Exploring cultural knowledge in clinical work with LGBTQIA+ patients: A qualitative study of Italian mental health professionals

Background/Objectives: Individuals with marginalized sexual and gender identities experience mental health disparities arising from chronic minority stress and systemic barriers within healthcare settings. Mental health professionals occupy a central role in addressing these inequities; however, persistent deficits in professional preparation and cultural knowledge continue to undermine affirming, identity-inclusive care. This study explored the cultural knowledge of Italian mental health professionals regarding LGBTQIA+ health needs, focusing on how such knowledge is conceptualized, enacted, and constrained in clinical practice, using the Culturally Competent Compassion Model as a theoretical framework. Methods: A qualitative study was conducted using semi-structured interviews with 14 Italian mental health professionals (psychologists, psychotherapists, and psychiatrists), purposively selected from a broader qualitative dataset of 33 professionals based on clinical specialization in mental health. Data were analyzed using reflexive thematic analysis. Results: Four themes were identified: (1) training as absent structure; (2) knowing without knowing; (3) the paralysis of partial competence; and (4) stigma as institutional climate. Findings showed that professionals often rely on partial and informal knowledge, experience uncertainty in clinical interactions, and encounter difficulties in translating knowledge into practice. Participants demonstrated awareness of explicit and subtle forms of stigma affecting LGBTQIA+ individuals within healthcare settings. Conclusions: The findings highlight a gap between declarative awareness and self-reported preparedness for clinical practice, underscoring the need for structured training programs integrating theoretical knowledge and clinical skill development. Cultivating cultural knowledge and cultural humility among mental health professionals represents a systemic investment in reducing mental health inequities and improving affirming care for LGBTQIA+ populations.