In Between: The need for competent mental healthcare for Queer People of Color in SLO County
During the past two years, LGBTQ+ Californians have endured more mental health struggles than their cisgender, straight neighbors, according to data from the US Census Bureau. In San Luis Obispo County alone, 51% of LGBTQ+ youth and 58% of Transgender and nonbinary youth have considered suicide, according to a 2019 Mental Health Needs Assessment by SLO County.
Yet, the scarcity of mental health services, especially in rural parts of SLO County, is an issue that has plagued the area for years.
Marriage and family therapist Kamala Proulx works as a counselor at Atascadero High School.
"Even before the pandemic, therapists in our area have been hugely impacted," Proulx said. "They've had huge waitlists. People aren't taking on new clients. On top of that, there is a lack of knowledge in providing affirming care., I think there's a lot of well-meaning folks out there that just really don't know how to — really — support people in the queer and trans community
Isolation from pandemic lockdowns has worsened the problem. One in five LGBTQ+ Californians have reported needing mental health services but not receiving help, according to a report done by the California Budget & Policy Center. Access to mental health care like a therapist — especially a queer-affirming therapist — can be hard to find.
According to SLO County’s Mental Health Needs Assessment, affirming therapy includes LGBTQ+ cultural competence that offers support for clients’ self-declared sexual orientations and gender identities. It also provides awareness of the connections between mental health and the different societal stigmas and discrimination that affect the LGBTQ+ community across a variety of intersecting, marginalized identities — like gender identity, race or disability, for example.
Proulx said affirming care lets clients know they’re being seen.
"That they're being respected, given just basic human decency. I mean, that is just the — the ground floor of what they need," Proulx said. "And — and it's not asking much just to use someone's correct pronouns. That's pretty easily done."
SLO County resident Roberto Cueva works as a texting programming coordinator at Central Coast Hotline. It’s a local suicide prevention and mental health resource hotline available to county residents for free. Cueva said he’s experienced his own difficulties accessing culturally competent mental health care as a queer person of color.
"I think it has to do a lot with the past politics of San Luis Obispo County being mostly conservative — I feel like in the past," Cueva said. "I think that has something to do with [the lack of services]. And still now in areas in different parts of the county being less accessible to people from the LGBTQ+ community, I think that has something to do with — I felt like — having the lack of diversity here."
Cueva has been living in SLO County since he was 3 years old and moved away for a short time to attend school in San Jose. He said there’s a “night and day” difference being a part of the LGBTQ+ community there versus in SLO County.
"Just feeling like there's less gay people around for myself to connect with, maybe some of the therapists don't feel like there's enough people here from that community — from those communities to be here practicing in SLO County," Cueva said.
Discrimination, family or social rejection and internalized oppression are also likely factors in increased rates of distress among LGBTQ+ individuals, according to a study done by #Out4MentalHealth. Socioeconomic status, cost of living and income can add even more stress to LGBTQ+ people. The study said that’s especially true for people of color, who have a higher risk for negative mental health outcomes due to their experiences with racism and heterosexism.
Leo Corley was born in Goleta and grew up in Paso Robles. Now he’s 40 years old and is currently looking for affirming mental health services in SLO County.
"I don't think people around here are very capable of serving, like, black people, necessarily, with their mental health," Corley said. "So how the hell am I going to find someone who can help me as, like, a black, queer and trans person? I'm going to look because, for me, I'm at the place in my life where I need mental health services. I'm not trying to be stigmatized about that. I'm not trying to be ashamed of that. I'm, like, running toward that like, where is it?"
"It's not asking much just to use someone's correct pronouns. That's pretty easily done."Kamala Proulx, Atascadero High School counselor
A study done by the Journal of Gay & Lesbian Mental Health found LGBTQ+ individuals living in semi-rural communities, like much of SLO County, may experience extra barriers trying to find affirming mental health care and building necessary community support networks.
"Let's not, you know, beat around the bush and pretend like this is an easy thing to just — you can't just go to the corner store and get me a therapist," Corley said. "Like, it's a whole ass, like, journey and search, and you got to deal with people who are, like, not good people to be dealing with when you're already, like, so vulnerable."
The lack of access to competent mental health care — or lack of knowledge or basic understanding about LGBTQ+ issues and affirming language — pushed some SLO residents to take matters into their own hands. One Cal Poly assistant professor and private practice therapist led a months-long research project in 2018 to help better assess the mental health needs in SLO County’s LGBTQ+ community.
Dr. Jay Bettergarcia partnered with the SLO County Behavioral Health Department to create Queer Community Action, Research, Education, and Support or Q C.A.R.E.S. Their goal was to reach out to people who aren’t typically contacted, particularly looking at outreach in the northernmost and southernmost ends of the county. Bettergarcia’s own personal experiences are similar to a disparity they saw in the way LGBTQ+ folks’ needs weren’t — and aren’t — being met.
"I identify as queer and trans and Latinx. And when I was looking for therapy, back in the day — when I was a college student here in San Luis Obispo— it was so hard to find someone," Bettergarcia said. "And it's, it's easier now, I think — a little bit easier — because there's more folks providing care. Still, there's not enough."
Bettergarcia said there aren't enough providers who can fully serve a patient who’s both queer and a person of color.
"And I think, often queer trans folks of color, sometimes we find ourselves in communities where we're in our community of color, and maybe people don't really get our gender or sexuality, right, or we're in communities where people are super — you know — we all have, you know, shared identities around queer and trans identity and, and gender and sexuality," Bettergarcia said.
"But it's a lot of white folks, right, or they don't understand our racial experience of what it looks like to live in the world. So I think that combination is so special, and so critical. And if people are only getting part of who we are, we're not getting the full support we need from our healthcare providers."
The Q.C.A.R.E.S assessment found that over 60% of SLO County respondents don’t know how to find an LGBTQ+ affirming provider, have no knowledge of mental health services in their neighborhood, experience “moderate to high levels of psychological distress” and link distress “at least in part, to their gender or sexual orientation.”
Bettergarcia said there are ways healthcare providers can address this. They include adding welcoming and inclusive signage in clinic lobbies, training staff in LGBTQ+ affirming communication, implementing trauma-informed care principles in the testing areas, and doing community outreach.
"When we first launched the needs assessment, there were some groups that had been well established for a long time, they're doing excellent work. And that's just blossomed over the last number of years," Bettergarcia said. "And Gala, the Pride and Diversity Center, Tranz Central Coast, they have done amazing, amazing work to take what has already been established and what we were already, you know, doing as a community with support groups and just creating more."
Another service that is making a difference is Central Coast Hotline, which is run by Transitions Mental Health Association.
It runs 24/7 and there is always someone available to talk or direct your call for mental health support. The hotline now has 24/7 texting for those who feel uncomfortable with a call, someone in a violent situation, individuals who may be hard of hearing, and those who want to remain anonymous. Melanie Barket, Central Coast Hotline’s program manager, said anonymity is especially important to queer youth.
"We also handle calls from family members who are like, 'my son, my daughter is having a really hard time, I don't know what to do next,'” Barket said. "And fortunately for us — because we know the team of programs really well — we can refer to those programs so that the family members and loved ones can get help to learn how to help their loved ones."
Not only is the team there to listen and share resources with someone who may have a mental health need, but they also have a dedicated dispatch team known as the Mobile Crisis Unit available to the City of San Luis Obispo. The crisis unit’s goal is to assist with mental health crisis interventions, treatment, casework and services in a way that is non-intrusive, compassionate and, ultimately, helpful.
The Central Coast Hotline number is 800-783-0607.
The growing need for therapists isn’t only an issue that is affecting SLO County — it’s a problem throughout California. While groups like Transitions Mental Health, and Tranz Central Coast are taking action in implementing many of the recommendations from Q C.A.R.E.S reports, there is much work to be done for the LGBTQ+ community to access affirming mental health care throughout the county.
In Between is made possible by a grant from the Community Foundation San Luis Obispo County.