Maggie McKay (Host): Welcome to Wellness Waves, a podcast from Bergen New Bridge Medical Center. I'm your host, Maggie McKay. Today, we're going to find out about the importance of integrating healthcare and behavioral health services for the LGBTQ+ community with Calla Myerjack, LGBTQ+ Clinical Community Liaison, and Vince Nicosia, LGBTQ+ Behavioral Health Specialist. Thank you so much for being here, both of you.

Vince Nicosia, LCSW: Thank you for having us.

Calla Myerjack, MS, PA-C: Thanks for having us, Maggie. Good morning. Yeah. What a good way to celebrate pride.

Host: Calla, let's start with you. What role do primary care providers play in integrating behavioral health services into routine healthcare for LGBTQ+ individuals?

Calla Myerjack, MS, PA-C: We are sort of the front lines in that regard, serving as a screening tool for our patients. I really think that it's important for primary care providers to have a template that they ask every patient in regards to not only their physical health, but their mental health as well. It's the primary care provider's role to, in a way that doesn't make it sound like psychiatric or mental health services are needed, kind of screen for that in every individual patient to begin getting that ball rolling for access to those resources, if the patient needs.

Host: And Vince, what are some of the healthcare challenges faced by the LGBTQ community? How can integrating behavioral health services address these challenges?

Vince Nicosia, LCSW: So, there's multiple challenges that the community faces. Right now, we're experiencing higher rates of anxiety and depression, during a very sociopolitical times that are challenging. People don't have access to care, right? Affirming care. There's not many knowledgeable, affirming providers that have the knowledge behind them to really back them up. And because of that, there's also an increased risk of suicidality, substance misuse, because they're learning poor coping mechanisms, They're relying on other alternatives versus mindfulness and therapy that can actually help navigate them through stressors.

Another barrier is insurance barrier. Some people don't have access to insurance or Medicaid funding. So, trying and navigating these times with uncertainty can increase everyone's stress levels, depression levels, and everyone's kind of like living in the unknown, so kind of like navigating that. Being able to bring that into behavioral health world, and being able to have an affirming provider can help navigate these difficult challenges.

Host: That's a lot to deal with, you know, in addition to just normal everyday life. But yeah, you're right. That's a lot of challenges. Calla, how do social determinants of health influence the necessity for integrated healthcare strategies, specifically for the LGBTQ+ population?

Calla Myerjack, MS, PA-C: I think the social determinants of health directly and indirectly influence a person's need for physical, mental, and spiritual health. There are five social determinants of health that are often talked about as individual components. But I just want to call attention to intersectionality and the fact that oftentimes a person is representative of more than one of those social determinants of health, more than one overlapping socioeconomic factors such as gender identity, sexuality.

So, individually, education, that can impact a person's health literacy in terms of them being aware that they may need help, mental health, physical health. It may call someone into that concept of you don't know what you don't know, and therefore asking for help. It's not up to a patient to necessarily always understand or be able to solve their own healthcare problems. It's just most important that they're able to ask for help. Education and economics are kind of overlapping, because it kind of talks about income and those who have a higher level of education are often able to access a higher level income. And that also calls for stability in terms of housing, access to transport to healthcare, and access to housing in areas where there is competent healthcare, which is the third social determinant of healthcare. And can the patients afford that care?

And then, we kind of talk about social community and built environment as two separate things, but they're kind of always overlapping. So, how's the built environment? There's some concepts that the outside environment can kind of reflect into the inner of a person. So, are they living in a city where there's just a bunch of concrete and no access to green space? That can kind of create a more grey picture on the inside. Do they have access to food? Do they have access to fresh food, not just fast food? And then, who are you surrounding yourselves with your social community? Are these people helping you to make good choices? Or are they encouraging maybe those coping behaviors that Vince was talking about that are sometimes necessary but not always fruitful?

Host: Maybe you could both weigh in on this, what barriers exist in healthcare systems that hinder the integration of behavioral health services for LGBTQ+ patients? And how can these be overcome?

Vince Nicosia, LCSW: I think number one thing is kind of like having providers that are experts in this field who know what they're doing to provide affirming care. I also think Bergen New Bridge is one of its kind, because we provide a comprehensive center where we are able to communicate just down the hallway from each other with primary care, the medical professionals and the bigger mental health professionals. We're closed corridors. We're not a referral system, we're not a, "Here's a list of people call them," right? We're right here, easy to access. We provide wraparound care.

With that being said, everyone here is in the know and provide the best care to our patients. And of course, outside of that, the barrier is also stigma and discrimination. A lot of people who have had bad experience in the past with affirming care, who they felt they've misgendered, then named, right? They don't feel seen or valid, right? Even people who are identified as gay and lesbian, they don't feel like they're being taken seriously. Or they're being poorly portrayed, because they're asking questions regarding PrEP, you know, and STI testing. Coming here to a center that's kind of comprehensive, and we are understanding, we are affirming, that provides a space where we actually amplify their voices, and encourage them to speak up about their feelings, because then we can best support them and where they're at currently.

Calla Myerjack, MS, PA-C: I'm going to jump right off Vince's point about stigmatization because that's what my brain went to right away with this question. I truly think that lived queer experience is invaluable when you're working with queer patients. Yes, we definitely live in a heteronormative world, built to reward those who remain complacent in that system.

A foundational concept of queerness is kind of always pushing the boundaries of social norms and where can I exist as a queer person within these boundaries, while also maybe kind of redefining what it is to be a human. When you're kind of battling that, it's very easy to feel like a dissonance between your spiritual, your physical, your mental wellbeing, and then it's easy but not permissible for providers to point at those things and say, "Hey, your gender, your sexuality. Like, these are the reasons why you're like this." We can't change our gender, we can't change our sexuality. What can change is systems.

So, we can change the access before a person gets to the doctor's office. Rides through insurance, rides through public transport. We can change the system, the environment in the healthcare office, in the waiting room and the environment in the patient's room, as well as the hospital overall, you know, the laboratory, the x-ray tech, the ultrasound techs. I think changing the systems is definitely a way to abolish those barriers.

Host: Good point. How does the integration of healthcare and behavioral health impact suicide prevention efforts among the LGBTQ+ teens and young adults, because that's a big issue it sounds like these days, right, Vince?

Vince Nicosia, LCSW: Definitely, definitely. And I think it's really important because, over here, we have a screening process. It's for all new patients, right? They come in, they do scale assessments with PHQ, they do the GAD, those are depression scales, anxiety scales, right? All the professionals here do that. And they're able to identify what is going on exactly in the patient's life, if it's a necessary referral. If it's a necessary referral, I get contacted right away and I make the next step referral to me, directly contact.

We also have a patient navigator that also helps me navigate getting ahold of patients too, because not everyone's easily accessible by phone sometimes, right? Or no one's able to answer the phone right away, or email. So, we have people here who are set in place of being able to pick up at all times. Even our front desk people, right? They have access to the phone, they have the access to the front desk number. They're able to call them even and then message me afterwards. We're able to communicate thoroughly.

The whole point is kind of like having access to mental health provider to reduce suicidality, being able to come to an affirming space to reduce suicidality. Because the more you feel seen, heard, and represented, the more safe you are about expressing your feelings and how you feel. And then also like, between the care coordination team here, we're able to get people who are HIV positive into care, right? People who are at risk Into care, people who are experiencing homelessness, seeing where they're at with homelessness, meeting where they're at.

And again, like even with what Calla said before about interpretation, right? Interpretation is a big one. Getting kids to their appointments. "You can't make it here. Let's figure out if your insurance covers it. If your insurance is covered, maybe we can offer a ride." If you can't offer a ride, maybe we can do telehealth. We try to figure out how can we best accommodate patients with referring providers that actually care for them, and see them as a whole person. I think that's kind of like where the whole reducing the stigma comes in. Because the more and more you feel heard and seen, the less stigma you feel, at least in healthcare.

Host: Calla, how can healthcare practitioners create an inclusive environment that prioritizes the needs of LGBTQ+ patients?

Calla Myerjack, MS, PA-C: it varies from being incredibly easy to incredibly complicated depending on your resources and the support of your system. Some easy things people can do, hang progress and trends flags in the office. Put them in flower pots, put them on the wall. That's our first signal. When we see that, "Oh, okay. This is a space where they're caring about me." Music selection, queer people make music. Straight people make music. Let's integrate that together. Let's have music representing every kind of person. If you have patients of color, add some music from artists of color in there. Music sets a vibe. We're talking visuals. We're talking hearing, and overall energy of a space.

If you are able to have gender neutral restrooms, cool. If that's not in the budget, you can just have a sign at the front desk that says, "Here's the key to the bathroom. Please choose the bathroom that aligns with your gender identity." Put pronouns in email signatures. And wear pronoun pins on your badges. It's not so much for cis folk, it's more for cis folk to signal to queer folk that, "Hey, I'm an ally," or, "Hey, you're safe with me."

Screen for mental health and psychiatric needs in all patients in a way that doesn't mean that they are necessary or accusing a queer person of needing these things. You just ask every single patient. The way I kind of phrase it is, "Hey, have you ever needed psychiatric care before?" "Hey, have ever needed to talk to a mental health provider?" Not everyone has to, and don't shame people who do or people who don't.

And the last thing I would say about that is, if you're unsure how to bring something up to a queer person, just preface it with a trigger warning. For example, if you're talking to a trans man about, OB-GYN care, "Hey, I have a question that might make you feel very uncomfortable, but it's important to contribute to overall health. Have you had your Pap smear?" And a lot of people really express appreciation for that trigger warning, and the conversation is much more productive.

Host: It sounds like you guys, well, your program and you both have thought of everything possible to make people feel welcome and want to come there. So, I think it's awesome. Again, thank you so much. This has been so educational and helpful. And I would think reassuring to people visiting you from the LGBTQ community. So, thanks for sharing your expertise with us.

Vince Nicosia, LCSW: Yeah.

Calla Myerjack, MS, PA-C: Thanks for having us on. And yes, we are with our community and we have great leadership that helps us accomplish these things, both in the program and in the hospital. So, very feeling much gratitude for that this week.

Host: Absolutely. Again, that's Calla Meyerjack and Vince Nicosia. To find out more, please visit newbridgehealth.org. That's newbridgehealth.org/healthservices-lgbtq-health, or just newbridgehealth.org.

If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wellness Waves from Bergen New Bridge Medical Center.