# Barriers and facilitators to addressing mental health needs among Asian, Black and Latin American men who have sex with men (MSM) in England and Wales: A qualitative study

## TL;DR

This study explores how cultural and social factors affect mental health service access for Asian, Black, and Latin American men who have sex with men in the UK.

## Contribution

The study identifies intersectional barriers and facilitators to mental health care for ethnic and sexual minority men in the UK.

## Key findings

- Hypermasculine norms and self-reliance shaped coping strategies for mental distress.
- Intersectional stigma and cultural norms restrict mental health service access.
- Private services are preferred but seen as financially inaccessible, worsening inequities.

## Abstract

Ethnic and sexual minority groups are underserved by mental health services globally despite having potentially greater need. This study aimed to explore how the intersections between sexual orientation and ethnicity shape mental health experiences and service access for Asian, Black and Latin American men who have sex with men (MSM) in the UK. This research was drawn from a qualitative sub-study of a larger HIV self-testing randomised controlled trial (SELPHI). Cis-gender Black, Asian and Latin American MSM who participated in SELPHI were recruited purposively to ensure sample diversity. Semi-structured interviews including a focused section on mental health were conducted between April and July 2020. A thematic framework approach was used to analyse the transcribed interview data. Twenty-nine participants were interviewed, comprising thirteen Black, eleven Asian and five Latin American MSM. The data were organised into three meta-themes exploring 1) Background, culture and upbringing, 2) Sexuality and manifestation of mental health issues, and 3) Barriers and facilitators to accessing mental health services. Childhood experiences of hypermasculine norms shaped the development of self-reliant coping strategies for mental distress. Peer support was protective of mental health, but alcohol, party drugs and chemsex could exacerbate feelings of isolation. Intersectional stigma restricted mental health service access, highlighting the need for culturally competent services. Previous use of mental health services and openness about mental health among social groups were facilitators to access. Private mental health services were often favoured due to perceptions of a superior quality of care and the speed of access, although participants recognised this as a financial barrier which further deepened structural inequities in access to mental healthcare. This study highlights the importance of multi-system and interdisciplinary interventions to facilitate discussions surrounding mental health within Asian, Black and Latin American MSM communities. In particular, services must be mindful of the barriers and facilitators faced by these groups when accessing mental health services, including norms linking self-reliance and masculinity.