[NYAPRS Enews] NMHCSHC: Focus on LGBTQI Mental Health Consumers

[Harvey Rosenthal]

Focus on LGBTQI Mental Health Consumers

National Mental Health Consumers' Self-Help Clearinghouse  October 2010

http://www.mhselfhelp.org/pubs/view.php?publication_id=202

 

Listening to members of the LGBTQI (Lesbian Gay Bisexual Transgender
Questioning Intersex) community speak of their experiences in the public
mental health system can break your heart. A. Dionne Stallworth, a
Philadelphia activist for transgender rights, described the ordeal of
going into a psychiatric hospital to be treated for depression in the
1990s. First, she recalled, the professionals acted as if both her
depression and her gender identity were problems. Then, some of the
patients drew lots to decide who would have to be her roommate. 

Stallworth's story is emblematic of the treatment that individuals who
are lumped together in the LGBTQI alphabet soup have experienced in the
mental health system. Now, however, effective advocacy by LGBTQI
activists and other concerned citizens is resulting in changes, albeit
incremental, in both mental health policy and practice. 

 

THREE BROAD CATEGORIES

The LGBTQI community is divided into three broad categories. Sexual
minorities are people who define themselves as at-tracted to members of
the same gender or to both genders. Gender variant indi-viduals are
those who self-identify as not conforming to the conventions of male and
female behavior. Within the gender variant community are transgender
persons who live at least some of their lives as members of the opposite
gender; those who seek gender reassignment surgery form a subgroup. A
third broad category - intersex - comprises individu-als who are endowed
with physical, genetic, or biochemical features of both genders.
According to Alicia Lucksted, Ph.D., a professor at the Center for
Mental Health Services Research at the University of Maryland in
Baltimore, drawing a circle around all of these communities is a way of
pointing out the common issue of marginalization. 

Members of LGBTQI communities continue to face barriers to acces-sible
and appropriate mental health treatment. The biggest obstacle is the
fact that, until 1973, homosexuality was defined as a mental illness in
the American Psychiatric Association's Diagnostic and Statistical Manual
of Mental Disorders (DSM). In reaction, many gay people rejected
anything that suggested that they might experience mental illness,
according to Mark A. Davis, a longtime activist for LGBTQI individuals
with mental health condi-tions and the founding president of the
Pennsylvania Mental Health Consumers' 

Association. While the gay community neglected individuals among them
with such disorders, in the mental health system old prejudices against
the gay community continued to hold sway. 

The identification of homosexuality as a mental illness in the DSM "was
our Tuskegee," said Davis, referring to the infamous medical experiment
on non-consenting African-American men that resulted in an overarching
suspicion of the health care system within the African-American
com-munity. "Gay liberation and the mental health consumer/survivor
movement ran a thousand miles away from each other," said Davis, who
facilitates the Pink & Blues, a Philadelphia peer support group for
LGBTQI individuals in recovery from psychiatric disabilities. "I
couldn't be safely out as a gay man in the mental health community or
accepted as a person living with bipolar disorder in the gay community."


Even now, people in gender variant communities face the same dilemma
that gay people encountered until 1973, in that "gender identity
disorder" is still considered a psychiatric condition. (At this writing,
in the draft DSM-V, the proposal is to rename gender identity disorder
"gender incongruence.") However, transgender individuals challenge the
very idea of gender distinctions. Dividing people into two mutually
exclusive genders "is not the natural state," Stallworth said. "Gender
is on a continuum." 

Transgender individuals have a tougher time than the LGB community, she
continued. "LGB people can choose not to come out, [but] a trans person
is [immediately] visible," Stallworth said. "From the most basic thing,
everything is problematic." The core difficulty that the dominant (i.e.,
heterosexual) culture has with transgender people is more fundamental
than the DSM definition, Stallworth added. "People are bashed, not
because of their sexual orientation," but because they don't conform to
conventional gender roles, which scares many people, she said. 

 

OPPRESSIVE PRACTICES

These issues color all interactions that LGBTQI persons with psychiatric
disabilities have with their environ-ment, and translate into oppressive
practices in the public mental health system. Mental health line staff
disap-prove of sexual interaction among consumers in general, said
Lucksted, and often cannot address LGBTQI-specific issues. Staff can be
superfi-cially affirming but subtly homophobic and trans-phobic. For
example, when providers segregate residential units, shelters, shower
rooms and bathrooms according to gender, they assume that they are
preventing sexual expression and overlook the possibility that LGBTQI
consumers may be present. If sexual or gender minority individuals do
make themselves known, others may see them as predators toward
same-gender clients and staff. 

In addition, individuals who may not feel welcome in these settings may
feel unable to speak openly even when en-couraged to do so, as in group
therapy. Peer intolerance can make consumer-run groups seem unwelcoming,
and can place LGBTQI consumers living in inpatient or residential
facilities at grave risk of harassment and even assault. Further,
therapists and staff may view conforming to a heterosexual norm as
indicating recovery, while misinterpret-ing as pathology dressing and
acting in ways consistent with LGBTQI cultures. 

Staff may also misinterpret as psychiatric issues the social problems
that gay or gender variant consumers face. Like members of LGBTQI
communities in general, who are fearful of the reactions of others if
they reveal too much, LGBTQI individuals who are living with psychiatric
disabilities have to expend a great deal of energy managing the way they
present themselves. 

Compounding their difficulties, LGBTQI mental health consumers often
cannot count on emotional or financial sup-port from their own families
or social networks, and the AIDS epidemic has deprived many of peers.
Instead of understanding that such individuals face a twofold problem of
discrimina-tion and lack of social support, staff may attribute their
emotional distress about these social problems to their sexual or gender
identities. 

 

LAYERS OF BIAS

Individuals with psychiatric disabilities from LGBTQI communities who
are also racial and ethnic minorities report increased barriers to
recovery with each additional layer of minority identity. Because of
these cumulative layers of bias, many LGBTQI consumers from racial or
ethnic minorities are not working, are homeless, or may not access help,
said Renae Sewell, an African-American lesbian and executive director of
Hearts and Ears, a peer-run center in Baltimore for LGBTQI people with
mental illnesses. All too frequently, there may be no single "home base"
where individuals of multiple minority backgrounds can feel fully
accepted.

The special issues that confront members of LGBTQI communities who are
mental health consumers are not well documented, said Davis, because
researchers have neglected doing focused research on their welfare in
such areas as inpatient treatment, outpatient social service provision,
and vocational rehabilitation. For example, in 1999, Mental Health: A
Report of the Surgeon General, published by the U.S. Department of
Health and Human Services, contained no substantive discussion of LGBTQI
issues; and the report's supplement on culture, race, and ethnicity made
no mention of LGBTQI communities as a culture. 

One issue that has received attention from both the LGBTQI and mental
health communities is youth suicide prevention. According to Davis,
"There is a bias toward [creating programs for] people becoming suicidal
over coming-out issues." Such programs may not address mental health and
addiction concerns, "nor are there significant suicide prevention
initiatives for adults and older adults" from the LGBTQI community,
Davis said. The higher rate of suicide in the transgender community is
also not being addressed, added Stallworth.

Despite the barriers that LGBTQI individuals with psychiatric
disabilities face, remedies can be simple, said Lucksted. She challenges
organizations to ask themselves how to become more welcoming: "Think
about the little things." (See sidebar below)

 

HOW CONSUMER GROUPS CAN HELP: 

IDENTIFY local LGBTQI leaders who can offer trainings on how to be
LGBTQI-affirming. 

COOPERATE with the LGBTQI community on issues of mutual concern. 

START an LGBTQI support group. 

PARTICIPATE in a gay pride march. 

INCLUDE a clause in your group's non-discrimination policy stating that
your organization does not discriminate against sexual or gender
minorities. If your group does not have such a policy, develop one.

DISAVOW "conversion" therapies that seek to change individuals' sexual
or gender identities.

USE inclusive language, such as the word "partner" instead of "husband"
or "wife." 

REMEMBER that LGBTQI communities are cultures akin to cultures of race,
ethnicity, and religion.

DO NOT ASSUME that every LGBTQI individual has the same concerns; they
come from all segments of society. 

HIRE LGBTQI consumer staff members who are diverse in terms of age, race
and gender. 

DISPLAY LGBTQI literature (posters, magazines, newspapers and flyers) to
create a welcoming atmosphere.

INVITE the local gay press to cover your events, and advertise in gay
periodicals.

TRACK your group's progress in becoming more inclusive of LGBTQI
consumers. 

 

SOME PROGRESS

There has been progress. A 2005 study published in Psychotherapy:
Theory/Research/Practice/Training indicated that in 1991 only 5 percent
of mental health professionals maintained an LGBTQI-affirming
perspective in therapy; in 2005, 58 percent were affirming. In
Pennsylvania in 2009, an LGBT workgroup developed a series of
recommendations for the state's Office of Mental Health and Substance
Abuse Services (OMHSAS) to improve be-havioral health services to the
LGBTQI community; the recommendations were embraced by OMHSAS officials.
In Maryland, the statewide consumer-run organization, On Our Own, has
held a statewide conference on LGBTQI issues, and includes a workshop on
the subject at each of its annual conferences. An On Our Own affiliate,
the Office of Consumer Advocates in Hagerstown, has begun an LGBTQI
support group. Another, Lower Shore Friends, includes LGBTQI news in
every issue of its newsletter. Still another, the aforementioned Hearts
and Ears of Baltimore, works specifically with that city's LGBTQI
consumer population. 

In several other cities, leaders have established organizations
specifically for LGBTQI consumers. The Zappalorti Society in New York
City and the Pink and Blues in Philadelphia are examples. On a national
basis, Parents and Friends of Lesbians and Gays (PFLAG) has developed a
program for transgender youth; and the Trevor Project, a suicide
prevention program for LGBTQ youth, operates an around-the-clock crisis
and suicide prevention helpline. 

Numerous guides and toolkits are available on the Internet for
assistance in developing policies of inclusion and welcome. (See sidebar
on Page 3.) 

In ever-increasing numbers, LGBTQI consumers are demanding to be treated
with dignity and respect. "Being denied your identity is the ultimate
non-recovery," said Stallworth. "We are not really very exotic,"
concluded Lucksted. "We just need to feel welcome and respected, and
that we can speak about our lives."

GLBTQI Mental Health: Recommendations for Policies and Services
http://www.upennrrtc.org/var/tool/file/222-GLBTQI_MH_Recommendations_for
_Policies_and_Services-1.pdf

Enhancing Cultural Competence: Welcoming Lesbian, Gay, Bisexual, and
Transgender Clients in Mental Health Services
http://medschool.umaryland.edu/facultyresearchprofile/uploads/59eabd4ebe
674d01ae00ebfad157c442.pdf

Issues of Access to and Inclusion in Behavorial Health Services for
Lesbian, Gay, Bisexual, Trangender, Questioning and Intersex Consumers
http://www.parecovery.org/services_lgbtqi.shtml

A Mental Health Recovery and Community Integration Guide for GLBTQI
Individuals:What You Need to
Knowhttp://www.nami.org/Content/ContentGroups/Multicultural_Support1/Fac
t_Sheets1/GLBTQI_Recovery_Community_Integration_booklet.pdf 

GLBT Mental Health 

(800) 553-4KEY (4539) 

www.mhselfhelp.org <http://www.mhselfhelp.org>  

info at mhselfhelp.org <mailto:info at mhselfhelp.org>  

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