Addressing Mental Health Needs of Bisexual Clients

Cultural Competence in Nursing: Addressing Mental Health Needs of Bisexual Clients


Objective: Exploring cultural sensitivity in mental health nursing for bisexual clients.

Importance: Understanding unique challenges faced by bisexual individuals.

Scope: Assessment, Diagnosis, Planning, Implementation, Evaluation, Summary.

Focus on Bisexuality: Addressing often overlooked or misunderstood needs.

Integration of Cultural Aspects: Considering sexual orientation in mental health care.

Goal: Develop comprehensive, individualized care strategies.

Approach: Holistic, culturally aware, and patient-centered.

A 22 year old Hispanic female presents at a mental health facility diagnosed with anxiety and depression.

Assessment of a Bisexual Client

Appearance: A 22 year old Hispanic bisexual female. Skin tone within normal limit, grooming and attire appropriate

Behavior: Avoids eye contact, withdrawn, and fidgets with hands

Speech: Slow and quiet, no accent or speech impediment

Mood: Worsening anxiety for the last year

Affect: Restricted affect, only displaying nervous energy and high anxiety

Perception: Denies hallucinations or illusions. All other perceptions are intact

Thought: Denies suicidal or homicidal ideations. There is a potential risk for self harm.

Judgement: Judgement is good and intact

Insight: Aware of symptoms. Reports symptoms of palpitations, excessive sweating, difficulty focusing, especially in school, headaches and nervous tremors to hands. Reports family dynamic stressors based on family’s religious beliefs and values against sexual orientation

Cognition: Alert and orient to person, place and time. Regularly forgets instructions or tasks assigned to her. Reports inability to concentrate

NANDA Diagnoses for Bisexual Client

Risk for Other-Directed Violence related to societal stigma as evidenced by client’s expressed concerns about potential harm from others due to sexual orientation (Doenges et al., 2022).

Social isolation related to inadequate psychosocial support system as evidenced by client reported lack of familial beliefs/ values incongruent with client’s sexuality (Doenges et al., 2022)

Anxiety related to fear of rejection/discrimination as evidenced by client reported  palpitations, headaches, and observed nervous tremors.

SMART Goals for Bisexual Client

Objective 1: Anxiety Reduction – Aim for a 50% decrease in anxiety symptoms within six months, leveraging the GAD-7 scale for measurement.

Objective 2: Social Engagement – Facilitate engagement with supportive networks to enhance social support by the four-month mark.

Objective 3: Coping Mechanisms – Develop and implement improved coping strategies within three months, monitored through therapy session observations.

Objective 4: Self-Acceptance Growth – Target a significant decrease in internalized biphobia, aiming for increased self-acceptance in six months.

Cultural Sensitivity Commitment – Ensure a respectful and acknowledging approach towards the client’s bisexual identity in all therapeutic interventions.

Measuring Tools Defined – Utilize the GAD-7 scale, self-reports, and therapy session observations as primary tools for tracking progress (Bishop et al., 2022).

Realistic Goal Setting – Establish achievable, relevant, and time-bound objectives, tailored to the client’s unique context and needs.

Nursing Interventions for Bisexual Client

Creating Supportive Environment: Acknowledging and respecting sexual orientation.

Staff Education: Training on unique needs of bisexual individuals.

Tailored Care Planning: Considering client’s experiences and challenges (Varcarolis & Fosbre, 2020).

Therapeutic Approaches: Utilizing CBT for anxiety and stress.

Family Dynamics: Facilitating family therapy for improved support (Jimenez & Thal, 2020).

Resource Accessibility: Providing access to bisexual-specific resources.

Empathetic Care: Non-judgmental, culturally aware nursing practices.

Evaluating the Effectiveness of Interventions

Measuring Anxiety Reduction: Using HARS and GAD-7 scales (McNamara & Wilson, 2020).

Safety and Comfort: Regular assessments using Likert scale.

Social Interaction: Monitoring participation in social activities.

Qualitative Measures: Client feedback and satisfaction (McNamara & Wilson, 2020).

Staff Attitudes: Assessing changes pre and post educational interventions (Varcarolis & Fosbre, 2020).

Objective Parameters: Clear goals and timeframes for evaluation.

Continuous Monitoring: Adjusting care plan based on evaluations.

Broadening Perspectives in Mental Health Care for Bisexual Clients

Intersectionality: Addressing the interplay of sexual orientation with other identity aspects like race, age, gender, and socioeconomic status (McNamara & Wilson, 2020).

Policy and Advocacy: Importance of influencing health policy to support bisexual individuals’ rights and needs in mental health services.

Research and Education: Encouraging ongoing research into the unique mental health needs of bisexual individuals and integrating findings into educational programs.

Community Engagement: Strengthening partnerships with LGBTQ+ organizations and community groups for resource sharing and support (Jimenez & Thal, 2020).

Technology Integration: Utilizing digital tools and platforms for outreach, support, and tailored interventions for bisexual clients.

Ethical Considerations: Upholding ethical standards in treatment, confidentiality, and respect for the client’s personal and cultural background.

Summary of Interventions and Outcomes

Anxiety Reduction: Notable decrease in client’s anxiety levels.

Challenges: Addressing other-directed violence and social support.

Future Efforts: Community-based support and LGBTQ+ advocacy partnerships.

Ongoing Training: Essential for culturally competent care.

Client-Centered Care: Focus on individualized, culturally sensitive approaches (McNamara & Wilson, 2020).

Improvement Areas: Identifying and addressing gaps in care.

Overall Success: Positive impact on client’s mental health and well-being.


Comprehensive Care Approach: Successfully integrated cultural competence into mental health care for a bisexual client, ensuring a holistic, personalized treatment strategy.

Key Achievements: Notable reduction in anxiety levels and improved self-acceptance in the client, demonstrating the effectiveness of tailored interventions.

Challenges Addressed: Actively worked on mitigating risks of other-directed violence and improving the client’s social support network, though continuous efforts are needed.

Educational Impact: Enhanced staff awareness and understanding of bisexual-specific issues through targeted education and training, contributing to a more inclusive care environment.

Client-Centered Focus: Maintained a strong emphasis on respecting and valuing the client’s cultural identity, ensuring their needs and preferences were at the forefront of care planning.

Areas for Improvement: Identified the need for broader community engagement and stronger advocacy connections to better support bisexual individuals in a healthcare setting.

Future Directions: Recommended ongoing staff training in LGBTQ+ issues and the development of more comprehensive community-based support initiatives.


Bishop, J., Crisp, D. A., & Scholz, B. (2022). A systematic review to determine how service provider practices impact effective service provision to lesbian, gay and bisexual consumers in a mental health setting. Clinical Psychology & Psychotherapy, 29(3), 874-894.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2022). Nursing Diagnosis Manual (7th ed.). F. A. Davis Company.

Jimenez, R. R., & Thal, W. (2020). Culturally competent mental health care. Nursing made Incredibly Easy, 18(3), 46-49. DOI: 10.1097/01.NME.0000658224. 50056.fb.

McEwing, E. (2020). Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students. Nurse education today, 94, 104573.

McNamara, G., & Wilson, C. (2020). Lesbian, gay and bisexual individuals experience of mental health services- a systematic review. The Journal of Mental Health Training, Education and Practice, 15(2), 59-70. DOI:  10.1108/JMHTEP-09-2019- 0047