Since it opened in 2017, the primary care clinic serving Portland’s LGBTQ+ community has seen more than 1,000 patients and has added two mental health providers
Prism Health, Portland’s first allopathic health clinic focused on primary care for the LGBTQ+ community, has seen immense growth in the past two years.
Since May 2017, this primary care clinic under the purview of Cascade AIDS Project, has provided care to a community of people who have been othered and pathologized by the largely normative, Western world of medicine, a field historically based on binary categories – male or female, sick or healthy, straight or gay, normal or abnormal.
Prism’s large, angular building, sporting a colorful emblem, sits on the corner of Southeast Belmont Street and 23rd Avenue. It’s within these walls that the LGBTQ+ community can find a health care setting and structure not often experienced or common in today’s health care landscape.
Since its opening, more than 1,000 people have come through Prism’s doors and checked in at the front desk, where a rainbow flag is situated next to pens used to fill out LGBTQ+ specific intake forms.
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As of May, two years after the clinic opened, Prism began offering mental health services to the queer community, employing two mental health practitioners who, like the community they serve, identify as queer.
This was good news to Ari Chadwick-Saund a non-binary person of color whose wife suffered a traumatic event about a year ago and now has symptoms of post-traumatic stress disorder.
“We want to get her with a great mental health care provider, preferably versed in queer culture, so that she can feel comfortable discussing with them her trauma and begin the mental healing process,” Chadwick-Saund said. “Due to some recent transphobic and homophobic abuse I experienced at a health care office in the Portland area, I will no longer refer LGBTQ+ community members to medical offices that do not offer protections based on gender identity and sexual orientation for both their patients and their employees.”
When CAP decided to open Prism Health as a primary care health care center, it became clear from feedback it received from the community and other providers that there was a large need for access to mental health services as well.
“There are great queer-friendly and queer providers for mental health in the area. The need is just bigger than what is out there,” said Caitlin Wells, director of health care operations at CAP. Wells has been with CAP since 2014, but will be leaving her post on June 28 for a job with Genentech.
“We thought we could contribute more access to mental health by opening up this program,” she said.
Finding quality mental health care for those in the LGBTQ+ community can be challenging and often falls on the shoulders of those seeking treatment. Professionals who provide therapy or counseling must be well-versed in the societal and individual issues that affect the LGBTQ+ community for therapy to be culturally competent and feel affirming of one’s identity.
Issues impacting the LGBTQ+ community include homophobia and transphobia; higher risk of anxiety, depression and suicide; closeting, disownment and excommunication; bullying; and sexual assault.
It took CAP two years to offer mental health services because leadership wanted to make sure primary care was established and stable before something different – and fairly unique – was offered.
“It’s a learning game every day,” Wells said.
As Wells and CAP initiated mental health services at Prism, Mike Duncan was at the tail end of his residency in psychology.
For the past several months, as he finished up his program, Duncan checked CAP’s website, looking at job postings. His interest in working in a queer-focused program started during his residency training, so when he learned that CAP was developing this program, he knew he wanted to be a part of it.
“I happened to check last November and saw an opening for a mental health provider at Prism. I had to apply,” he said.
He was hired on as a licensed psychologist in March.
Duncan said it’s important for him to work at a place like Prism. He wants to see this mental health program be successful for many reasons, including that he identifies as a queer person representing various shades of queerness.
The therapy that Duncan provides is mostly humanistic-existential.
“I emphasize the importance of insight and awareness around the stories we tell ourselves about our experience. I also incorporate aspects of cognitive behavioral therapy and dialectical behavioral therapy,” he said.
“Our community has experienced unique traumas that make a program like this valuable. Part of trauma-informed care at Prism’s mental health program, for me, is developing a sense of community within the workplace itself.”
Duncan said a strong sense of community at Prism contributes to a welcoming, community-oriented atmosphere.
“For me, this includes how I dress, how I present myself, and what my office looks like,” he said. “How I do this at Prism is very different from how I did it at every clinic I worked at before coming here, which catered to the needs of a larger, normative population.”
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Duncan, who wears bright-colored shoes, said that he doesn’t have to put on masculine airs.
“I get to be professional in my own queer way, and I’m very happy about that,” he said.
For instance, Duncan is working on a personal goal to get a pair of shoes for each color of the rainbow. He said he gets the most compliments with purple shoes that have pink, sparkly stripes.
“My experience has been that a lot of other places wouldn’t take a psychologist like that very seriously,” he said.
Wells hopes that there is an element of perceived and real safety and openness when people walk in the doors at Prism and that they can quickly feel comfortable.
“You will never need to provide an explanation about your identity,” she said, “and that is not something you can get everywhere.”
Duncan said that his patients are the experts on their experiences. Acknowledging transphobia, homophobia and heterosexism while being sex-affirmative, kink-aware and poly-friendly, he said, means respecting people’s stories and giving them space to express their lived experiences.
Duncan said he is always willing to explore topics in therapy that may be considered taboo or controversial in more mainstream clinics.
“I think it’s important,” he said, “because I’ve known too many patients who have sought mental health services with providers who were unwilling or unable to see past their gender, sexuality or relationships; who saw their identities themselves as a mental illness; or were not given the same attentive care that might have been given to a normative person. We deserve a space where our stories are afforded the same care and respect as other people.”
Danielle Walsh, Prism’s licensed professional counselor, also sees that there is a need for accessible LGBTQ+ mental health services. Walsh is seeing her patients come in for all different types of support, and she said the incidence of mental illness can be higher in the queer and trans community.
“This isn’t because something is wrong with queer or trans people,” she said, “but because of systematic oppression that queer and trans people face.”
Walsh said she brings a commitment to social justice to her work.
“It isn’t enough for me to sit between the four walls of a therapy room and listen to my clients’ experiences of discrimination and oppression,” she said. “If I really care about my clients, self and community, I need to be an advocate and force for change in the larger world.”
One way Walsh puts actions to her words is by doing what she calls “homework” outside of the therapeutic session so that her clients who are queer or gender diverse don’t have to expend their emotional capital “just so I can understand basic parts of their identity, like terminology or how to use pronouns properly,” she said. “Asking that of a client is unjust.”
Walsh describes her therapy as humanistic and person-centered, which she said is about giving clients the benefit of the doubt.
“Everyone is doing the best they can with the resources they have,” she said. “Life can be super hard, and we all deserve someone to listen to us with compassion. I hope that, in providing compassionate listening and reflection, I provide a model that clients internalize so they can champion and advocate for themselves in their new ways.”
Both Walsh and Duncan explained what culturally competent care looks like, specifically providing mental health services to the queer community. It can be having patient paperwork that reflects the diversity of the human community, for example, or having sexually diverse and gender-diverse people reflected in the materials of the waiting room, or using names other than people’s legal names.
“Anything that lets queer and trans people know you’re not invisible here; we see and love you,” Walsh said.
At the end of the day, Walsh said, providing culturally competent care is really about not making assumptions, which she said can be hard because of the heterocentrist culture that’s entrenched in a binary gender system.
Prism’s staff thinks mental health services will expand in the coming years. And because the program is still fairly new, the sky is the limit, Duncan said.
In four years, Duncan hopes Prism can hire more mental health providers and an Oregon Health Plan case manager and begin a training program for psychology students.
“I would love to supervise students who will be future psychologists and provide them the opportunity to learn how to provide culturally competent mental health care to queer people,” he said.
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