Pride Month 2020: What Does Good Mental Health Care for LGBTQ+ People Look Like?

June 28, 2020 Mark Wilhelm

The LGBTQ+ community (individuals who identify as lesbian, gay, bisexual, transgender, queer, or as another nontraditional gender identity or sexual orientation) has made many great strides in recent years. In 2015, the U.S. Supreme Court made same-sex marriage legal in all states, and earlier this month, it ruled to protect gay, lesbian and transgender people from employment discrimination. Despite these recent achievements, however, many people who identify as LGBTQ+ or are questioning their gender identity or sexual orientation still face serious challenges to their overall well-being.

For example, at least 1 in 4 LGBTQ+ people report experiencing some form of discrimination in their daily lives. Discrimination or fear of discrimination can be especially harmful for youth in this population. According to a 2019 survey conducted by The Trevor Project, 71% of LGBTQ+ youth reported feeling sad or hopeless for at least two weeks in the past year, and 39% of LGBTQ+ youth seriously considered attempting suicide, with more than half of transgender and non-binary youth having seriously considered suicide.

Proper behavioral health care can help LGBTQ+ individuals deal with the challenges of discovering and living out their gender identity and sexual orientation. Unfortunately, this care isn’t always readily available. This is partly because not all behavioral health professionals have access to the training and resources they need to treat this population. “In my experience providing therapy over the last four years, one barrier is a lack of LGBTQ-specific resources for mental health professionals,” says Julie Campbell-Miller, an Intake Specialist and Outpatient Therapist at Cummins Behavioral Health. “Even as a self-identified queer person, treating someone from the other side is much more difficult than I ever imagined.”

This begs the question: what does respectful, effective behavioral health care look like for LGBTQ+ individuals? How can mental health professionals help their clients discover and feel comfortable in identities that other people might not understand or agree with? In this post, Julie Campbell-Miller explains what behavioral health care should look like for people struggling with issues related to their gender identity or sexual orientation.

Placing Control in Clients’ Hands

Julie Campbell-Miller, LCSW, Intake Specialist and Outpatient Therapist at Cummins Behavioral Health — "I identify within the LGBTQ+ community, and I have some lived experience in regards to discrimination and knowing how difficult it is to come out to your loved ones. I think it's extremely important for community mental health centers to be vocal and show that they are a safe place to come and talk about these kinds of things," says Julie Campbell-Miller, LCSW, an Intake Specialist and Outpatient Therapist at our Putnam County office.

When a consumer of behavioral health care is seeking help for problems like depression, anxiety or substance use disorder, it is sometimes appropriate for their therapist or counselor to take close control of their treatment. Mental disorders and illnesses can be very complex, but there are typically clear guidelines for treating them as well as clear goals to work toward. However, this is not the case for someone who is questioning or struggling with their gender identity or sexual orientation.

In many cases, LGBTQ+ individuals may not have a specific behavioral disorder that they are seeking treatment for. Rather, they might simply be looking for someone to talk to. “Most people who are seeking services because of their sexual orientation or gender identity just want somebody who’s empathetic and willing to ask questions and learn more,” Julie says. Instead of assuming they know the solutions to their clients’ problems, providers should strive to learn more about their situation, ask what they would like to get out of therapy or counseling, and then work with them toward that goal.

If a person is seeking help to make sense of their gender identity or sexual orientation, it’s also important that professionals resist the urge to come to a conclusion for them. Questioning one’s gender identity or sexual orientation is a deeply personal and sometimes confusing experience, and the person going through this process must ultimately make their own decisions about who they are. Therapists and counselors should act only as guides and sounding boards for this process, as Julie explains:

“It’s different than your traditional talk therapy. You don’t want to tell them what they are because it’s very specific to an identity, as opposed to something like trauma where you can simply point out the cognitive distortion they might be having. For someone who’s trying to explore their own identity, you want to support them in a way that they can come to it on their own. For example, I might give them some resources to read through as homework, and then the next time they come in, we discuss what they thought about it. This helps them to self-identify as opposed to me saying, ‘Oh, I think you might be pansexual,’ or something like that.”

Building Up the Whole Person

As we’ve suggested, there are many educational resources that can be helpful for someone who is questioning their gender identity or sexual orientation. Part of a care provider’s job should be directing consumers toward these resources when appropriate. “One way providers can help is by exposing consumers to resources such as the Human Rights Campaign, The Trevor Project, and Indiana Youth Group,” Julie explains. “For example, I use HRC a lot because they have a glossary with definitions for various sexual orientations and gender identities.”

Beyond simple education about the many gender identities and sexual orientations a person might have, some tools can even help walk them through the process of questioning their identity. “There’s one workbook I like called The Gender Quest Workbook, and it utilizes cognitive-behavioral therapy techniques specific to LGBTQ+ youth who are on the journey of figuring out how they want to identify,” Julie says.

However, behavioral health professionals should also emphasize that their clients are more than their gender identity and sexual orientation. A person-centered, strengths-based approach to therapy should be used to remind clients that they are worthwhile and valuable regardless of what gender they identify as and who they are attracted to. “Counseling is the perfect opportunity for them to identify all of their great qualities as opposed to the one facet they’re trying to make sense of,” Julie says.

Finally, it’s possible that a person might not fully understand or come to terms with their gender identity and sexual orientation by the end of their treatment. This process often takes many years to complete, and it might not be the primary goal of someone’s therapy or counseling. Care providers should reassure their clients that there is nothing wrong with this, and that they can still live fulfilling lives as they continue to work toward this long-term goal.

“I think it’s important for providers to be upfront that they are not necessarily there to help someone identify who they are. They’re there to address what the person is struggling with,” Julie explains. “If you are questioning, and you happen to come to that conclusion by the time you’re done with therapy, that’s awesome. But my goal is for you to feel confident that even if you don’t have that specific identity, you can still live and be happy while you’re figuring it out, and that it will be OK.”

Cummins Behavioral Health is committed to providing exceptional mental health care to people of all genders, races, ethnicities, creeds and sexual orientations—including those individuals who belong to the LGBTQ+ community. If you would like to speak to a behavioral health professional about struggles related to your gender identity or sexual orientation, we encourage you to give us a call at (888) 714-1927.

Or, if you’d like to learn more about the basics of gender identity and sexual orientation, we recommend starting with our blog post about the five dimensions of gender and sexuality!

Drug Free Marion County and Cummins BHS Answer “What Are Friends For?” for Substance Use Stigma

June 25, 2020 Mark Wilhelm

Substance use disorder, also known as addiction, is one of the biggest public health crises affecting Americans today. According to the National Survey on Drug Use and Health, around 20.3 million Americans suffered from a substance use disorder (or SUD) in 2018. This includes an estimated 389,000 Hoosiers aged 12 or older. Indiana has been hit especially hard by the ongoing opioid crisis, ranking 14th for most drug overdose deaths by state in 2017.

Despite the vast number of people afflicted with SUD and the well-established science that explains how addictive substances hijack the brain, there is still a significant amount of stigma surrounding substance use disorder. Unfortunately, this stigma only makes SUD more devastating for those who suffer with it. For instance, consider the story of Matt Baker, one of Cummins’ Peer Recovery Specialists who fought to overcome his own struggle with substance use disorder.

Matt’s Story of Addiction and Recovery

Matt was no stranger to the painful realities of substance use growing up. As a child, addictive substances were a common facet of his home life. “That lifestyle was the norm around my home—substance use and a lot of the things that go in line with it. Domestic violence, involvement with the law, time spent in and out of the jail system and other institutions,” Matt says.

When he was old enough, Matt joined the military and escaped this lifestyle for a time. However, he was medically discharged from the service in 2012 after being injured in combat. Upon returning home, his life quickly took a turn for the worse. “I went right back to what I knew, which was an unhealthy coping skill, and that was substance use. I went down that path—being locked up, losing my freedom. I lost my family, I lost everything that really meant something to me,” Matt says.

As he fell deeper and deeper into addiction, Matt started to believe that he was to blame. He thought there must be something wrong with him that made him act the way he did. “I honestly took that old-school view that it was a moral defect of character,” Matt explains. “I literally thought I was a bad person.”

Matt’s substance use became so severe that he eventually ended up in the hospital because of it. It was while he was admitted to the psychiatric unit of a VA hospital that something remarkable happened. “A guy came in who had his own experience with substance use and mental health issues,” Matt says. “He came and talked to us, and he normalized it. He didn’t treat us as ‘less than.’ I could relate to this man. He had a peace and a calm about him, and I thought, ‘I want some of that in my life.’ “

This experience was a major turning point for Matt. From that moment on, he was committed to recovering from substance use and taking back control of his life. However, a major hurdle on his journey toward recovery was overcoming the stigma he felt as someone with substance use disorder. “I couldn’t do it until I tore down some of that stigma,” he says.

Breaking Down Substance Use Stigma in Indiana

The Marion County Public Health Department’s “What Are Friends For?” campaign is aimed at reducing the stigma surrounding substance use disorder.

Despite what some people still believe, substance use disorder is not a moral deficiency or weakness of character. Individuals who struggle with substance use are not “bad people.” As its name suggests, SUD is a behavioral health disorder. No one chooses to suffer from it, and those who do have great difficulty changing their thoughts and behaviors. In fact, their situation is not so different from someone who struggles to control the thoughts and behaviors associated with major depressive disorder, borderline personality disorder, or an anxiety disorder.

This is the message that organizations like Marion County Public Health Department (MCPHD) and Drug Free Marion County (DFMC) are working to spread in Indiana. MCPHD’s “What Are Friends For?” advertisements (such as the video above) teach that one of the best ways we can help a friend or family member who’s struggling with addiction is to be understanding and compassionate.

Sometimes a loved one may need help resisting cravings, avoiding overdose or finding treatment for their substance use. But according to Michaelangelo McClendon, Interim Executive Director of Drug Free Marion County, sometimes they only need a friendly ear to share their struggles with:

“Our agency gets calls every day from people struggling with substance use, and sometimes they just need us to listen. And that’s what friends are for. Our friends listen when we’re in pain. Sometimes we’re the listening board that can help guide them through the pain of addiction.”

Empathy: The Key to Ending Stigma

Ultimately, being a friend to someone who struggles with substance use means putting ourselves in their shoes. It isn’t enough to understand how addiction works and take pity on those who suffer from it. We must truly empathize and admit that we, too, have our share of struggles in life; we, too, are flawed individuals; and we, too, could have developed the same problems with substance use if we had lived their same life experience.

“We live in an environment where people are afraid to show who they really are. We’re afraid of judgment and afraid of being ridiculed for not being perfect,” McClendon says. “We also have a society that is just now learning that people who are struggling with substance use are not throwaways. Life is hard. We all struggle, and we all have different ways of coping. We have to be honest about who we are as humans and create a much more open environment for people to say, ‘I’m imperfect.’ And that takes community.”

And what about Matt Baker—how did his struggle with substance use disorder end? Fortunately, he is now living successfully in recovery and has made a career out of helping others who struggle with the very same issues he once faced. His story serves as a message of hope for every person who suffers from substance use disorder: despite the odds, recovery is possible.

“It’s amazing what happens in recovery,” Matt says. “The people who come out are completely different from the people who went in. There’s definitely hope, and people do change. People do recover.”

If you or someone you know needs help with substance use and lives in Marion County, we encourage you to visit Drug Free Marion County’s website and MCHD’s What Are Friends For? webpage for resources and assistance finding treatment. You can also call our offices at (888) 714-1927 to discuss if Cummins’ SUD treatment services might be right for you.

If you’d like to learn more about substance use disorder and Cummins’ SUD services, we recommend reading these other posts from our blog!

Cummins Mobile Medical Clinics: At-Home Medication Services for People with Severe Mental Illnesses

June 8, 2020 Mark Wilhelm

Although it may not always seem so, mental illness is very common in the United States. According to the National Institute of Mental Health, nearly 20% of American adults—or 46.6 million people—had a mental illness in 2017. This includes people with a wide variety of behavioral disorders such as anxiety disorders, depression, bipolar disorder, attention deficit disorder, post-traumatic stress disorder, obsessive-compulsive disorder, eating disorders and substance use disorders.

However, a smaller percentage of people have mental health disorders that are highly disruptive to their daily lives. These may be severe cases of the kinds of disorders listed above, or they may be what are known as psychotic disorders, which cause people to experience hallucinations or have beliefs that are disconnected from reality (called “delusions”). About 4.5% of U.S. adults—or 11.2 million people—suffer from severe mental illnesses.

Psychotic disorders and other severe mental illnesses can be very difficult to manage, which is why many people are prescribed medication to help control their symptoms. These medications can greatly increase an individual’s quality of life, but restrictions made necessary by the COVID-19 pandemic have also made it harder for some people with severe mental illnesses to receive their medication doses. Behavioral health care providers have had to innovate in order to continue serving these clients during this difficult time.

At Cummins Behavioral Health, our medical services staff have converted our consumer transportation vans into mobile clinics in order to deliver medications directly to the homes of these high-need individuals. Thanks to these mobile clinics, our consumers with severe mental illnesses have been able to continue receiving the medications that keep them safe and their symptoms under control.

We spoke with Beth Borders, our Medical Services Practice Manager, and Brandy Fergason, one of our Medical Assistants, to learn how the mobile medical clinics are helping consumers continue their regular treatment during the COVID-19 crisis.

How the Mobile Clinics Keep Consumers Safe

Medication can be helpful for managing a variety of behavioral health conditions when prescribed in conjunction with therapy. At Cummins, our medical services team gets involved when a therapist believes medication could be beneficial for a particular consumer. “If someone is receiving services here with a therapist, they would talk to the therapist about medication, and the therapist would collaborate with a psychiatrist to create a treatment plan,” Beth explains.

Some of Cummins’ consumers—such as those who suffer from schizophrenia, schizoaffective disorder, borderline personality disorder or strong obsessive thoughts—receive antipsychotic medications as part of their treatment. Many of these consumers receive long-acting injections of their medication, and many also utilize Cummins’ transportation services to get to and from their appointments. However, this arrangement has become problematic due to COVID-19, as Brandy explains:

“We are not allowed to transport consumers anymore, so a lot of the people that we were seeing didn’t have a way to get to the office for their injection. Some of these people had to be switched to oral medication, but the issue with that is they may not remember to take oral medication on a continuing basis, which is why they were receiving long-acting antipsychotics in the first place. So, we’re now going out and seeing these people who relied on our transportation as well as people who face higher risk from COVID-19.”

Crucially, the mobile clinic program protects these at-risk consumers from the negative consequences of missing their medication. “If these individuals don’t get their medication, they could be prone to having symptoms,” Beth says. “We want to keep them from having any symptoms, and we want to keep them from having bigger issues like being admitted to the hospital. We want to keep them safe.”

What Happens During a Mobile Clinic Visit

When a mobile clinic van arrives at a consumer’s home, the first thing that’s done is a precautionary screening for COVID-19. “We take their temperature and screen them right outside the van. Once they pass the screening and are wearing a mask, they can come into the van,” Beth says.

Inside, consumers are greeted by a private, controlled environment where they can receive their treatment. “We’ve made the inside of the vans exactly like what we would have in an outpatient lab,“ Brandy explains. “We have a place for them to sit down, we have their paperwork, we have all of our instrument trays, syringes and blood collection tubes. We’re able to give them their injection or draw blood right there in the van.”

Beth and Brandy typically handle visits in Hendricks, Putnam and Montgomery Counties, while two other members of the medical services team, Jeanne Lehman Lopez and Allyn Smith, operate the second mobile clinic in Marion County. The full team involved with the mobile clinics is as follows:

Beth Borders, BS, Medical Services Practice Manager
Jeanne Lehman Lopez, BS, RN, Registered Nurse
Brandy Fergason, RMA, Medical Assistant
Allyn Smith, CMA, Medical Assistant
Andrea Henderson, CMA, Medical Assistant
Sonny Bennett, Driver
Woodie Hutcheson, Driver
Kevin Rogers, MBA, Director of Environmental Services & Safety Officer
Brent Dugan, Maintenance Technician

Fortunately, the mobile clinic team has found that their extra efforts to treat consumers have not gone unappreciated, especially among family members and loved ones of consumers with severe mental illnesses. According to Beth,

“Sometimes the consumers don’t really realize what we’re doing for them because they’re trying to heal and get better, but the family members do. We had one individual who had just started receiving injections and didn’t have any transportation, so we went to her home and gave her the injection instead. Her mother was home at the time, and she was so appreciative of what we were able to do for her daughter. That was an ‘a-ha’ moment for us. It reinforced that we have to make this work for our consumers, even if they might not realize how important it is for them to get their medication.”

Our medical services team is committed to serving all of our consumers during the COVID-19 crisis—especially those at the highest risk of suffering negative health consequences. We are proud of their innovation with the mobile medical clinics and the hard work they’re doing to continue treating individuals with severe mental illnesses!

For more information about new services Cummins BHS is providing during the COVID-19 crisis, read our articles on telehealth and virtual addiction treatment below!

Women’s Mental Health Awareness: Dr. Corinne Young on How to Provide Effective Behavioral Health Care for Women

June 8, 2020 Mark Wilhelm

For much of history, the mental health struggles and needs of women have been misunderstood. In ancient Egypt and Greece, medical professionals believed that behavioral abnormalities in women were caused by the uterus being incorrectly positioned inside the body. During the medieval and Renaissance periods in Europe, many women with mental illnesses were believed to be witches or possessed by evil spirits. And as recently as the early 1900s, women experiencing symptoms of mental illness were diagnosed with a condition called “hysteria,” which comes from the Greek word for “uterus.”

Fortunately, behavioral health professionals now know that women and men experience mental illness for largely the same reasons. The vast majority of behavioral health issues have nothing to do with a person’s biological sex, and effective treatment for a particular issue looks the same regardless of a person’s gender. With few exceptions, women and men suffer from mental illness for the same reasons resulting from genetics and environmental factors.

However, a person’s gender can affect the kinds of behavioral health problems they are likely to suffer. Due to the different roles women and men have in our society, they are often exposed to different sources of stress and trauma, which can lead to different behavioral health consequences. Effective behavioral health care should take these factors into consideration, anticipating gender-related hardships that a person may be struggling with and working to address these issues when they are present.

In honor of Women’s Health Month observed in May of each year, Cummins Behavioral Health hopes to bring awareness to the unique mental health challenges that women sometimes face. We spoke with Dr. Corinne Young, a staff psychologist who has a strong interest in women’s health, to learn what issues women may struggle with and how care providers can most effectively meet women’s behavioral health needs.

Depression, Trauma, Body Image and Childcare Stressors

Although a person’s mental wellness is not predetermined by their gender, decades of psychological research has found that women are more likely than men to suffer from certain types of behavioral health problems. There is some evidence that women’s sex hormones may place them at higher risk for certain disorders, but traditional gender roles and expectations are also key contributors. “Women have historically been more exposed to disenfranchisement, and as a result, women are a bit more susceptible to some disorders,” Dr. Young explains.

For example, women are about twice as likely as men to suffer from depression or anxiety sometime in their lives. Sometimes these issues are caused or worsened by hormonal activity, such as in cases of premenstrual dysphoria, postpartum depression or perimenopausal depression. However, depression and anxiety can also be rooted in domestic violence and sexual violence, which women are significantly more likely to experience than men.

Rates of eating disorders and body-image issues such as body dysmorphic disorder also tend to be higher among women. These problems can be partially attributed to the high standards of attractiveness that Western society expects women to live up to. “Our media really supports a specific image of women and how women are supposed to look, so it is a big influence on body-related issues for women,” Dr. Young says.

Finally, women who have children are often expected to handle the majority of childcare responsibilities, which can serve as an additional source of stress as well as an obstacle to receiving behavioral health care. As Dr. Young explains,

“Women still provide the majority of childcare, so in addition to working outside the home, they have the added stresses of taking care of the children and the household. Women then have the challenge of managing all these competing needs. They may need to focus on taking care of their family rather than taking care of their own mental health needs, not necessarily realizing that in order for them to be a good mom, a good spouse and a good provider for their family, they also have to take care of themselves physically and mentally.”

How Care Providers Can Better Meet Women’s Behavioral Health Needs

Knowing the behavioral health issues that women may be likely to experience, what can care providers do to ensure these issues are addressed? First and foremost, they can work to raise awareness among their colleagues as well as among the general public. The more people understand women’s mental health challenges, the more likely it will be that women who suffer from these challenges receive help. At Cummins, our Cultural Competency Committee works to keep providers informed about the unique needs and struggles of every consumer population we serve.

Next, care providers should make a point to ask women (in a sensitive and respectful manner) if they are experiencing these common challenges. Consumers may sometimes be hesitant to mention these issues on their own, or they might not even realize they are suffering from them. “We need to ask more questions in our assessments and not be afraid to ask,” Dr. Young says. “For example, asking about trauma. We know that almost everyone has experienced some form of trauma, whether it’s ‘Big T’ Trauma—physical abuse, sexual abuse, neglect—or ‘Little t’ trauma, such as losses that may not be life threatening but can affect our adjustment.”

Effective care also means being accommodating regarding women’s barriers to receiving treatment. Providers should understand that poor engagement or attendence do not necessarily indicate noncompliance with treatment, as Dr. Young explains:

“If someone is having trouble with attendance or returning our calls, it might not mean that they’re failing to engage. There are usually other reasons. Maybe they have family responsibilities, or maybe they’re about to lose their job and are just trying to survive. In substance use treatment, for instance, we may be quick to discharge someone if they’re not attending, but we also know that trauma and substance use go hand in hand—that substance use can be how someone avoids thinking about trauma. We need to be sensitive about that, be willing to meet someone where they are, and be able to troubleshoot how to overcome these barriers with them.”

Although women have a heightened risk of experiencing the mental health challenges mentioned in this post, it’s worth noting that effective treatment for women looks a lot like effective treatment for any individual. It is grounded in a person-centered approach that emphasizes listening, asking questions, and striving to treat the whole person.

Cummins Behavioral Health is committed to continually improving our care for consumers of all populations. To better serve women who have suffered trauma, we hope to soon begin facilitating groups using the evidence-based Trauma Recovery Empowerment Model (TREM). We are excited about this opportunity to improve our care for our consumers!

Looking for more articles about meeting women’s behavioral health needs? We recommend our blog posts on trauma-informed care and domestic violence shelters below!