2SLGBTQ+ individuals may delay or avoid seeking services because of their experiences of past discrimination or perceived homophobia in the health care system. Because 2SLGBTQ+ immigrants and refugees may have come to expect rejection in their lives, it may be helpful for providers to build an accepting, empowering and compassionate relationship with clients (Kahn et al., 2017).

Awareness of a client's sexual orientation and gender identity is key to providing effective service. Some mental health concerns may be related to sexual orientation and/or gender identity issues, particularly those aspects linked to stigma, isolation, harassment and discrimination—all problems that are compounded for those who also have refugee status. However, 2SLGBTQ+ newcomers are often uncomfortable coming out about their gender and sexual identities when accessing services, and clinicians may be uncomfortable asking questions that would help clients disclose such information (Logie et al, 2016). As a result, these clients are often poorly served, with adverse consequences for their health.

Some 2SLGBTQ+ clients may not want to disclose their sexual orientation with their health care provider as it might be something they don't see as important in identifying with the provider. However, they may still feel comfortable in the provider's presence.

In clinical practice, it may be helpful for mental health professionals to become familiar with the client's country of origin before meeting with the client to consider cultural or social conditions that might have affected the individual (Burnett & Peel, 2001). The use of a trauma-informed approach may be helpful in facilitating clients' need for safety while recognizing their sources of resilience (Elliott et al., 2005).