Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.

Deborah Howell (Host):  Welcome to BayCare HealthChat. I'm Deborah Howell and I invite you to listen as we discuss mental health and the LGBTQ+ community. I'm joined today by Meena Mohan, a Licensed Clinical Social Worker with BayCare Behavioral Health. Meena, a true pleasure to have you with us.

Meena Mohan, LCSW, ACSW, DMCP (Guest): Nice being here too Deborah.

Host: All right, so let's jump right in. Can you tell us a little bit about gender dysphoria and sexual orientation and the meaning of LGBTQIA2-S?

Meena: Sure Deborah, I'd love to. Basically gender dysphoria, formerly known as gender identity, is completely different because the person feels that their biological sex is not the assigned sex they need to be. Sexual orientation is basically how they see themselves as their sexual identity. And the meaning of LGBTQIA2-S means L is for being lesbian,G's for being gay, B is for bisexual, T is for transgender, Q is for questioning, I is for intersex, A is for asexual, and 2 is two spirits where they believe they're both masculine and feminine residing in the same biological body and S is for sexual identity confusion. So, this is what it means and there are also two other variations in the social identity metrics, which is gender expression and chromosomal sex.

So, that's the difference. So, just because a person identifies themselves as a particular gender doesn't mean their expression is the same as their chosen gender and then sexual orientation also can be completely different.

Host: So, what's the importance of establishing cultural and linguistic competency as standards of care for organizations serving the LGBTQIA2-S community?

Meena: According to the US Department of Health and Human Services the national cultural and linguistic appropriate standards also known as CLAS are a way to improve the quality of services for these individuals to help reduce health disparities and achieve health equality. The CLAS standards are a set of 15 action steps intended to advance health equity, improve quality and help eliminate health care disparities, kind of providing a blueprint for individuals in health care organizations to implement culturally and linguistically appropriate services.

So, most of us kind of include these following things when we are providing information or being sensitive to this particular population. So, we need to acquire appropriate education for this, use the right terminology, like I just talked about and we have to advance health literacy and referral to additional services if needed.

Host: Sure. Now, speaking of health, what are some common types of mental health disorders present among this community?

Meena:  You will see mostly post-traumatic stress disorder, bipolar disorder sometimes misunderstood as dissociative identity disorder also because if you have someone with two spirits, people assume that they're having two different identities, actually it's one identity. And also generalized anxiety disorder, major depression, and at times schizophrenia too.

Host: Sure. Can you give us some strategies to creating a healthy and safe therapeutic environment between providers and LGBTQIA2-S?

Meena: So, the first thing I would say is sure, we have to understand the trans specific health literacy, how they see every body parts and understand how we can have multimodal aspects of gender transition involved. So, as health care providers, one of the ways we can strengthen this is increased awareness. And increased education among different community organizations, including hospitals and regular clinics, so that they're more sensitive to this particular population. So, basically the gender transition involves multiple modes of evolution, which includes medical, which is the cross-sex hormone therapy or surgery or lab work, social, adjustment to, or rejection of new social roles. Involvement in advocacy, psychological. That's where I come in, when I do the assessment and treatment of gender dysphoria. Financial, because it's a huge financial cost for them with medical treatment, lost wages, under employment. Physical, which includes how they're developing secondary sex characteristics, voice, hair, masculinity stature, et cetera, that also involves hormonal replacement therapy and spiritual where how much are they relying on their core values, how they embrace it, how they struggle with it, how they reconcile or reject it. And of course, relational, which includes disclosing to an impact of their relationship with their family, partners, peers, friends, and the last, but not least is the legal name change, gender change, birth certificate, court order, US passport.

So, while one of these transitions is going on, the medical team is very critical and important to enhance the overall wellbeing of this community. When they get involved medically, it's important to understand that their transition is in layers. So, some people are in medical transitions, some are there in social transitions, some are there financially, some are there physically or spiritually or legally. Based on where they are, we need to start from there and understanding and integrating services. The trans-specifics specific sources that helps a lot with communities and promoting awareness that trans resources such as WPATH Standards of Care and at UCSF Transgender Care and Center for Excellence.

We also have to take into consideration how these people are able to access resources like the FDM book list of new gender clinics, health care insurance, and trans and or legal services also. So, that helps a lot in helping the providers understand how to use the right terminology and exactly where they are in that transition process and becoming more sensitive and supportive to the client's needs, the patient needs. And then involving the families also along with it.

Host: Great, Meena, how can we help promote awareness and understanding of the LGBTQIA2-S among communities?

Meena: First thing is being sensitive and being aware that they do exist. They're considered as the invisible population, which is a misunderstanding. Many of them are afraid to come out because of the discrimination and lack of understanding. So, the first thing is education. I cannot stress this enough, Deborah, and being sensitive to the fact that their transition is a long lifetime journey and a dream, sometimes. Some of them are able to fulfill their complete journey and live the life that they need and want to live. And some cannot because of many obstacles in their lives. So, whatever the process is, the first thing is understanding. They are a visible community. And they are part of our community and being sensitive like we are with any race, gender, or ethnicity and inclusive services and not discriminate them based on their identity and asking, not assuming what they like to be called as because they like to be known by their specific pronouns, how they like to be addressed.

For example, I will introduce myself as cis-gender someone who is heterosexual and born biologically female. I like to use the pronouns she, her, hers and the same way you can ask them, like first question is, how would you like to be identified? And how do you see yourself? And that helps a lot first of all, in connecting with the patient and connecting with the client and that awareness and that sensitivity is huge in building a therapeutic or healthy rapport between the client and the patient after which that's when you want to know what part of the transition they are in and getting to know with the linguistic competency and the cultural competency as standards of care, when you're providing services to these organizations and communities. Also reducing fear and myths, that helps a lot. Because there are a lot of myths around what this community is and what they're not.

So, it's important to get connected and increase your awareness, training, sensitivity to it. And that would help a lot in helping them integrate very beautifully into the community. So, protection is critical, especially for adolescents who are not comfortable coming out to their families, I would say. So, we need to help them assist with this transition. And that is one of the challenges I face as a provider. And what I do is normalize it as much as I can and help understand that the person behind the whole physical presentation is still the same person, but especially in the wrong body, just like someone who believes they should be driving a Honda, is driving a Chevy.

You know? So, it's just a matter of understanding that and being sensitive and saying my engine is different. I was built to be a Porsche, but I have the body of a Chevy. So, using the right pronouns is critical. So, awareness really starts with acceptance and protection for them and promoting and advocating for them.

Host: Last question for you, Meena, what would you say to somebody who just throws up their hands and says, it's too complex. I don't understand what to call you. You know, what would you say to a person like that?

Meena: I would say that, yes, it is very scary in the beginning, but just like a person's ethnicity or culture or where they come from are so completely different, and you would take time as a provider to get to know that the best thing is to admit like, yeah it's too overwhelming and confusing, would you mind if I take some time to educate myself, would you mind to understand my professional limitations and competency?

And would you mind if I refer you out, so that I can get you the best service that you need is totally okay. All right. And that would help a lot and they will guide you. I mean, this community is extremely good in giving their own needs and presenting it very clearly what it is they're expecting. Some of them have transphobia, also. They have internal transphobia where they're not ready to deal with it. And they're really coming from mental health issues, and or physical issues. And they will say let's park that for a second and just deal with my other issues if you can, and then give me resources, then I'll follow through with it. It's okay. It's a new area. And very challenging and rapidly growing. And I would tell the person, teach me how to help you and together we heal you.

Host: I love it. Well, Meena, and this has been so enlightening. Thank you so much for all the good information you've given us today and the good work you do. It's a great gift.

Meena: Thank you so much for this opportunity. Take care.

Host: For more information, please visit BayCareBehavioralHealth.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts so we can share the wealth of information from our experts together. This is Deborah Howell.

Have yourself a terrific day.