By Loree
Cook-Daniels
A growing number of "mainstream" groups are training
their constituents about "LGBT" needs. One such training
document is "Meeting the Mental Health Needs of Gay, Lesbian,
Bisexual and Transgender Persons," a publication of the National
Technical Assistance Center for State Mental Health Planning (which
they abbreviate as NTAC).
NTAC is a joint project of the National Association of State Mental
Health Program Directors -- i.e., the people in every state charged
with creating public mental health programs -- and the Center for
Mental Health Services of the Substance Abuse and Mental Health
Services Administration -- i.e., a primary federal agency concerned
with mental health. Thus, what NTAC says is going to have an impact
on public policies that, in turn, will impact us.
The good news is that this document includes trans content well
beyond the title. At one point, they even caution that "[T]reatment
or self-help settings that are lesbian or gay affirmative are not
necessarily transgender affirmative." The authors separate
out sexual orientation and gender identity consistently, and note
when the needs of trans people differ from the needs of non-trans
LGBs. Unfortunately, they don't always have the data they need to
do this.
They also include a full chapter devoted to "transgender concerns."
This chapter begins with a description of the Tyra Hunter case,
in which a non-op MTF was refused services by the Washington, D.C.
fire department responding to her auto accident and who subsequently
died. It then moves into terminology and prevalence -- always contested
in trans contexts -- but one statement in particular surprised me:
“Transsexuals may be male or female, heterosexual, homosexual
or bisexual; they typically report...low libido." This chapter
mentions "the lifelong persecution and suffering" trans
people experience, and lists a number of reasons why transgender
persons may seek therapy (unfortunately, this list does not reiterate
that LGBTs may seek mental health care for reasons unrelated to
their sexual orientation and/or gender identity). Although the section
on the role of the mental health service provider says, "group
therapy has been recommended with all sexual minorities to combat
isolation and provide a safe atmosphere in which to grapple with
issues related to sexual orientation and gender identity,"
it does not offer any advice for suburban and rural settings in
which such groups would be difficult to form. The chapter also notes
that "many [emphasis added] people may attempt to pursue sex
reassignment surgery who do not have a gender identity disorder."
Despite these drawbacks, however, the majority of this chapter is
respectful and at least provides a baseline of information for providers
who may have had no previous contact with trans people or issues.
Some of the basics the publication misses include:
- A discussion of "transphobia" (a word they never
use despite several discussions of homophobia);
- The special mental health concerns and needs of SOFFAs;
- Sex work and its connection to some trans people; and
- The high rate of HIV infection among trans people.
This NTAC series includes descriptions of "several mental
health programs that have successfully tailored their services to
meet the needs of diverse consumers." In this case, there are
three.
Seattle Counseling Service for Sexual Minorities reports that in
1998 it served 2 FTMs and 32 MTFs, equaling approximately 5% of
their clientele. The description of their spousal support program
refers only to spouses from a heterosexual relationship where one
partner is coming out as gay or lesbian, and their domestic violence
program seems only open to victims of same-sex violence. Their transgender/transsexual
services are for "people exploring gender identity or who are
in the process of meeting the Benjamin Standards to prepare for
sex reassignment surgery." On the other hand, their commitment
to "culturally competent services" says that "any
client that identifies as a minority -- racial/ethnic, older adult,
child, deaf/hard of hearing, developmentally disabled or other --
must have their treatment plan reviewed by a minority specialist
representing these other identifications, in addition to the sexual
minority specialist."
The South Beach (New York) Psychiatric Center's Outpatient Department
formed its LesBiGay and Transgender Affirmative Program in February
1996. At the (unspecified) point the report was written, they had
served 60 individuals, 90% of them men. This program offers weekly
support groups, cultural awareness groups, and a "reading room";
a monthly coffee klatch; and advisory boards and outreach efforts
within the clinic environment.
Pride Institute, founded in 1986, with facilities in Minnesota,
New York City/New Jersey, Chicago, Dallas and Ft. Lauderdale, offers
"a full continuum of care for the entire spectrum of psychiatric
and addictive disorders." It was unclear from the description
how much trans-related content this "LGBT" program actually
has.
The 76-page NTAC report is available for $10.00 from:
National Technical Assistance Center for State Mental Health Planning
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
(703) 739-9333 (voice)
(703) 548-9517 (fax) |
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