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How to not be perfect

How to not be perfect

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How to not be perfect

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  1. How to not be perfect

  2. Taking care of yourself It’s okay to…. • Leave the room • Stand in the back of the room • Play on your phone • Fidget • Respect others, limit distractions Remember to… • Move • Breathe • Drink water

  3. Terms Used • LGBTQ+ • Queer • Trans/Gender non-conforming • Substance use • Mental health/illness • Homeless • Transition Age Youth

  4. Overview/why you should give a s*** • SPMI/LGBTQ/homelessness • “Competency” • Prescreening • Paranoia and oppression • Trauma • DBT/invalidating environment

  5. SPMI among LGBTQ people • LGBTQ people are at greater risk of experiencing severe and persistent mental illness • LGBTQ people are less likely to rate satisfaction with their mental health services • Mental health services are often inadequate and/or stigmatizing • Therapeutic benefits of being “out” in treatment programs • Isolation, violence, and discrimination are all linked to increased symptoms • Lack of research on experiences of LGBTQ people with mental illness • LGBTQ focused organizations have inadequate training on SPMI and mental health organizations are not trained enough on LGBTQ issues • Gender confirming care is correlated with reduction in psychosis symptoms

  6. TRANSVESTITE EPISODES IN ACUTE SCHIZOPHRENIA* “The onset and duration of transvestite behavior in such cases varies from patient to patient. For instance, in the patient reported on in that paper, the transvestite tendencies appeared in the twelfth year of his schizophrenia: another schizophrenic transvestite began to have transvestite desires 11 years after he developed the first symptoms of psychosis. Thus it may seem that it takes many years of schizophrenic withdrawal, brooding and bizarre preoccupation with sex, before a latent transvestite predisposition breaks through the crust of social conventions and prohibitions, and results in manifest transvestite behavior.”

  7. Portland’s Homeless Youth Continuum 53% are people of color 47% are LGBTQ 10% transgender and/or gender nonconforming 93% have psychiatric and or substance use related disability

  8. Contributors to mental health and substance use issues for LGBTQ people Foster care Family Conflict Discrimin- ation Sexual violence Racism Criminal Justice Sexual solicitation PTSD Symptoms Peer Suicidality Depression Substance Abuse

  9. LGBTQ Youth Homelessness • LGBTQ youth are more than double the risk of homelessness compared to non-LGBTQ peers • LGBTQ youth had over 2x the rate of early death among youth experiencing homelessness • Youth who identified as both LGBTQ and black or multiracial had some of the highest rates of homelessness • Among youth experiencing homelessness, LGBTQ young people reported higher rates of trauma and adversity • Transgender youth often face unique and more severe types of discrimination and trauma Chapin Hall. (2018, April). Missed opportunities: LGBTQ youth homelessness in America. Retrieved from http://voicesofyouthcount.org/wp-content/uploads/2018/05/VoYC-LGBTQ-Brief-Chapin-Hall-2018.pdf

  10. “Having appropriate mental health care is so important. There are so many therapists out there that are not educated at all on LGBT issues, and, even if there are a little bit, when it comes to trans or, like gender identity-related issues, they’re very, very, very uneducated. Um, and that’s coming from me and basically every single other trans person that I know and I’ve talked to have had negative encounters with therapists or psychologists or psychiatrists.” -Jess Voices of Youth Count report

  11. Super Queer Force Outside the Frame, 2018

  12. Intersectionality • It’s a thing (in lots of ways this presentation isn’t covering) • Intersecting oppressions • Sexual Orientation • Gender • Physical Health • Race • Immigration Status • Disability status • Substance Use • (and more) • Stigma and barriers to accessing privileged spaces of care • Generational trauma • Think critically about space - what messaging are you giving about who is welcome? What faces do people see when they walk in?

  13. Other thoughts • Historically pathologized • Assumptions of people with SPMI being asexual • Homosexuality was in DSM until 1987 • Gender dysphoria continues to be in DSM. • Therapist letters for medical care • Denying transition related care to people experiencing psychosis • Current legal protections/lack of protections • Different experiences for clients from different states • Sex positivity, how we talk about sex and bodies • Surgery stuff • Access to care/OHP

  14. Employment • “soft skills” • Discrimination/invalidation • Lack of legal protection

  15. LGBTQ Employment Protections

  16. How to not be perfect • Do your own research… • …and ask questions • Mess up gracefully • Consider your team • Measure things • Ask for pronouns and offer your own* • Let your clients tell you who they are, and believe them

  17. Questions?