Towards barrier-free counselling for sexual/gender minorities and sex workers in rural Tasmania

Aims: This paper combines a service review and proposed research and, thus, has two aims: to present a model of successful service delivery regarding the development of barrier-free counselling and to present the design of in-progress doctoral research that has been informed by this clinician’s practice. Sexual and gender minorities (SGMs) and sex workers (SWs) in rural or remote (R/R) Tasmania are the focus.

Clinical practice approach: Common barriers to accessing mental health services were identified in clinical practice through a service review that included observation and client consultation. Barriers were addressed and enablers enacted to support the biopsychosocial realities of marginalised people in R/R Tasmania. Support consists of inclusive, intersectional, sex-positive counselling; free/reduced-cost counselling; after-hours appointments; all-ages counselling; client-determined settings for service; and outreach support. Practice-based and anecdotal evidence suggested reductions in severity of mental ill health; alienation caused by stigma and minority stress; and likelihood of negative health indicators (excessive drug use, self-harm, suicide).

Doctoral research methods: The PhD, a nexus between practice and research, is occurring between March 2018 and March 2021. The research will follow a mixed-methods design that is commencing with systematic literature reviews on the barriers, uptakes, enablers of mental health and related services for SGMs and SWs. The focus will then narrow in on SGMs and SWs in R/R Tasmania, specifically, with an online survey and in-depth, one-on-one interviews. The publication of papers based on research findings as well as presentations to other counsellors and services will occur to promote barrier-reducing approaches to direct practice support.

Relevance: This approach will give marginalised people in R/R Tasmania a voice in the nature and direction of their mental-health care to improve outcomes and wellbeing. The research will generate vital data that is currently lacking on these populations in this region. It will also provide improvement opportunities for service providers and users alike through the development of health access standards.

Conclusion: Improving the mental health of SGMs and SWs in R/R Tasmania through access to barrier-free or barrier-reduced counselling has the potential to improve individual lives, lessen the burden of negative and compounding health impacts, and provide these populations with the inalienable human rights that have been restricted or denied.