To the Editor: There is little documentation in the literature on culturally focused services for lesbian, gay, bisexual, and transgendered (LGBT) persons with major mental illness, despite the unique sociocultural issues and identities that they bring into long-term mental health care settings (1,2). We report here on a sample of individuals attending a culturally focused program for LGBT patients with a diagnosis of major mental illness.
Participants attended the Rainbow Heights Club (RHC) in Brooklyn, New York (3), which was created in 2002 in association with the LGBT Affirmative Program of South Beach Psychiatric Center in Brooklyn (4). Seventy-five individuals were assessed during May and June 2006. After informed consent was obtained, participants completed a multiple-choice questionnaire measuring level of participation and impact of the program. Data were analyzed through response frequencies and multivariate analysis of variance (MANOVA).
Study participants had been in psychiatric treatment an average of 16 years. The percentages reported here are based on the number of participants who completed each item. Among the 69 participants who completed the item about diagnosis, affective disorder was the most common diagnosis (32 participants, or 46%), followed by psychotic disorders (24 participants, or 35%), anxiety disorders (seven participants, or 10%), and other disorders (six participants, or 9%). Information about medical conditions and about substance abuse was available for 72 participants. Thirty-six (50%) reported having significant medical conditions. Three (4%) admitted to current abuse of alcohol or other drugs.
Of the 73 participants who answered the question about duration of program attendance, 31 (43%) had attended for more than two years, 22 (30%) had attended for one to two years, and 20 (27%) had attended for less than a year. Thirty-four (47% of 72 respondents) attended more than once a week, and 13 (18%) attended less than once a month. Fifty-five participants (76% of 72 respondents) stated that they found the RHC program very helpful. Thirty-six participants (54% of 67 respondents) reported being more adherent to their mental health treatment because of their involvement in the RHC. Fifty-three participants (80% of 66 respondents) reported that their psychiatric symptoms were better or much better since they began attending the RHC. Forty-one (61% of 67 respondents) reported that their relationships were better or much better since they began attending, and 26 (39%) said that their relationships were the same as before program entry.
Thirty-six participants (51% of 70 respondents) reported spending time with other members outside the club, and 66 (92% of 72 respondents) reported that it was somewhat or very helpful to think about the club when they were not there. Fifty-three participants (78% of 68 respondents) reported better or much better self-esteem since they began attending RHC. Forty-three participants (63% of 68 respondents) reported better or much better ability to manage stress, and 53 (78% of 68 respondents) reported that their sense of hope was improved or much improved.
The MANOVA tested the relationship between five independent variables (substance abuse, helpfulness of the RHC, spending time with members outside RHC, sexual identity, and age) and five dependent variables (symptom improvement, relationships, self-worth, stress, and sense of hope and purpose). A significant association was found between spending time with RHC members outside the club and the dependent variables (Wilks' λ=.719, F=3.360, df=5 and 43, p<.012). The between-subjects test indicated a significant association between spending time with RHC members outside the club and a general improvement in social relationships since joining the RHC (F=5.68, df=1 and 1, p<.021).
These findings indicate that the members of a culturally focused program for LGBT individuals with major mental illness experienced improvements in symptoms, mental well-being, and socialization. Further research is necessary to validate these findings and to determine whether they are causally related to specific program elements and why program members benefit. Studies of this minority population are rare and have been limited by small samples. These preliminary findings hold promise for culturally sensitive LGBT programs for persons from sexual minority groups who have chronic and disabling psychiatric disorders.
The authors are affiliated with South Beach Psychiatric Center, Brooklyn, New York.
The authors report no competing interests.
Hellman RE: Issues in the treatment of lesbian women and gay men with chronic mental illness. Psychiatric Services 47: 1093—1098, 1996
Hellman RE, Sudderth L, Avery AM: Major mental illness in a sexual minority psychiatric sample. Journal of the Gay and Lesbian Medical Association 6:97—106, 2002
Rosenberg J, Rosenberg SJ, Huygens C, et al: Stigma, sexual orientation, and mental illness, in Community Mental Health Challenges for the 21st Century. Edited by Rosenberg J, Rosenberg SJ. New York, Routledge, 2006
Hellman RE, Klein E: A program for lesbian, gay, bisexual, and transgender individuals with major mental illness, in Handbook of LGBT Issues in Community Mental Health. Edited by Hellman RE, Dresher J. New York, Haworth, 2004