To the Editor: The two reports by Willging and colleagues (1,2) in the June issue documented disparities in rural mental health services for sexual and gender minorities. However, the problem is more widespread. There is evidence that it is an endemic problem, not only a rural issue, in psychiatric treatment settings. For example, Lucksted (3) has documented that such disparities are far more generic than is realized. Moreover, in response to many of the same concerns that have now been documented in the rural setting, I have previously discussed the development of treatment services for persons from sexual minority groups who have mental illness and live in the heart of New York City (4,5). Institutional reforms are clearly needed at all levels of care no matter the population density.
Dr. Hellman is director of the LGBT Affirmative Program at South Beach Psychiatric Center, Staten Island, New York.