To paraphrase Tolstoy: happy clients are all alike – but unhappy clients are each unhappy in their own way. However, as the recovery movement gains ground, providers are finding that clients can have a bewilderingly diverse array of ideas about what would make them happy.
These days, clients can, and often do, express recovery goals that include education, work, love, and relationships, in all their rich variety. Care providers are now allies and supports for a vastly broadened horizon of possibilities.
This new widening of the horizons can sometimes make care providers feel unequipped to support the range of goals and objectives that their clients are now asking for help with. What if a mental health consumer asks a care provider for help with finding a same-sex partner to date and settle down with? What if clients ask for supportive resources to explore their gender identities? Care providers want to help, but they may be uncertain about how, exactly, to move forward with these challenges. They may also feel confused when clients ask for help in moving toward recovery goals that either used to be pathologized in the DSM (such as same-sex relationships) or still are (such as the exploration of gender identities that don’t conform to the gender the client was assigned on the day they were born).
That’s why, several years ago, Rainbow Heights Club developed a training program for mainstream care providers. Care providers don’t have to be LGBT (lesbian, gay, bisexual or transgender) to be effective and affirming with LGBT clients. They just need some basic information, and a commitment to do this work. Rainbow Heights Club’s cultural competency training program sets out to give care providers the tools they need to be effective with all the clients they serve.
We know (based on data from the annual Community Health Survey conducted by the New York City Department of Health and Mental Hygiene) that between 5% and 10% of New Yorkers have same-sex sexual relationships. These figures don’t include LGBT people who are celibate, as many people living with serious and persistent mental illness choose to be. The numbers also don’t include people who identify themselves as transgender, or who don’t conform to stereotypical experiences or expressions of their gender identity. (Unfortunately, research with this population is still in its early phases, and it’s impossible to make accurate estimates of prevalence at this time. However, one-third of Rainbow Heights Club’s active client base is transgender or gender non-conforming, which indicates that for many people, affirmation of their gender identity can be an extremely salient part of their mental health recovery process.)
Rainbow Heights Club is a publicly funded psychosocial support and advocacy agency specifically serving lesbian, gay, bisexual and transgender people who are living with serious and persistent mental illness. We are located in downtown Brooklyn, and we provide services to clients living in all five boroughs. We’ve been providing our services entirely free of charge since we opened in 2002, and we now have over 500 members. Our doors are open six days a week, with evening hours Tuesdays through Fridays. Members help to plan, shop for, prepare and clean up after an evening meal each day. We even offer Sunday brunch.
We know that LGBT people often have a hard time finding affirming and culturally competent mental health services. LGBT people seek mental health treatment more often than our heterosexual counterparts, but we often don’t find the support that we need, which frequently results in our leaving treatment prematurely (Garnets, Hancock, et al., 1991: Issues in psychotherapy with lesbians and gay men, American Psychologist, 46:964; Liddle, 1996: Therapist sexual orientation, gender, and counseling practices as they relate to rating on helpfulness by gay and lesbian clients, Journal of Counseling Psychology, 43:394). The same NYC DOHMH community health survey cited above also found that gay and lesbian people experience more poor mental health, more smoking, more drinking, more drug use, and even more domestic violence than our heterosexual counterparts do. In other words, we badly need competent and affirming care. (I say “we” because I’m a member of the LGBT community myself.)
That’s why Rainbow Heights Club was formed, seven years ago: to provide a way out of the isolation that multiple layers of stigma can bring.
A study by Lucksted (in Hellman & Drescher, 2004, eds.: Handbook of LGBT Issues in Community Mental Health. Binghamton, New York: Haworth Medical Press), commissioned by the Center for Mental Health Services, summarizes a number of issues and problems cited by LGBT mental health consumers across the country. In mainstream mental health settings, they often feel compelled to hide their sexual orientation or gender identity; conversely, in the LGBT community, they try to hide their mental health status. Care providers often consider any exploration or expression of sexual or gender identity on the part of their clients to be further evidence that the clients are mentally ill. Moreover, especially in inpatient units and day programs, other consumers are frequently derogatory or even threatening toward LGBT clients. These obstacles impede the recovery process and the effectiveness of the treatment and services being provided (for instance, see Rosenberg S, Rosenberg J, Huygen C, Klein E, 2005: No need to hide: Out of the closet and mentally ill. Best Practices in Mental Health, 1:72-85).
Unfortunately, mental health professionals have helped to create this situation. Until 1973, the American Psychiatric Association defined homosexuality as a mental illness, and even today, people who question the gender they were assigned at birth are considered mentally ill. LGBT people with mental illness are acutely aware of their dependency on their care providers; as a result, they hesitate to do anything that might cause providers to withdraw their care and support. Many LGBT people have experienced the loss of friendships, family relationships, and the support of religious communities as a result of disclosing their sexual or gender identity. Unless care providers do something to demonstrate that they want to accept and affirm clients’ choices regarding the expression of their sexual or gender identity, clients are likely to assume that their providers would rather not hear about their sexuality, gender identity and relationships. Even in New York City, many LGBT clients state that they have never dared to disclose to their own therapists and psychiatrists the simple fact that they are LGBT. Unfortunately, this makes it impossible for care providers to provide help where it is needed the most.
Rainbow Heights Club was designed to provide a safe place where LGBT people who have been struggling with serious and persistent mental illness in isolation can finally find the safety and support that they need to support their recovery. We offer support groups, activity groups, Internet access, computer tutoring, cooking classes, and most of all, a safe place to build social skills and social support. Members help to design the programming, plan the meals, and come up with events and excursions. Many of them state that Rainbow Heights Club is the first place they have ever felt welcomed and accepted, and the first place where they have felt comfortable telling the complete story of who they are.
Over the past seven years, we’ve conclusively demonstrated that when LGBT people receive the support and affirmation that they deserve, their ability to care for themselves, and each other, dramatically improves. Over 87% of our members say that they are able to stay out of the hospital and in the community every year, because of the support that they receive at Rainbow Heights Club.
Over the years we’ve provided training to the staff of over 150 agencies, hospitals, residences, clinics and day treatment programs. The staff at these agencies report that since the trainings, they are experiencing better relationships with their clients, and better treatment outcomes, as a result of improved ability to affirm and effectively work with all of their clients, regardless of their sexual orientation or gender identity.
At Rainbow Heights Club we believe that it is vital to meet the needs of both consumers and providers. Our members receive direct support and are encouraged to take on roles of leadership and direct participation in the club’s activities. We reach out to providers to build referral networks and linkage agreements, but also to share information and education that will build providers’ competency and confidence in working in an affirmative way with the full range of their clients, regardless of their sexuality or gender identity. The same values drive our work with both consumers and providers: we believe that if we give people a supportive environment and the respect and safety that they need, they will spontaneously grow past their former limitations. I encourage all care providers who have expertise in working effectively with marginalized or underserved populations to do the same.
Christian Huygen, PhD, is a licensed clinical psychologist, and the Executive Director of Rainbow Heights Club: Caring for lesbian, gay, bisexual and transgender clients – and the providers who serve them (www.rainbowheights.org). He may be reached at firstname.lastname@example.org.