LGBTQ Mental Health: The long road to wellness

Third in a three-part series on mental health

“They say coming out is a continual process,” said Terence Nelson. “I guess I really didn’t expect I’d still be doing it at my age, but in a way, it gives me purpose — educating a whole new group of people about who is gay and what that means. Especially at this age.”

Nelson was talking about coming out as gay in an assisted-living facility and as a person who lives with depression.

At 77, In May of this year, Nelson moved into a Center City assisted-living facility “just in time for Pride month.” His partner of 22 years died two years ago and Nelson’s health has been “shaky” since. “I didn’t want to leave our home,” he said, “but it felt less and less like home without James in it.”

Nelson began researching queer-friendly assisted-living facilities after James was diagnosed with cancer for the two of them, but then James died suddenly.

In the initial months after his partner’s death, Nelson said it was comforting to be surrounded by memories, but then it became a source of pain.

“I just kept seeing our life together,” Nelson said. “The one we no longer had. It felt like every day I was losing James all over again.”

Nelson said depression and anxiety “began to take over each day.” He would go to an early mass at the church off Rittenhouse Square where he and James were parishioners and spend time with friends, “but then at home it was always the same. A kind of darkness I had never experienced before, and it scared me. I was beginning to feel suicidal.”

Nelson decided he needed to be in an atmosphere with other older people “and be part of a regular community that was right there, that I could just wake up in the morning and it would be there, waiting for me.”

He wanted to get back to living, “instead of feeling like death was inevitable and looming.”

More importantly, he wanted to be somewhere that could provide him with treatment for depression.  “ I needed to be somewhere I could get some therapy for what I was feeling and be around other people who had experienced it,” Nelson said, adding, “Now that I’m here, I feel like I am living again. It’s better for me to be here, surrounded by purpose and companions than to be home, thinking about all I had lost, rather than how much more there is left.”

Teresa Theophano works with older adults at Services and Advocacy for GLBT Elders (SAGE) as a clinical social worker. SAGE is America’s oldest and largest nonprofit organization dedicated to LGBT older adults and aging. Theophano said many LGBTQ people deal with the kind of feelings Nelson was having.

“Depression, anxiety and social isolation are not uncommon among LGBT older adults,” Theophano explained. “But seeking services doesn’t always feel safe for the aging population.”

Theophano said there is a focus on youth in LGBTQ mental health, particularly with regard to death by suicide. In May, she attended an American Foundation for Suicide Prevention conference on LGBTQ issues and “among the symposia, only one was on older adults. All of them were about youth.”

According to the Suicide Prevention Resource Center and the National Institutes of Health, the highest death by suicide rate in the U.S. is among men over 60, and the numbers increase with age. While older adults make up only 12 percent of the population, they represent 20 percent of those who die by suicide. Younger people may attempt suicide more often, but older adults plan their suicides more carefully and choose more deadly means, with nearly 90 percent using guns or suffocation.

When New York City therapist Bob Bergeron died by suicide on New Year’s Eve in 2012, a dialogue began surrounding issues of aging and depression in the gay male community. Bergeron was handsome, accomplished, respected in his field and at the pinnacle of his career with a new self-help book on gay male aging soon to be published. His family was supportive of him as a gay man; he had an active social life, was at the gym every day working out and was known to friends as being “relentlessly cheerful.”

When Bergeron didn’t show up for a series of appointments with his clients, alarms sounded. He was found dead in his Manhattan apartment. A suicide note and all his financial details were carefully arrayed for whomever found him.

The New York Times wrote a detailed story about his death in March 2012, interviewing his friends, family, clients and publisher. The story, with numerous photos of a youthful-looking Bergeron, ran not in the news or even health section of the paper, but in the fashion and lifestyle section.

Theophano explained, “While being out as LGBT and living with a mental health condition can be challenging at any age, elders who came of age in a repressive and oppressive social environment may be all the more reluctant to seek care.” She added, “This is exacerbated by the presence in their lives of family members, including caregivers, who may not be LGBT affirmative.”

Affirmation remains fundamental to mental health, but accessing support and therapy often needed to address depression, anxiety or other mental health conditions is not simple for LGBTQ people. Mental health advocates assert that homophobia and transphobia can present daily cause for psychological trauma and exacerbate existing mental health conditions.

Anna Kiesnowski is a licensed social worker and supervises the Gender-Affirming Services program at Mazzoni Center. Kiesnowski said, “LGBTQ mental health services in general and TGNCNB [transgender, gender nonconforming, nonbinary] services in particular are viewed as specialty care, and it’s really not.”

She said the goal has to be to expand services everywhere to be inclusive and competent in care for LGBTQ people with mental health care needs. Services like those at Mazzoni need to be incorporated into all facilities and programs that address mental health, Kiesnowski said.

Theophano agreed with this assessment, noting, “Providers have to be mindful of issues that come along with being older, or with youth, or with multiple marginalized identities, TGNCNB — anyone on that spectrum.”

She said, “more people are coming out as TGNCNB” and “there is so much trauma embedded for queer people.”

For older LGBTQ adults, Theophano said providers must “pay attention to what informs their experience. Threats of fear and intimidation can be lasting. It hasn’t been that long since people could be arrested just for not wearing the three articles of clothing ascribed to their gender.”

Constant roadblocks make it hard for LGBTQ people to access mental health care, but work is being done to make it less arduous, said Kiesnowski.

“Geography is a challenging barrier,” she said, noting that people often drive as many as eight hours to get to therapy appointments at Mazzoni because of the “dearth and scarcity of programs and services, particularly with regard to gender-affirming and queer-affirming care.”

One of the things Mazzoni does, Kiesnowski explained, is “vouching and vetting outside referrals. Contacting therapists to check out their trans and queer competency.”

She said, “finding trans-competent therapists” is especially challenging. “Trans- and queer-competency goes beyond knowing pronouns and the TGNCNB words. It means understanding the underlying trauma and being able to address that fully.”

Kiesnowski sees programs like hers at Mazzoni as both innovative and modeling for others. “We can do this everywhere,” she said. “We really can create programs and train therapists to offer the kind of care everyone needs.”

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

This article originally appeared in Philadelphia Gay News on August 15, 2019.