Research Brief: Crisis Provider Reflections on Providing Crisis Services to LGBTQ+ Kansans
Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face high rates of stigma, oppression, and victimization, increasing their need for supportive mental health and crisis response services.1,2 It is essential that the providers who serve LGBTQ+ Kansans provide competent and ethical crisis care. However, little research has explored crisis provider reflections on providing crisis services to LGBTQ+ Kansans to better understand their experiences and challenges.
The Project: A team consisting of academic researchers, crisis counselors, LGBTQ+ Kansans, and community leaders advertised focus groups and interviews for 1) crisis providers in Kansas and 2) LGBTQ+ Kansans. A total of 64 people participated: 28 engaged in one of nine focus groups, 28 completed interviews, and an additional 8 completed an alternate anonymous survey. Of the 64 participants, 24 were crisis providers (11 of whom were LGBTQ+) and 40 were LGBTQ+ Kansans. Participants’ gender, sexual orientation, age, and race/ethnicity are shown below.
Participants were spread throughout the state with 64% in the Northeast, 23% in the Southeast, 11% in the Middle, and 2% in the Southwest regions. About 16% lived and/or worked in rural communities. Crisis providers answered questions about their perceptions and reflections on providing crisis services for LGBTQ+ clients throughout Kansas.
Reflections on the Crisis Needs of LGBTQ+ Clients
Crisis providers shared their reflections on providing crisis services for LGBTQ+ Kansans, discussing four primary areas: needs of LGBTQ+ Kansans in crisis, provider skills required, involving law enforcement, and provider fears and concerns.
LGBTQ-Specific Needs
In discussing their experiences providing crisis care for LGBTQ+ Kansans, providers noted the range of needs presented by LGBTQ+ clients. Specifically, they discussed four areas that related to clients’ experiences as LGBTQ+ individuals: trauma and mental health, coming out and family challenges, finding LGBTQ+ resources, and systemic issues.
Trauma and mental health included the experiences LGBTQ+ Kansans faced because of stigma and oppression related to LGBTQ+ identities, such as bullying, discrimination, and victimization. These experiences sometimes led LGBTQ+ Kansans to seek crisis support.
“Right now my population is mostly middle school and high school, and it’s usually in concerns of coming out, bullying, and just wanting support because it’s really scary. It can be really scary. Especially when you feel like you don’t have someone to talk to and this is a big deal. It’s not, but it is. It shouldn’t be a big deal, but everyone in society treats it like it’s this ….”
Related to the traumatic experiences of oppression and stigma, participants shared that LGBTQ+ Kansans sometimes needed crisis support related to family issues and challenges related to coming out.
“I’ve had times that I’ve had people call me from the closet literally because their family members don’t accept them, don’t support them, don’t even want them calling the crisis line to talk about it.”
“There’s definitely been times talking to callers whose…families who aren’t super accepting or super supportive which is extremely tough.”
Another need for LGBTQ+ Kansans that providers noted was access to affirming resources throughout the state. Numerous providers shared how they faced challenges even finding these types of resources to share with clients.
“I had an older adult, and really the only thing I could find besides individual counseling was an LGBTQ elder hotline for the phone, which is great, but he could really only use his flip phone or whatever it was. So, finding other things where he could find a sense of community was difficult because a lot of it is tailored to the younger population.”
Some providers shared how LGBTQ+ Kansans were experiencing crisis related to the sociopolitical climate or systemic issues in Kansans, such as proposed and passed anti-trans legislation.
“We had (an older) trans woman who had gone through years and years and years of gender confirmation surgeries and had spent a lot of time and money and effort and emotional labor and all of this…and she came to (crisis center) after she was very, very serious about her being suicidal, had a plan, intent, means all of those things…It was the bathroom laws in Kansas when that happened. It hit me that we were going to see an influx of people in crisis over bathrooms because they wouldn’t have a safe place to pee.
General Support Needs Finally, not all LGBTQ+ clients need support related to their LGBTQ+ identity. Providers shared how some clients needed general support beyond their gender or sexuality, while still being affirmed as a person.
“(A) chatter reached out…it was not specific to their sexual orientation or their identity…They were just talking about a past trauma that was a bully…but not because of their sexual orientation, it was because of something else…It was pretty much just the chatter wanted to talk to somebody.
Reflections on Necessary Provider Skills to Serve LGBTQ+ Clients
Crisis providers shared their reflections on the types of skills providers needed to effectively and competently serve LGBTQ+ Kansans in crisis. Specifically, they described how providers need skills at 1) self-awareness and challenging one’s biases, and 2) repairing mistakes.
Self-Awareness & Challenging One’s Biases
Providers reflected on the importance of critical self-awareness, understanding one’s own preconceived ideas and biases, and being able to challenge those biases in their practice. This self-awareness includes educating oneself, as well as learning and growing from this knowledge.
“It’s very important that we not let our own personal bias, by it politics, religion and that, play into our work. We as clinicians are held to a higher standard. And that’s not only at work, that’s in our personal lives as well. So I guess hold yourself to that standard. Remember that we’re all people and we all have that right that was given to us to be the people that we are, not who someone thinks we should be..”
Repairing Mistakes
Another important skill providers discussed was being able to repair with LGBTQ+ clients when mistakes occur, such as misgendering a client. Repairing mistakes sends a message to clients that the provider values the client and aims to affirm their LGBTQ+ identity.
Challenges and Concerns Involving Law Enforcement
Providers also discussed their challenges and concerns with involving law enforcement, especially for LGBTQ+ clients given their marginalized identities. They shared LGBTQ+ callers to crisis lines expressing concerns about having law enforcement called due to their crisis. They also expressed concerns about calling law enforcement for LGBTQ+ clients in crisis in rural communities and how they might prepare LGBTQ+ clients for this possibility.
“A lot of the time they also ask about authorities. And I do say that’s less than 2% of our calls, is that we reach out to the authorities because that number really helps calm them down because they’re like, “Okay, cool.” And then I reiterate everything you’re telling me is between us, and I reiterate, unless it’s for safety of yourself or others.”
“The area that we cover is very, very rural. So with that, I think, comes some different experiences. We see the most with the people that we partner with, law enforcement agencies and stuff, not having as neutral or LGBTQ-friendly policies and practices.”
“Something I try to always do if at all possible when I have to call dispatch is, we always tell the person we have to call dispatch because of X-Y-Z reasons, but I also tell them, ‘I am going to stay on the phone with you until they arrive, until I hear them arrive, unless you end the call before then, but I will stay on the phone with you until they are there.’ And I tell dispatch that, ‘I am on the phone with them. I told them I will stay on the phone with them until help arrives.’ That’s not always possible, depending on the situation and nature of what’s going on and why dispatch had to be contacted. But I think there’s probably been multiple instances that that initial contact maybe went a little smoother because they could see, ‘okay, this person’s on the phone, we know they’re not holding a gun, they’re holding a phone. We were told they would be on the phone.’”
Provider Fears and Concerns
Finally, providers shared their fears and concerns about providing competent crisis care to LGBTQ+ clients in Kansas. Specifically, they discussed their own capacity to provide help and their concerns about inadvertently doing harm.
Capability to Help
Providers shared their fears about their own capacity to help LGBTQ+ clients in crisis. Some providers, who were cisgender and heterosexual, expressed fearing that they would not be able to adequately support LGBTQ+ clients because they are not LGBTQ+ themselves. Additionally, some providers shared fearing they lacked the specific skills needed to support LGBTQ+ clients in crisis.
“I’m not part of the queer community and I feel like I feel very not equipped with the necessary knowledge to do a better job…All I have is just an open mind…but the reality is there are probably a lot of nuances I do not know, I do not understand, and I could have said something offended people on the line without me even knowing.”
“I think the fear of missing something. Sometimes slang or keywords, or just not understanding something that they’re saying, but also not knowing to ask a follow-up question, I guess. And that’s the same with working with kids. They could say something, you’d be like, that was weird, but okay, let’s move on. Then it’s actually something really important that you didn’t want to ask the question, because you didn’t want to feel dumb.”
Doing Harm
Providers also shared fears of inadvertently doing harm to their LGBTQ+ clients in crisis, often due to a lack of training or skills.
“, I don’t know what is appropriate half the time, what’s not. I feel like I’m always going to offend someone and I don’t want to do that.”
Recommendations
● Crisis service organizations should ensure that staff and volunteers, including non-clinical staff, have opportunities for training in LGBTQ+-culturally responsive crisis intervention on an annual and ongoing basis.
● Crisis service organizations should provide opportunities for crisis providers to reflect on their own biases, challenges, and fears to build community and promote ongoing self-awareness and reflection.
● Providers should engage in an ongoing process of critical self-reflection and self-education on working with LGBTQ+ clients in crisis.
● Leadership at crisis service organizations should examine alternative strategies for harm reduction beyond calling law enforcement for clients in crisis.
Funding: This project was facilitated as part of a $250,000 Transformation Transfer Initiative (TTI) grant from the Center for Mental Health Services (CMHS) awarded to the Kansas Department of Aging and Disability Services (KDADS) in 2022. KDADS contracted with the University of Kansas Center for LGBTQ+ Research and Advocacy, Kansas Suicide Prevention Headquarters, and Center of Daring to serve as the Project Development Team during the research phase of the project.
Authors: Megan S. Paceley, PhD, MSW; Michael Riquino, PhD, MSW; Liz Hamor, MS; and Shana Green.
References:
1. Gower, A.L., Valdez, C.A.B., Watson, R.J., Eisenberg, M.E., Mehus, C.J., Saewyc, E.M., Corliss, H.L., Sullivan, R., & Porta, C.M. (2019). First- and second-hand experiences of enacted stigma among LGBTQ youth. The Journal of School Nursing, 37(3). https://doi.org/10.1177/1059840519863094
2. Katz-Wise, S.L. & Hyde, J.S. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. The Journal of Sex Research, 49(2-3), 142-167. https://doi.org/10.1080/00224499.2011.637247
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