Toward Transformative Practice: Facilitating Access and Barrier-Free Services With LGBTTIQQ2SA Populations

Abstract

This article explores the process of critical reflection on the development and implementation of a strategy to provide more appropriate access and barrier-free services to lesbian, gay, bisexual, transsexual, transgender, intersex, queer, questioning, 2-Spirited, and allies (LGBTTIQQ2SA) populations at a community-based early psychosis intervention mental health program in Toronto. There is a long history of mental health assessment and diagnostic issues for LGBTTIQQ2SA populations that have been associated with the medicalizing of difference and the pathologization of gender and sexual orientation. The experiences of people of diverse gender identities, gender expressions, and sexual orientations have resulted in unique mental health service needs, requiring affirming and appropriate services that do not participate in the reproduction of Othering through labeling and stigmatization. The strong relationship between institutionalized oppression, school victimization, discrimination, LGBTTIQQ2SA-directed violence, and mental health issues highlight the complexities that demand critical reflection and reflexivity in order to transform mental health services beyond discursive or rhetorical changes. This article explores a summary of the findings and achievements in this journey toward transformation as well as lessons learned, recommendations for similar initiatives, and questions for future research and practice.

KEYWORDS:

• early psychosis intervention
• LGBT mental health
• community mental health
• anti-oppressive practice
• health equity
• clinical practice

Notes

1. ¹ As Jill Aaers describes, “the use of two-spirit by Aboriginal people to replace terms such as in LGBTQ has spread rapidly. Two-spirit has been ‘deployed as a panhistorical as well as a pantribal term’ (Roscoe, 1998. p. 111, cited in Alaers, 2010). Identifying oneself as two-spirit is in itself an act of decolonization, as individuals break free of essentialist and sometimes derogatory Euro-colonial terms such as berdache [sic], gay, lesbian, transgender, homosexual, or hermaphrodite. Further, acronyms such as LGBTQ create divisions between gender, sexual, cultural, spiritual, and other aspects of identity. It is understood by two-spirits that one’s sexuality cannot be separated from their culture (Roscoe, 1998, cited in Alaers, 2010). Separation of various aspects of the self is not congruent with many First Nation beliefs where sexuality and life are seen as circular (Roscoe, 1998, cited in Alaers, 2010). ‘Two-spirit’ is inclusive of men, women and intersexual individuals. It facilitates Aboriginal people uniting in a way that is inclusive to various sexual orientations, including heterosexuality, while equally recognizing traditional Aboriginal cultural beliefs and identity” (Alaers, 2010, pp. 71–72.).

2. ² See Barber (2009) and Bishop (2002) for discussions regarding becoming and ally. Within Ontario, EPI programs include family education and support. In the case of the MOD program that is the subject of this article, support is available to family members as defined by the service user, and as such, can include support around allyship.

3. ³ As Schilt and Westbrook describe, “Cis is the Latin prefix for ‘on the same side.’ It compliments trans, the prefix for ‘across’ or ‘over.’ ‘Cisgender’ replaces the terms ‘nontransgender’ or ‘bio man/bio woman’ to refer to individuals who have a match between the gender they were assigned at birth, their bodies, and their personal identity” (2009, p. 461).

4. ⁴ The terms “accessibility” and “barrier-free” services in the article and title refers to current language in Ontario’s Early Psychosis Intervention Standards and in Canada’s national mental health strategy, Changing Directions Changing Lives (Mental Health Commission of Canada, 2012, pp. 10 & 11; Ontario Ministry of Health and Long Term Care, 2011, p. 30) .

5. ⁵ Because this article focuses on services for youth we believe it is important to make space for queer identities, which are particularly relevant for this age group. As a Kenta Asakura’s 2010 study on Queer youth describes, “Queer Youth Space was found to provide sexual minority youth with protective attributes as such as (1) a sense of safety, (2) meaningful relationships with others, and (3) positive identity development” (p. 371).

6. ⁶ It is important to note that in contrast to the medical model, transgender identity is widely understood within LGBTQ communities as a self-applied term “meant to convey the sense that one could live nonpathologically in a social gender not typically associated with one’s biological sex, as well as the sense that a single individual should be free to combine elements of different gender styles and presentations, or different sex/gender combinations” (Currah, Green and Stryker, 2008). Contemporary transgender communities have provided new understandings of trans experiences in which trans people are not mentally ill people, but rather emotionally healthy people whose gender expression does not happen to fit rigid societal expectations (Denny, 2002).

7. ⁷ It is important to note that many people are assumed to be gay, lesbian, bisexual, or queer because of their gender expression.

8. ⁸ We acknowledge that in the Samuel et al. quotation there appears to be a conflation of sexual orientation and gender identity, a tendency noted in our introduction. Specifically, the section that states, “the mental health needs of the lesbian, gay, bisexual, & transgendered (LGBT) population differ from those of heterosexual seriously mentally ill individuals” comments on a comparison among the LGBTQ population and heterosexual individuals but does not comment on a comparison among the LGBT population and the dominant gendered population.

9. ⁹ Used to maintain anonymity.

10. ¹⁰“RHO is a province-wide program that works to improve the health and well-being of lesbian, gay, bisexual and trans people in Ontario through education, research, outreach and public policy. Our mission is to improve access to services and to promote the health of Ontario’s lesbian, gay, bisexual and trans communities” (RHO, 2006).

11. ¹¹ “CRT belongs to the family of critical postmodern theory that ‘attempt[s] to understand the oppressive aspects of society in order to generate societal and individual transformation’ (Tierney, as cited in Solórzano & Bernal, 2001, p. 31, cited in Ortiz & Jani, 2010, p. 1761). It does not assume the existence of universal truths and rejects master narratives that attempt to encompass all phenomena or dictate the construction of lives. Instead, it is based on the following assumptions: race is a social construction, race permeates all aspects of social life, and race-based ideology is threaded throughout society. Proponents of CRT are also committed to social justice, locating the voice of the marginalized, and employing the concept of intersectionality” (Delgado & Stefancic, 2001; Solórzano & Yosso, 2001, cited in Ortiz & Jani, 2010, p. 176).