Peer Support for Lesbian, Gay, Bisexual or Transgender (LGBT) Individuals

by Ronald E. Hellman, M.D., FAPA, Director,

LGBT Affirmative Program of South Beach Psychiatric Center published in Recovery To Practice Newsletter, reprinted at http://keystothecloset.blogspot.com/

The LGBT Affirmative Program (LGBTAP) of South Beach Psychiatric Center was initiated in 1996 as one of several multicultural services provided by this large, public sector community mental health center in New York City. The program is based at the Heights–Hill Mental Health Service in downtown Brooklyn, one of seven outpatient clinics at South Beach, which serves a multi-ethnic, low socioeconomic population with serious, chronic mental illnesses.

Several years into the program, we observed that our sexual minority population, much like our general psychiatric population with significant disabilities, had great difficulty reintegrating within the larger LGBT community and the general community at large, despite the provision of LGBT–affirmative therapies. We came to believe that it was incumbent upon us to facilitate the creation of a socio-cultural component within a recovery model, in addition to the psychosocial and medical services already offered.

This resulted in the creation of an affiliated membership program, the Rainbow Heights Club (RHC). As members, individuals did not have to be enrolled at the clinic, and this allowed LGBT patients from all over the New York metropolitan area to attend. The larger numbers helped to approximate the diversity found within the city’s LGBT community. And, with the creation of an LGBT consumer advisory group, members came up with a name for the club and helped steer program development.

LGBT individuals with major mental illnesses can be reluctant to engage in psychiatric treatment and adhere to treatment regimens over time, because they are less likely to identify with mainstream settings. They are a minority in these settings, and are also subject to stigma in the LGBT community because of their mental illness and in psychiatric settings because of their sexual minority status. And, unlike other ethnic and racial minorities, their families typically do not share their sexual identity. Thus they can be particularly prone to a lack of affirmation and supports.

LGBT patients have to adapt to largely heterosexual, cisgendered (those comfortable in their gender of birth) mental health settings in virtually all areas of service delivery. Well-intentioned, “integrated” settings fall short when they do not provide safe, culturally relevant opportunities for the alienated LGBT patient. Culturally appropriate programming, fostered at all organizational levels, has the power to transform these patients into LGBT persons in recovery.

A crucial component of recovery for the LGBT consumer is peer support. LGBT peer support allows for a process of authentic identification with others like oneself. It promotes forms of socialization, role modeling, and individuation not otherwise available in the generic setting. Mainstream cultural settings often inadvertently rob the LGBT patient of their experience as a sexual minority person with a different, yet valid, worldview. LGBTAP and RHC were organized to facilitate peer support by bringing a “proto-community” of individuals together that had never previously connected.

Separation from the dominant heterosexual, cisgendered world and connection with sexual minority peers is a common step in the healthy psychological development of sexual minority individuals. Major mental illness can tear people away from that process, and mainstream psychiatric settings typically provide no substitute. LGBTAP and RHC created the conditions and opportunities for these individuals to connect with each other, thereby creating a unique cultural community in which pride, place, self-esteem, support, and hope could be nurtured, as the weight of mental illness became merely a shared part of that larger process.

As a unique, regional program, RHC has served almost 500 members. Collaborating with staff and peer specialists, members have made their needs and interests known, the result being an ever-evolving program of groups, support, skills training, and advocacy. An outcome study of this recovery model found that participants attributed significant improvement in adherence with treatment regimens, reduction in psychiatric symptoms, enhanced self-esteem, improved stress tolerance and hopefulness to the program, despite an average of 16 years of previous psychiatric treatment.¹ To appreciate the depth of this program, please visit http://www.rainbowheights.org.

¹ Hellman, R.E.; Huygen, C.; Klein, E.; Chew, M.; & Uttaro, T. (2010.) A study of members of a support and advocacy program for LGBT persons with major mental illness. Best Practices in Mental Health: An International Journal, 6(2), 13–26.