The diverse culture of South Florida brings Miami’s Jackson Health System a considerable number of partners, and patients, from the lesbian, gay, bisexual, transgender (LGBT) community. And Jackson Behavioral Health Hospital is taking the lead in creating health equity for this population by addressing an unmet need – mental health. Through expert care, specialized clinics and services, and staff training, Jackson is reducing disparities in care for this vulnerable population and serving as their provider of choice.
“I shifted the focus of our behavioral health hospital toward the LGBT population because research suggests they are at high risk for some forms of major mental illness such as depression, anxiety, and substance abuse disorders,” says R. John Repique, RN, MS, vice president and chief administrative officer of Jackson Behavioral Health Hospital.
As noted in a hospital blog post, “Given the marginalization and stigma that LGBT people face throughout their lives, it is not surprising that mental health problems are more prevalent in this population than in the general population.”
Repique leverages the skills of his staff, which includes psychologists with expertise in transgender mental health and psychotherapy for the LGBT population, to offer a variety of services. Community members can seek psychiatric treatment, individual or couples group therapy, and referrals in a safe, welcoming, and culturally competent environment.
Children have access to both inpatient and outpatient care, with psychologists who specialize in the effects of bullying, bullying prevention, and suicide prevention. “We also partner with Miami-Dade County Public Schools to bring teachers into the hospital, creating an onsite school for inpatients,” Repique says.
Adults have access to the entire range of behavioral health services, along with specialty care from The Healing Place. The Healing Place is an outpatient clinic that provides specialty mental health services for patients with comorbid psychiatric and medical disorders, with a strong emphasis on HIV.
These initiatives have landed Jackson on the Human Rights Campaign’s (HRC’s) Leader in LGBT Healthcare Equality list for three years in a row. Repique credits support from Jackson leadership, including the health system’s president and CEO Carlos A. Migoya, and the external affairs department for this achievement and his continued success in building LGBT-centered initiatives in behavioral health.
Repique has also taken steps to ensure staff are supportive and comfortable providing care to the LGBT population. “Miami is very diverse, and some cultures are very religious,” he says. “We had to break the ice for staff because everyone has individual bias.”
To help staff engage, Repique and his staff at Jackson North Community Mental Health Center used grant money to bring in the Yes Institute, which conducts community dialogues and education around gender and sexual orientation.
Repique also conducted executive training through the HRC’s healthcare equality index (HEI), which included a webinar on the needs of transgender patients. “About 80 percent of leadership participated in this training,” Repique says, “and many have said it’s one of the best sessions they have attended. A significant number of executives had no idea this population has special needs.”
As chief nursing officer for both Behavioral Health and Correctional Health Services, Repique also provided HEI training for nurse managers and directors who work with inmates in the county jails. He notes that this is a particularly important area for ensuring comfort with working with the LGBT population. Repique plans to include frontline staff in next year’s training, but notes that culture change filters down, so leadership is a good place to start.
Also in 2014, Repique plans to sponsor an initiative to capture standardized data on the LGBT population through Jackson’s electronic health record system. In 2011, the Institute of Medicine found that “… researchers need more data about the demographics of [LGBT] populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.” Repique hopes to add to this evidence base. “In health care, there is such a gap in what we know of this population,” he says. “Yes, we’re caring for them, but it’s not data-driven.”
According to Repique, all of this work underlies Jackson’s mission to serve vulnerable populations, part of which is to reduce disparities in care. “We’re expanding the definition of diversity to include the LGBT population,” he says. “We’re focusing on Healthy People 2020, which strives to improve the health of all groups.”
For more information about Jackson Behavioral Health’s LGBT initiatives, please contact:
R. John Repique, RN, MS
Vice President, Chief Administrative Officer
Jackson Behavioral Health Hospital
Chief Nursing Officer
Behavioral Health and Correctional Health Services
Jackson Health System