LGBTQ mental health: The perils of the system

Second in a three-part series on mental health.

President Trump blamed mental health conditions for the latest wave of mass shootings in an Aug.5 speech delivered at the White House when he said,  “Mental illness and hatred pulls the trigger, not the gun.”

In a tweet the day before Trump said, “We must reform our mental health laws to better identify mentally disturbed individuals who may commit acts of violence and make sure those people not only get treatment but, when necessary, involuntary confinement.”

The American Psychiatric Association responded with a statement Aug. 6, which read in part, “It is important to note that the overwhelming majority of people with mental illness are not violent and are far more likely to be victims of violent crime than perpetrators of violence. Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment.”

There has been no involuntary confinement of people with mental health conditions without proof that they are a danger to themselves or others since 1964 in the U.S., when deinstitutionalization acts began being legislated.

Stephanie Schroeder is a mental health advocate and the co-editor, with Teresa Theophano, of “Headcase: LGBTQ Writers and Artists on Mental Health and Wellness,” a compendia of writings by people with mental health conditions as well as mental health professionals. Included is some history regarding harm done to LGBTQ people by the mental health system.

Schroeder explained that the book is fundamentally “about marginalized people hitting barrier after barrier which is our mental health care system.”

One of Schroeder’s personal goals is to help LGBTQ people with mental health conditions combat stigma and find help that is safe and won’t add to any existing trauma.

Schroeder, who previously authored a memoir, “Beautiful Wreck,” about her own experience with bipolar disorder and her stint in a mental hospital, advises on how to treat LGBTQ people in the mental health system. Non-LGBTQ people don’t understand how LGBTQ people are treated both within the system and by law enforcement, Schroeder explained. She said she is “bringing LGBTQ 101” to places like the shelter where she works where “everyone is well-meaning, but they just don’t get it.”

One thing Schroeder is adamant about is how careful people must be when calling EMS on folks with mental health conditions, particularly when they are trans, nonbinary or gender nonconforming.

Schroeder said it’s crucial people understand that jail is where most people suffering from mental health conditions will be taken, though some may be lucky enough to visit the emergency room. This can criminalize those suffering from mental health conditions.

While Emma Marcus was taken to the hospital when she had a psychotic break during a manic episode of undiagnosed bipolar disorder, she said, “I probably would have gone to jail or would have been shot if I hadn’t been a white woman with a recognized social services person advocating for me.”

A gender nonconforming lesbian, Marcus said she had been under intense stress at her job for months before the incident and had been having constant panic attacks.

When she didn’t show up for a planned meeting with her ex-partner, Lara Moore, Moore went to Marcus’ house to check on her. She was greeted by a frantic Marcus, who “seemed out of control and talking very fast.” Deeply concerned and unsure what was happening, Moore tried to convince Marcus to go to a doctor or the emergency room. Marcus refused and left the house. Moore called a close friend, Zora Taylor, a social worker, as well as Marcus’s doctor. She then called police, concerned Marcus might harm herself.

Several hours later, over a dozen police officers put Marcus in a police van. She had struck two officers, knocking one to the ground. Police repeatedly asked Moore if Marcus was using drugs. She was not. Moore kept pleading with police not to harm Marcus, as did Taylor.

Police offered Moore and Taylor the option of jail for Marcus with assault and other charges, or a 72-hour hold in a psychiatric ward. They chose the latter. Marcus was handcuffed and put in a police van.

It took nine hours for Marcus, who was brought to the hospital by police, restrained and sedated on a gurney, to be processed. She was transported to Einstein Medical Center and admitted for a court-ordered 72-hour examination in a locked psychiatric ward. Marcus has only minimal memory of the confrontation with police and none of the first 36 hours at the hospital.

Marcus called the police response to her “disproportionate” and said, “This is how people get shot, tased and beaten up by the cops while lying in the street.”

She added, “In Philadelphia, police have a remarkable lack of training with mentally ill people. I didn’t have a weapon. But what if you’re wearing a jacket and reach for something?”

When PGN contacted the Philadelphia Police Department to ask about procedures and training for dealing with folks with mental health conditions and LGBTQ people in particular, the police provided a 16-page PDF on how police should respond to SMDP: severely mentally disabled persons. Moore and Taylor said virtually none of what Taylor deemed “really comprehensive” rules for were followed with Marcus.

Taylor said, “The police were not patient, nor were they gentle with Emma. She was repeatedly struck. What’s more, they really wanted to charge her with crimes when she was obviously…in the street in a near-textbook case of psychosis.”

Marcus was diagnosed with bipolar disorder and has been on medication with concomitant therapy since that incident. But she said her experience left her traumatized and with a level of fear she didn’t have before. She had to quit her stressful job and was unemployed for some time, which spiraled into poverty.

Schroeder said many LGBTQ people suffering from mental health conditions like Marcus often end up on the street. Of her own experience, she said, “The reason I was able to recover was because I had housing and friends.” She said it was “pretty damn hard to get life-saving treatment” and she’s a well-educated middle-class white lesbian. But she added that “obtaining meds and not having insurance” can be a literal killer for LGBTQ people. She said the system does not welcome LGBTQ people, nor even, for the most part, understand them.

Schroeder explained, “Queer people are at the bottom of the social ladder, facing every single barrier — barrier after barrier — to getting the help they need. We have to work on that, because there’s a crisis out there that is not being met.” 

Some names have been changed to protect the privacy of the interviewees.

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Victoria A. Brownworth is a Pulitzer Prize-nominated award-winning journalist whose work has appeared in The New York Times, the Los Angeles Times, The Philadelphia Inquirer, Baltimore Sun, DAME, The Advocate, Bay Area Reporter and Curve among other publications. She was among the OUT 100 and is the author and editor of more than 20 books, including the Lambda Award-winning Coming Out of Cancer: Writings from the Lesbian Cancer Epidemic and Ordinary Mayhem: A Novel, and the award-winning From Where They Sit: Black Writers Write Black Youth and Too Queer: Essays from a Radical Life.