In the extensive literature on the mental health treatment needs of minority populations, scant attention has been given to lesbian, gay, bisexual, and transgender (LGBT) persons, particularly those living in ethnically-diverse, rural areas. We propose a two year ethnographic project to examine the availability and use of mental health services for LGBT persons in New Mexico. New Mexico is one of the states with the highest percentages of Hispanic and Native American residents in the U.S. The demographic characteristics of New Mexico suggest that many LGBT persons possess multiple minority status and, thus, may be subject to varying forms of ethnic-based as well as LGBT-based prejudice and discrimination. The largely rural and economically depressed character of New Mexican communities may intensify social, financial, and psychological stress experienced by LGBT persons, and exacerbate the mental health needs of this ethnically diverse population. In spite of such powerful stressors and barriers to care, we expect that many LGBT persons in these settings have developed viable coping strategies that promote positive mental health. With the intent of better understanding the effect of rural living on the mental health needs of LGBT persons, we propose a study to conduct semi-structured interviews and participant observation among providers, LGBT community members, and LGBT patients in two rural counties and, as a comparison, two counties with metropolitan centers. Our three specific aims are: (1) To assess the ways that mental health providers serving rural and urban areas conceptualize (a) the diagnostic, treatment, and referral needs of LGBT persons and (b) the effect of personal bias and institutional barriers to care for LGBT persons. (2) To assess the ways that gender identity, gender role, sexual orientation, and varying forms of discrimination affect the experience of mental distress and illness among LGBT persons of African American, Anglo, Hispanic, and Native American descent. (3) To examine the help-seeking processes of rural and urban LGBT persons with mental health problems, documenting both barriers to care and LGBT strategies for overcoming impediments. The overall objective is to ensure the availability of culturally appropriate, quality care for those segments of the LGBT population that have limited access to or choice of mental health services. This objective will be achieved through the inclusion of LGBT persons in the design and execution of the proposed research. The results of this research will provide much needed information on both risk and protective factors specific to LGBT mental health, which is essential to the design of effective public health prevention, intervention, and direct care programs. This project also will lay the groundwork for a comprehensive research agenda targeting multiple minority status LGBT persons in the Southwest.