Practice Profile

Eight years ago, Julie spent 15 hours a day sleeping and her only regular human contact was her weekly visit to her therapist. Then, Julie, a 49-year-old lesbian with major depression, psychotic features and post-traumatic stress disorder, found out about Rainbow Heights Club in Brooklyn, N.Y., a safe, welcoming gathering place for lesbian, gay, bisexual and transgender (LGBT) people with mental illness.

She goes there two to three afternoons a week, to work on art projects, to join in the various support groups the club provides and simply to sit and talk with other members. Rainbow Heights, she says, has become her family and she credits its supportive and loving atmosphere with keeping her mental illness under control and keeping her out of the hospital.

“My temporary moods pass, and pass much quicker because I know I’m cared about,” says Julie.

Now, in addition to being a club member, Julie has led several Rainbow Heights groups and classes as a peer counselor. The club’s heart is its executive director, clinical psychologist Christian Huygen, PhD, who specializes in LGBT mental health. Huygen began to understand the need for a space like Rainbow Heights Club in 1999 as an intern at Heights-Hill Mental Health Service in Brooklyn. Although the clinic was training its therapists to provide affirming and sensitive care to LGBT clients, many of them felt just as isolated as Julie, says Huygen. These clients were receiving culturally sensitive, high-quality treatment, yet still felt that they had no place to feel safe or be fully open about both their mental illness and their sexuality. Beyond the clinic, they often felt like outsiders, says Huygen, who is openly gay himself.

That’s when Huygen began to understand the important role community interventions play in successful mental health treatment. So, when Heights-Hill’s community advisory board applied for and received a grant in 2002 from the New York City Department of Health and Hygiene to create Rainbow Heights Club, Huygen jumped at the opportunity to be its first director. He’s now its executive director, overseeing a staff of 12 social workers, psychologists and peer advisers who run support groups and counsel club members.

The publicly funded club, which has operated for eight years, has 500 members. Anyone over 21 years old who self-identifies as LBGT and who has been diagnosed with an Axis-I mental health disorder can join. Members come to Rainbow Heights as often or as little as they want, Huygen says. Some visit only occasionally, others every day. The high point of each day, says Huygen, is when club members and staff sit down to a family-style meal at 4 p.m. Members help plan, cook and shop for the meals, including budgeting so the meal costs only $1 per person.

“They’re learning life skills that many of them have never learned and participating in a lovely social ritual,” say Huygen.

Huygen’s become a real ambassador for the LGBT mental health community, and not just on behalf of Rainbow Heights, says psychologist Barbara Warren, PhD, director of Hunter College’s Institute for LGBT Social Science and Policy. Huygen is also a passionate advocate for LGBT cultural competency, making the case to therapists, lawmakers and mental health administrators that people in the LGBT community are just as deserving of culturally appropriate treatment as any other marginalized group.

“Some people are good at running programs, some people are good clinicians, some are good at research,” says Warren. “Christian’s amazing at all of it. He’s been tireless as the voice of the LGBT mental health community.”

Moved to help people

Huygen didn’t decide to be a psychologist until he was nearly 30. But as an English major with a psychology minor at Oberlin College, and then an actor, playwright and director, he was fascinated by the psychological accuracy of writers such as Virginia Woolf and Samuel Beckett. After college, he wrote a playful drag-queen remix of Beckett’s “Waiting for Godot” called “Waiting for Godette,” which ran successfully at San Francisco’s Theatre Rhinoceros in 1993.

Then, after eight years in the theater world, he realized that his artistic endeavors didn’t move him as much as volunteering for the Visiting Nurses Hospice Association, where he worked with AIDS patients. “I felt like I was having an enormous impact on people’s lives,” he says. “I realized that I wanted to move more in that direction.”

In 1996, he attended a clinical psychology graduate program at the New School for Social Research in New York City. Both his research, on the role social context plays in autobiographical memories, and his clinical work focused on the needs of the LGBT community. He came to Heights-Hill Mental Health Service as an extern in 1999, where he worked primarily with LGBT clients, many of whom spoke with him about the isolation they felt out in the world. While Huygen was at Heights-Hill, staff psychiatrist Ron Hellman, MD, and chief of service Eileen Klein, PhD, began brainstorming ways to create a community support center for mentally ill LGBT patients. Their idea blossomed into Rainbow Heights Club and in 2002 they hired Huygen as director.

Because the club is designed to provide a safe place for members, not meet all their mental health needs, members must receive separate treatment for their mental illnesses. The approach appears to be both successful and cost-effective, says Huygen. He estimates the program saves New York state millions of dollars each year by helping keep close to 90 percent of its members free of psychiatric hospitalization. After joining Rainbow Heights Club, members tend to participate more consistently in treatment, which in turn prevents relapse and hospitalization.

That’s certainly been the case for Julie. She can recall six occasions since she joined Rainbow Heights when she thought she might need to be hospitalized for her mental illness. “Because of the intervention of the staff and the other club members, that wasn’t necessary,” says Julie who has also begun working part time tuning pianos, cleaning and writing.

She’s a great example of how Rainbow Heights brings out members’ strengths, says Huygen. “We often don’t fully recognize the resilience, courage, creativity and playfulness that it takes to build an identity and a web of support even in the face of stigma and oppression,” he says. “The strengths I see Rainbow Heights Club members showing every day are inspiring to me.”

The club’s success may also lie in the power it gives to members to shape how the program operates, says Huygen. For example, they created the club’s code of conduct and provided input on the focus of weekly support and activity groups. Today, the groups include a men’s group, a thoughts-and-feelings group, a dreams-and-goals group, and even a shopping group.

Huygen points out that while the club’s social workers and staff psychologists provide much-needed clinical experience, just as important are its peer counselors. They may or may not be LGBT, but all have experienced mental illness and what it takes to recover, says Huygen. They act as mentors and provide enormous support for club members. In the end, it’s the community created by Rainbow Heights, rather than any individual service, that makes it successful.

“I was trained to work one-on-one with people with the idea that the individual is the locus of the problem,” says Huygen. “At Rainbow Heights, we work instead within a whole social context, with a whole community, and watch as people become sources of support for each other.”

Spreading the word

When Huygen isn’t at Rainbow Heights Club, he’s promoting the need for LGBT cultural competency among mental health providers and agencies. He estimates that as many as 11,000 LGBT mental health patients live in New York City alone, but argues that many of them don’t feel comfortable being open about their sexuality even with their therapists.

Therapists can be insensitive, assuming heterosexuality until proven otherwise, and putting the burden on clients to open up and discuss their sexuality and gender identity, says Huygen, who co-chairs and sits on several city and state-wide LGBT advocacy committees.

Many studies find that people in the LGBT community are at increased risk for depression, anxiety and suicide; they have higher rates of drinking, drug use and other unhealthy behaviors. They also seek help more often, says Huygen. “But when they don’t get their needs met,” he adds, “they leave treatment prematurely.”

It’s not difficult to learn the skills to provide LGBT mental health patients with affirmative care, says Huygen, who has presented his cultural competency program on LGBT mental health issues to service providers in more than 200 different agencies, universities, hospitals and clinics. To start, clinicians can include in their waiting rooms brochures about LGBT-affirming programs, and LGBT magazines along with the other publications on display. “It sends a clear message that everyone is welcome,” says Huygen.

Clinicians can also learn to use inclusive language. For example, rather than ask whether a client is married or has a boy- or girlfriend, they could ask whether the client is “in a relationship now.” And, when clients make disclosures about their sexuality, clinicians can say, “I’m glad you told me that.” More practice guidelines are available at Rainbow Heights Club, as well as from APA.

Huygen believes all clients, not just those who are LGBT, can benefit from these types of skills.

“The real goal of the work we do is to have all mental health consumers receive acceptance, regardless of who they are,” says Huygen. “Do that and you’ll see treatment improve dramatically.”

Beth Azar is a freelance writer in Portland, Ore.