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LGBTQ Mental Health Vancouver

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Brett Marshall

on 19 November 2014

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Transcript of LGBTQ Mental Health Vancouver

LGBTQ Older Adult Mental Health Vancouver
Presentation Outline
Introduction
Historical Overview
Specific Aging Issues for LGBTQ Communities
LGBTQ Older Adults and Mental Health
Critical Question Discussion
LGBTQ Older Adults in Vancouver
Resources & Services Profile
Practice Implications & Recommendations
Limitations
Reflexivity
LGBTQ Older Adults
Poor Health Outcomes

Compared to Heterosexuals LGBTQ experience increased substance use disorders, affective disorders, and suicide
Alcohol, tobacco and other substance use is two to four times higher
Accessing community services remain closeted due to fear and harassment

Social Factors

Bisexual and trans people are over represented among low income Canadians
Are targets for sexual, physical harassment and hate crimes
Additional factors impacting LGBTQ mental health include coming out, isolation and alienation


Family rejection is associated with poor health outcomes and higher suicide rates.
Loss of family and social supports
LGBTQ Canadian youth face the risk of attempting suicide and substance use that is 14 times higher than their heterosexual peers
77% Trans youth seriously considered suicide and 45% had attempted suicide

Intersection of social factors racism, sexism, poverty, disability
Internalized discrimination

Diagnostic and Statistical Manual of Mental Disorders DSM
First published in 1952 by the American Psychiatric Association and defined homosexuality as a mental disorder
1973 major mental health organizations agreed to remove homosexuality from the manual
Homosexuality not de-listed until 1980
Gender identity disorder

Psychotherapies

National Association for Research and Therapy of Homosexuality (NARTH) - addresses unwanted homosexual attractions
Reparative or Conversion therapy - based on the assumption homosexuality is a mental disorder

In The News
"Coming out all over again: Why the first gay-rights generation faces familiar challenges in old age"
A Closer Look At Some Resources....
Taking a Closer Look
At Some Resources....
Critical Question
What are your reflections on the news article?

Why do you think this is happening and what are some possible solutions?
Gay and lesbian communities and their aging members
Studies that link mental health outcomes
with sexual orientation
Cochrane, Sullivan & Mays
Key findings:
higher prevalence of mood, anxiety, and substance use disorders compared to heterosexuals
higher utilization of mental health services



Johnson
Key findings:
Rates of depression & anxiety
Mental health
Sexual orientation and access to healthcare
Unique health needs

Studies that link mental health
of seniors and sexual orientation

The Aging and Health report
Key findings:
Depression & anxiety
Alcohol abuse
Internalized homophobia
Suicide
Overall mental health

Studies that link seniors' mental health outcomes with sexual orientation
Minority Stress Theory

Stigma, prejudice and discrimination are at the root of why LGBTQ’s have more mental health disorders




Linkages in the news
CBC News - Toronto

"He would visit during non-family visiting hours, and he would take his partner out of bed, help him into the bathroom and close the door behind him. Then they would hold each other for as long as they could and hug, and then he would open the bathroom door, put him back in bed, and not touch him again."
Factors that contribute to poor
mental health for LGBTQ seniors:
Barriers in accessing healthcare
Exploring an Informal Resource ...
Queer Intergenerational Meet-Up

This is an opportunity to meet and build community with folks of all ages and challenge inter-generational divisions in our spaces.
Are you LGBTTQ* and living in the Lower Mainland? Are you interested in meeting other LGBTTQ* folks of different ages and generations? Do you have a love for community-building, storytelling, queer history, and potlucks? This may be the group for you
Who:
Discussions:
Reflections:
More youth than adults. FB invites. Older adults active in the community.
Desire for community and queer spaces.
Disclosures about personal issues around coming out, housing, etc.
Healthcare issues discussed included: segregation vs. intergration. Awareness of aging out report and concern about aging and care facilities. Community of care mentality harkening back to the AIDS crisis.
Intersectional factors may have influenced communicated needs and desires.
Tensions between integrated and segregated services.
A great opportunity for networking and establishing informatl support networks/ connecting to resources.

The Mission of HIM is to strengthen gay men’s health and well-being through trusted, tailored, targeted research-based health promotion services and by engaging the community through volunteer involvement, online access and events.
Met with Program Manager Darren Usher, MSW
Primary Mental Health Concerns for Older Gay & Bisexual Men
Understanding generational cohorts
Isolation
Grief & Loss
Increased rates of suicide
Oppressive history of psychiatry
Services for Older Gay & Bisexual Men
and OMSM
Key Issues
Systemic change
Integrated services vs. separate services
Services by and for older gay & bisexual men
Transgender Healthcare
Summary of Main Issues
Reflexivity
Practice Implications & Recommendations
Factors that contribute to poor
mental health for LGBTQ seniors
3 Pillars of Service: client service, education and training, and advocacy

Will consult on inclusive policy measures for providers and health authorities

Host special events such as the honoring our elders tea
"We value recognition, we want the community to know that , 'we see you are there', as well as provide the opportunity to be joyous" - Allison Jones, Generations Coordinator
No direct requests for mental health services



Partner QMUNITY counselling


Indirect mental health benefits of community building and volunteer opportunities
Key Discussion Points
Community issues:
The process of invisiblization: identity can be jeopardized with isolation and facility placement
Gaps in service:
West End service concentration may be problematic in the context of economic factors resulting in forced relocation away from the village.
Best Advice...
Proactively become educated and gather the information and training to be able to respond when needed.

Language:
Many subtleties. Take the clients lead. Ex. "queer", "roommate"
Met with Allison Jones, Generations Coordinator
Older lesbian women well represented: Coordinators mainly women & male resource saturation in WE
Resilience

• Mastery of stigma
(Brotman & Ryan, 2008, p. 3)
Resilience

Common Themes in LGBTQ Aging
Creation of alternative family and care networks
Resilience

"A lifetime of dealing with the stigmas, crises, and discrimination experienced by gays and lesbians may actually better equip some, upon entering later-life, for dealing more expertly with the stigmas, crises, and discrimination experienced by seniors in an often ageist society"
Interactions with Healthcare
Transitioning in later life
Early life transition
Legal Implications
(Brotman & Ryan, 2008)
Lesbian Aging
Comparatively high rates of openness around sexuality
A different experience for "pre-liberation LGBT individuals"
(Hillman, 2012)
Trans Aging

Community: Gender or Orientation?
More likely to live alone
Self-reported concerns?
Aging Out Report
Health
Importance of chosen families
LGBTQ seniors fearful that health authorities, assisted living & residential care facilities are not equipped to meet their basic needs
Difficulties accessing adequate healthcare
Qmunity, 2014
Historical oppression, trauma, and social movements
Aging and Gay Men
Bisexual Older Adults
Differences in Identification and discovery
The Nonexistent Belief
The Aging and Health Report, 2011
Over/under-sexualized dichotomy
Historic experiences of discrimination
Continuation of homophobia today
Invisibility of gay and lesbian elders
“I obviously don't want this place to be heterosexist. And at the moment, l'd say the majority of them are still very heterosexist. Especially elder services because over the years there has been a lot of work done with hospitals and those contexts. But in the elder care field, there's been very little"
(female, age 66)
Johnson, 2008
HIV/AIDS epidemic
Higher rates of discrimination and violence
Health
Two Key Recommendations:
LGBTQ seniors are invisibilized
Absence of LGBTQ-specific policies
1) Train InterRAI Administrators to ask questions on sexual orientation and gender identity and record the information in the free text box


2) Amend the term 'appropriate' to factor in LGBTQ identities in determining the most appropriate bed (First Appropriate Bed Policy)
Address isolation
Training & Education - regular and consistent education and training
Advocacy within LGBTQ community to challenge ageism
Advocacy within seniors and elder care organizations and mental health services (eg. LGBTQ-specific assessment tools)
The Aging Out Report, 2014
Greater risk for physical and mental illnesses due to a lifetime of stigma, discrimination and violence
Social isolation, depression and anxiety, poverty, chronic illness, delayed care seeking, poor nutrition and premature mortality
D'Augelli & Grossman, 2001
LGBTQ Youth
Coping & survival strategies
"I look to my own community for answers before I look to medicine so that's an adaptive strategy I guess"
(in Johnson, 2002)
“The LGBT community has stepped up in the past
to address coming out, AIDS, and civil rights.
The next wave has to be aging.”
63-year-old gay man
The Aging and Health Report, 2011
"In spite of some of the hassles I have had in my life because I am gay, I consider being gay a gift. It has made my life richer and opened so much of the world for me. Of course if I had to do it over again, there are some things I would have done differently but being gay isn't one of them."
- 70 year old gay man
Aging & Health Report, 2011
How can we harness the resiliency already present in the LGBTQ community in order to address mental health concerns among LGBTQ older adults?

LGBTQ Poor Health Outcomes
Katie Anderson, 2014
Full transcript