census-level national data on sexual orientation and gender identity may be regarded as crucial, without which no sample in Ireland can be assumed representative with subsequent unidentified limitations on service planning. It is increasingly recognised that engagement with the people who will be impacted is paramount for developing culturally congruent services to respond effectively to community-identified needs (Israel et al. Reference Israel, Eng, Schulz and Parker2010).

Evaluation and quality improvement

Finally, the emphasis on monitoring and service evaluation within the Guidelines may be seen as fundamental to accountability and continuous quality improvement. Any interventions arising from the MHC Guidance, including training and visibility initiative, should be evaluated for effectiveness, ideally assessing impact on both immediate and longer-term practice. Possibilities of vulnerability within the cohort remain conceivable, hence some subgroups may feel excluded by targeted visibility markers which further underscores the need for careful evaluation. Systematic data collection of mixed methodology on access, satisfaction, and clinical outcomes further classified by sexual orientation and gender identity is essential to identify persistent inequities and guide further targeted interventions (Kcomt et al. Reference Kcomt, Gorey, Barrett and McCabe2020).