Mary E. Barber

Special Issue on Homelessness and the Transgender Homeless Population

Special Issue on Homelessness and the Transgender Homeless Population Shane S. Spicerabc; Alan Schwartzd; Mary E. Barberef a College of Physicians and Surgeons, Columbia University, New York, New York b The Lesbian, Gay, Bisexual and Transgender Community Center, New York, New York c Private Practice, New York, New York, USA d William Alanson White Psychoanalytic Institute, and Private Practice, New York, New York, USA e Rockland Psychiatric Center, Orangeburg, New York f Columbia College of Physicians and Surgeons, New York, New York, USA

Lesbian, Gay, and Bisexual People with Severe Mental Illness

Very little has been written about lesbians, gay men, and bisexual people (LGBs) with severe mental illness (SMI). In general, LGBs with SMI have the same mental health needs as their heterosexual counterparts. However, there is a need for some basic understanding and confronting potential bias among health practitioners. Although specialized services for lesbian, gay, bisexual, and transgender (LGBT) people with severe mental illness exist in some large metropolitan centers, efforts need to be made to expand access to services that are safe and welcoming to LGBT people, whether those services are specialized or not. Practitioners can help their LGB patients with severe mental illness by taking a thorough sexual history, being aware of gay-affirmative mental health services in their area, and advocating for services where none exist.

Mental Health Issues in LGBT Seniors

Despite their increasing numbers, older lesbian, gay, bisexual, and transgender (LGBT) adults have mental health needs that remain poorly characterized and treated. This special issue of the Journal of Gay & Lesbian Mental Health, featuring the 2010 Association of Gay and Lesbian Psychiatrists Annual Symposium, aims to address this deficiency by presenting the case of an older gay man with depression and substance use problems, discussing diagnostic, treatment, and management considerations. The case presentation and discussion highlight the need for clinicians to think broadly about the multiple components of mental health in older LGBT adults, with awareness of the historical, developmental, and social contexts that shape their well-being. This discussion also describes the frustrations, quandaries, and opportunities inherent in providing care to an older adult patient with multiple co-morbidities that have become reinforced, in part, by the invisibility and stigma many older LGBT adults experience. The case presentation by Howard Rubin, MD, of an 83-year-old gay man whom he co-treated with David Ortmann, LCSW, followed by a discussion paper by Daniel Hicks, MD, address an understudied topic in LGBT mental health: that of substance abuse in older LGBT persons and, more generally, mental health and well-being in older LGBT persons. Written from a clinical perspective, this section can be read in a multitude of ways: a case history of a patient with depression and co-morbid substance misuse, a candid account of a split treatment with a characterologically challenged patient, a

The GAP Online LGBT Mental Health Curriculum

The authors describe the development and publication of an online curriculum to teach psychiatry trainees about important topics in LGBT mental health (www.aglp.org/gap). The curriculum was written by members of the LGBT Committee of the Group for Advancement of Psychiatry (GAP, www.ourgap.org). This paper outlines the history and mission of GAP and the history of the GAP LGBT Committee. The rationale for the curriculum and its structure are discussed, as well as suggestions for its use.

An Inside Look: Appreciating the Complexity of Gender Identity

The American Psychiatric Association (APA) has been undergoing the process of examining the scientific literature and revising the Diagnostic and Statistical Manual of Mental Disorders (DSM), its official manual of mental disorders, since the late 1990s. This is a monumental project, with a 15-year timeline. One of APA’s stated goals in writing the anticipated DSM-5 is to rigorously examine the recent literature and apply new insights to the revised manual. Reviews of earlier DSM editions resulted in the removal of the diagnoses of homosexuality and later ego-dystonic homosexuality (Drescher & Merlino, 2007). The depathologization of homosexuality has had far-reaching effects, not only on the mental health community or gay and lesbian patients but also on the culture (Bayer, 1981). Asserting that homosexuality was not a mental illness was one important factor in moving the wider culture toward more acceptance of gay and lesbian people. Gender Identity Disorder (GID; APA, 2000) is a diagnosis under review for the DSM-5. In nondiagnostic language, this applies to some people under the wide umbrella of transgender identities. Understandably, the transgender community, as well as many in the lesbian and gay community, are interested to know about the process behind considering whether to continue, modify, or delete the GID diagnosis from the DSM-5. Who is making recommendations and on what basis? Who will make the final decision? Will my/our opinion be heard? In this issue of JGLMH , we have the opportunity to reflect on the complexity of the issues surrounding the future of this diagnosis.

The Black Community and Its LGBT Members

The collection of papers in this special issue of Journal of Gay & Lesbian Mental Health was originally presented as a symposium at the American Psychiatric Association Annual Meeting in May 2012 i...

Advocating for Marriage and LGBT Mental Health Through Op-Eds

This paper describes a project undertaken by the Group for Advancement of Psychiatry (GAP) Lesbian, Gay, Bisexual and Transgender (LGBT) Committee, that of writing opinion pieces (op-eds) advocating for marriage for gay and lesbian couples and other issues related to LGBT mental health. GAP and the GAP LGBT Committee are described. The paper details the rationale for professionals taking on an advocacy project and the struggles and lessons gleaned from the project. Among other things, members of the LGBT Committee learned how to use existing position statements from their profession as well as scientific studies to assert their professional voices in opinion pieces.

Growing the Research Base

This is an exciting time for lesbian, gay, bisexual, and transgender (LGBT) health and mental health research. The Joint Commission (TJC), the main accreditation body for hospitals, has recognized the need for medical treatment to be culturally competent in order to be accessible and effective (The Joint Commission, 2010). TJC has included sexual and gender minorities among cultural groups that medical professionals need to show competence in treating. In turn, the Institute of Medicine (IOM, 2011) issued a report reviewing the current evidence that LGBT populations carry higher risk of health and mental health problems and called for more and better research on LGBT people. In roughly a generation, the scholarship on LGBT health and mental health has gone from the level of anecdotal clinical reports, to small studies done with convenience samples, to data taken from representative sample surveys and even the U.S. Census. Having the weight of government agencies and regulatory bodies behind this work will certainly continue to push the knowledge base forward. In the service of asking different questions at different levels of detail, we still need clinical data and convenience sample studies. The good thing about all this attention is that with it comes the ability not only to support larger, comprehensive studies but also the willingness of more academic institutions to support smaller and more specific efforts as well. The Journal of Gay & Lesbian Mental Health (JGLMH) has no doubt benefited the growing number of investigators who are able to study LGBT mental health. This issue includes no fewer than four original research

A Review of “The L Life: Extraordinary Lesbians Making a Difference.”

What could be more delightful than a coffee table book about lesbians? The L Life is a beautiful, polished volume of profiles of 26 lesbians, some famous, some less well-known. The chosen 26 includ...

The Full Spectrum

This issue of the Journal of Gay & Lesbian Mental Health marks the beginning of our fourth year as editors. We strive to continue to grow the Journal’s breadth, depth, and quality, seeking to portray the full spectrum of LGBT lives, as well as the full array of mental health issues and services used by LGBT people. In the first Journal issue of 2012, we offer papers on a variety of topics, from educating the public and professionals about LGBT issues, to papers on clinical treatment and clinical research, to the interface of transgender identity and trans people’s portrayal in the media. In the opening paper, “A Critical Review of Assumptions About Gender Variant Children in Psychological Research,” authors Sarah Gray, Alice Carter, and Heidi Levitt write of the need for a sense of context and culture in approaching gender atypical children. Noting that research on gender variant children has typically narrowly focused on whether the children will grow up to be gay or transgender, the authors suggest a different approach might be in order. Such an approach would consider the child in the context of her environment, culture, and relationships and would focus on mental health and adjustment as outcomes rather than solely focusing on gender and sexual identity. The authors review the existing literature through this lens, and we hope their viewpoint will stimulate more dialogue on this important topic. We are pleased to include the proceedings of the 2010 John E. Fryer Award lecture in this issue. Evan Wolfson, founder and director of Freedom to Marry, has turned his riveting 2010 Boston address on winning marriage for gay and lesbian couples into an equally compelling paper. The topic is particularly meaningful given New York’s marriage victory this past summer. Wolfson was given the Fryer Award, which honors an individual who has