By Ben Labonte
ESWA LGBT Peer Worker
While researching the names of psychotherapists who indicate that they are "gay friendly," I came across what is for me a new term: Elderly Persons Disorders. Therapists who list working with EPD try to help older adults cope with the mental health implications of conditions and diseases that affect seniors.
That, of course, begged the question: What "disorders" do older adults commonly face? Sridhar Nadamuni, a freelance health writer, listed typical physical ailments in a 2009 article on livestrong.com:
Researchers say that common elderly diseases may include one or more of the following: Arthritis, Cancer, Cardiovascular (Blood Pressure and Heart Disease), Cerebrovascular (Strokes), Dementia, Depression, Diabetes, Falls and Injuries, Gastrointestinal Disorders, Hearing impairment, Memory, Nutrition, Osteoporosis, Parkinson's Disease, Respiratory Disease, Pressure ulcers, Sleep problems, Thyroid Disease, Urinary Disorders and Visual impairment.[i]
What mental or behavioral disorders complicate old age, and how likely are older people to get them? According to Mental Health Canada,
Having good mental health throughout life does not ensure immunity from severe depression, Alzheimer's disease, anxiety disorders and other disorders in the senior years of life. In fact, some studies show elderly people are at greater risk of mental disorders and their complications than are younger people.[ii]
Loss is a major factor in the mental health of older adults, who face almost inevitable losses of friends and loved ones, a perceived or real loss of financial security, loss of a sense of identity, and loss of faculties, both mental and physical. In addition, old age often causes anxiety about future housing and care. For LGBT elders, those losses can be complicated by long-term discrimination because of sexual orientation or gender identity.
According to the National Alliance on Mental Illness, "researchers found that gay and bisexual men were more likely to report major depression and panic disorder in the previous twelve month period" than heterosexual men. "Lesbian and bisexual women were more than three times as likely to have experienced generalized anxiety disorder."[iii]
LGBT older adults can experience triple stigma: being gay, bisexual or transgender; having a mental illness; and being old in a youth-oriented culture. In addition, they may have lost the support of families of origin by coming out years ago. They may have buried their LGBT identities deep within themselves, which is itself a risk factor for mental illness. LGBT elders may have been victims of violence and marginalization. As if all these things are not enough, they may have been their own worst persecutors. Internalized homophobia (irrational fear or hatred of gay people) can do even more damage to the psyches of LGBT people than any external force.[iv]
The cost of mental health care only adds to the anxiety an elder may experience. In fact, Medicare will cover half of the fee of outpatient treatment by a qualified therapist who has agreed to participate in Medicare. Deductibles and copayments may apply.[v] A supplemental plan to Medicare may require that a provider be in its network. Sometimes a referral from a primary care provider is also required.
The first step can be the hardest to take toward getting help. Finding a therapist who is appropriate for an individual's needs can be daunting. Personal recommendations can be helpful, but a person may not want to disclose why he or she is looking for a therapist. For a list of steps for finding a gay friendly therapist, go to http://www.gayfriendlytherapists.com/choosing-a-therapist.htm. However, I found the site's search page to be problematic because of a lack of Massachusetts therapists in its database.
Another resource is http://therapists.psychologytoday.com/rms/prof_search.php. Put a zip code in the search bar. Click on the '+' button to increase the miles to the distance you are willing to travel from that zip code. A list of cities and towns will appear below. Click on a community to bring up a list of therapists. Finally, click on 'Gay Issues' in the 'Sexuality Gender' category in the list along the left to limit your choices to therapists who say they work with LGBT people. Look for specific mention of your situation: for instance, if you are transgender, the therapist should list "Transgender" or "Gender Identity and Expression" or similar key words. The profile should also list whether the practitioner treats older adults. You may also sort the results by price, alphabetically or by gender by clicking a tab at the top of the results list. Read through each therapist's profile. Make sure the provider accepts payment from whatever health insurance you have. (If you have a Medicare Advantage plan or a form of MassHealth, be sure the provider accepts payment from those sources.)
These are just a few of the online resources available. If you don't have access to the Internet, go to a public library or senior center that has public-access computers. Happy hunting!