Bottcher on LGBTQ Mental Health

As Pride month came to a close, Council Member Erik Bottcher met with Fountain House, the national mental health nonprofit, to discuss the current state of LGBTQ mental health, as well as his own personal experiences with coming out as a teen and confronting mental health challenges. Excerpts of the conversation:

You represent the 3rd District as a New York City Council member, which is home to Fountain House’s Manhattan Clubhouse. How did you first come to learn about Fountain House?

I first learned about Fountain House when I worked for New York state as the Governor’s liaison to Manhattan about 10 years ago. And, when I became chief of staff to Corey Johnson in 2017, I spent time at Fountain House.

As an out gay man, you’ve openly shared that growing up as a gay adolescent in a small town led to depression and multiple suicide attempts. Can you share more about your experience with mental health challenges, and how this shapes your work?

As an adolescent, I struggled with a lot of the same things that many adolescents go through. But, being a gay person in a rural area in the early 1990s, when we did not yet have the internet or LGBTQ role models on television, I felt extremely alone in the world. I remember feeling that I was the only person going through what I was going through. I also believe that I was predisposed to depression as well. I decided that I didn’t want to live anymore, and at the age of 15, I attempted suicide a few times. The last time, I was hospitalized for a month in a mental health institution in Saratoga, New York. In that hospital, I was with other young people from around New York state – victims of sexual abuse, drug abuse, gang involvement, depression, and other mental health challenges. That was a formative experience for me, because I had never been exposed to much at all outside of my hometown. Here I was, exposed to folks from all different backgrounds. That was the beginning of my political awakening ... If I hadn’t gone through that experience, I don’t know that I would be in public service today.

It’s a rarity — and still often seen as taboo — for representatives to speak so openly about their personal mental health journeys. What prompted you to share your story?

I never really considered keeping it a secret, because I’m not ashamed. It’s important for public officials, when they can, to help destigmatize mental health and to talk about it openly. Same goes for celebrities. I think that when you bring your lived experience to governing and to policy, that’s a very powerful combination. It truly helps advance change.

As a teenager, you experienced being involuntarily committed to a mental health hospital for a month, and have since been a vocal advocate for expanding mental health services for people who are experiencing mental health crises. What do you feel needs to be done to address the shortage of mental health crisis services?

What we’re experiencing now, in New York and across the country, are significant gaps in the continuum of care, from the emergency room, all the way through to permanent housing. What I hear from people who work in the hospital system, is that when they serve people who are having a mental health crisis, they often release them, and discharge them onto the streets or into the shelter system. There’s a huge need to have places for them to go, where they can continue to receive inpatient psychiatric services and emergency room hospitalization, and beyond that, have permanent places to live or supportive housing. We also have a gap of residential and inpatient psychiatric facilities for people with severe mental illness. Over the last 75 years, we de-institutionalized as a country, with the goal of providing community-based outpatient services, but we really haven’t followed through on that promise. We’ve closed the facilities, that’s the easy thing to do. But we never stepped up with the replacement services.

Another big gap in the continuum of care is the lack of clubhouse capacity. You could have an apartment, and you could have stable housing, but one thing that people forget is that everyone needs something to do all day long. People need places for socialization, for recreation, vocation, and opportunities for friendship. There are very few spaces that are welcoming for people with serious mental illness. Oftentimes people are forced to hang out on the street, which is not good, it’s not healthy. We need to build up clubhouse capacity and provide spaces that help to truly integrate people into society.

What do you believe are the most pressing LGBTQ mental health issues that need to be addressed, both on a local and national level?

We’ve made incredible progress as a community, more progress than almost anyone expected in such a short amount of time. But that progress has not been shared by all members of our community, particularly transgender people of color, who continue to be murdered at the highest rate of anyone in our country. We need to do everything we can to help the transgender community and gender non-conforming people, because there’s vicious discrimination happening every day, and terrible messages coming from the media.

Transgender individuals are nearly four times as likely to experience a mental health condition. What can and should be done to protect and defend the transgender and nonbinary community?

Everyone needs health care, in every setting of their lives, and that’s true for transgender people, too. We have to make sure that all people have access to mental health care. In school, through their primary doctors and through their medical networks, and we must make sure that in those health care networks, the mental health care is culturally competent, and affirming of their identities. That’s not always the case. We have to be vigilant.

LGBTQ individuals also face higher rates of suicide attempts and homelessness ... often the result of family rejection or discrimination based on gender identity or sexual orientation. This risk is especially high among Black LGBTQ youth.

In New York City, we’ve done a good job in recent years of increasing the number of shelter beds for runaway and homeless youth, specifically for LGBTQ people. And that number has increased year over year. But we still need more, particularly for people over the age of 24. A lot of people who age out of the youth system will “age out” at 24, and then they go into the adult system, which can be particularly hostile to members of the LGBTQ community. We have to increase capacity for them.

The LGBTQ community often struggles to find quality mental health care due to a shortage of culturally competent mental health care providers, and a lack of training. Are there specific measures that can be taken to improve this on a local level?

Our public hospitals are a great model. There’s been a lot of really great work done within NYC Health + Hospitals in recent years. My colleague in the City Council, Lynn Schulman, who is the chair of the Health Committee, she worked at NYC Health + Hospitals to help create many of those programs, which train providers and establish quality control, to ensure that guidelines are being followed and that regulations are being followed. This happens in many hospitals, some more than others. That should be scaled up here in New York City.

You’ve developed a mental health plan, outlining eight steps to address serious mental illness, bringing attention to what you’ve referred to as a “shadow pandemic.” What is the shadow pandemic that we’re currently facing?

The COVID-19 pandemic – the death toll, the number of hospitalizations and the number of us who’ve been sick – has been extremely visible. But the shadow pandemic is the toll that all of this has been taking on everyone’s mental health, which is not always visible, but can have just as devastating of an effect. The number of people who have been diagnosed with depression, the number of people who have taken their own lives, the number of people who have developed many other mental health issues, the number of people who have succumbed to substance abuse ... this has all been happening at the same time. It’s a forest fire that’s happening all around us, that many people don’t even see.