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The Hamilton Centre Podcast | Exploring Mental Health & Addiction is for service providers, individuals and family members dealing with co-occurring mental health and substance use conditions. In response to the recommendation of the Royal Commission into Victoria's Mental Health System (2021), the Centre was established to create a more inclusive and supportive system by promoting integrated care in Victoria, Australia.
Our podcast will feature interviews with service providers, individuals with lived experience, and workers who assist people with co-occurring conditions. We aim to promote holistic care throughout Victoria by breaking down barriers to treatment and through open minds and open doors.
This series features Gemma Turvey's composition, "Turquoise," performed by Gemma on piano, Craig Beard on vibraphone, and the talented musicians of the New Palm Court Orchestra.
Welcome to the Hamilton Centre Podcast, a space where we explore the thinking of leaders, service providers, workers, and people with living and lived experience shaping the landscape of integrated care in mental health and addiction services in Victoria. I'm Annie Williams, Hamilton Centre relationship and partnership lead, and your host today. The Hamilton Centre acknowledges with deep respect all First Nations people and traditional owner groups within Victoria. We extend that respect to the traditional owners of the land on which this episode is recorded, the Wurundjeri-Woi wurrung people of the Kulin nation, and pay our respects to elders past and present, and acknowledge their unceded connection to land, sea and sky. Hamilton Centre recognises people with lived and living experience of mental ill health, alcohol and other drug issues, and of recovery, and the experience of people who have been the carers, families or supporters of people with co occurring issues, as their experiences help us shape services that are safe, accessible and inclusive.
Annie:In today's episode, I'm excited to welcome 2 guests from Thorne Harbour Health to discuss the intersection of mental health, substance use and the LGBTIQASB plus communities. We'll explore the stigma these communities face, the challenges in seeking support and how we as a community can create more inclusive and supportive environments for people living with these experiences. Joining me is Keiran, who has been working with Thorne Harbour Health for 2 and a half years. Keiran is a peer support worker at the Positive Living Centre, the world's last HIV positive drop in centre. He has also worked as a post group support worker with the AOD team, supporting men who have completed Thorn Harbour's REWIREED program.
Annie:With a personal history of IV Methamphetamine use, Kieran brings a unique perspective as a peer with lived experience. He is also part of the health promotion team, providing community outreach in sex on premises venues. Kieran's background in sex work spans 17 years, adding further depth to his expertise in the field. Welcome Kieran. I'm also joined by Molly, an AOD Counselling Practice Lead at Thorne Harbour Health, working to support individuals within the LGBTQIASB plus and HIV positive communities.
Annie:Passionate about reducing stigma and promoting inclusivity, Molly works to provide compassionate, person centred care and leadership that empowers people to overcome challenges and embrace their identities. Welcome to you, Molly.
Molly:Thanks so much.
Annie:I'd like to begin our conversation, please, with just a little bit of an explanation about how Thorne Harbour came to be. Keiran?
Keiran:So, Thorne Harbour Health, as it's known now, was originally the Victorian AIDS Council, and they, started as a bunch of queer activists. It was a meeting at the Laird Hotel, and, it was due to just government inaction over the AIDS crisis. And it was basically a bunch of, like, can do lesbians, and some gay guys got together and said, we need to we need to do something. People are dying. The first confirmed, AIDS death was in 1983.
Keiran:And, so, yeah. The Victorian AIDS Council, started in 1984.
Annie:So they stepped up very quickly?
Keiran:Absolutely. And really, through that, you know, ACT UP, which they were, you know, doing their their their death ins in lying in churches and really, creating a fuss, drawing attention to the crisis.
Annie:And who's and who's Thorne Harbour named after?
Keiran:So, it's, Alison Thorne, and Keith Harbour, and they were both, instrumental in, their their first meeting from then. They, both die hard queer activists. And, Keith, died from AIDS, but Alison Thorne is still, yeah, a very much a present sale.
Annie:So their legacy continues in Absolutely.
Molly:Harbour Health. So I think it's about 6 years ago now they, changed the name to Yes. Thorne Harbor. Yeah. With the HIV and AIDS, crisis in the community being managed, you know, more effectively, it left room to to service the community in in a variety of other ways.
Molly:So they thought, a name change, you know, would reflect the the broader work that that the org is doing now.
Annie:So that brings me to my next, queries around the community, and the mental health and AOD sectors. Are there any insights that you can both share with us regarding the specific challenges faced by the community?
Molly:Well, I guess that's a pretty big question. You know, I guess off the bat with regard to, mental health and AOD, LGBTQIASB+ people experience mental health challenges and AOD presentations at much higher rates than, you know, the general population. You know, particularly, trans people experience the highest rates of suicidality, of AOD use, of mental health in general, you know, compared to the other, you know, people in the queer community, but also, you know, then again in the general population. And, you know, not only that, there's a higher prevalence, or an established link now that there's a lot more research in around, neurodiversity. And yeah.
Molly:So I think, basically, the queer community experiences all of these challenges at a higher rate than the general population. Yeah. I guess what more specifically would you like
Annie:No. I was just wondering, like, are there any, are any agencies keeping, sort of figures? Are there any statistics that you said that they the community experiences these issues at a higher rate. But but what for those of us who don't
Molly:know Yeah. Sure. So, one really good resource, that releases statistics, quite regularly is, like, the Rainbow Realities research that is done. I can't remember for the life of me right now who by. But, yeah, so there's I can't also remember the statistics off the top of my head, but, you know, basically the queer community experiences a higher percentage in the general population, and then within that, trans people again experience higher rates.
Molly:And, you know, that that again is nuanced within those different identities as well. But we're talking things like thoughts around suicide, you know, self harm behaviors. We're talking, attempts, at suicide, like just a higher, yeah, higher rate of those experiences within community. You know, specifically, we see a lot of methamphetamine use, particularly with gay men. That's a really particular presentation that we see.
Annie:And would you say that stigma drives a lot of these statistics?
Molly:100%. Yeah. Absolutely. Yeah.
Molly:I think, you know, queer people experience what I would call, like, compounding stigma.
Annie:Mhmm.
Molly:Mhmm. You know, there's stigma around identity that's reinforced often from a very young age, depending on where you come from. Minority stress and incremental trauma throughout the lifespan. And then, you know, when you add in any mental health presentations that they are more likely to experience, there's an added stigma there. And then if there's any substance use, you know, there's an added stigma there.
Molly:If they are neurodiverse, there's another one there. There's also a real link in the community to sex work and other sort of marginalized, just like things, marginalized identities. Stigma. A marginalized people. HIV again.
Molly:So, depending on who you are and what your experience is, there are many compounding stigmas that can reinforce, or explain, I guess, those statistics. Yeah.
Annie:So the WHO defines stigma as a mark of shame, disgrace, or disapproval, which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society. Mhmm. So you've already highlighted, Molly, some of the the areas of stigma that are causing major barriers, to seeking treatment for addiction and mental health issues. Given that we know that seeking help is even more challenging for the community, what have you observed or experienced in terms of this stigma, that people on a day to day basis might experience when seeking help for their mental health or
Annie:Substance use issues.
Molly:I guess I can speak on that a little bit. Yeah. Yeah. So like I kinda mentioned before, minority stress and incremental trauma are good sort of concepts here. Incremental trauma is basically that long term discrimination that people can face.
Molly:So, whether that's, like overt sort of big T traumas or, you know, the the smaller sort of sometimes innocuous exclusion from things or experiencing extra negative feedback or being policed more for behaviors that are associated with, you know, being queer in some way, or trans. So it's a it's a kind of a good concept to sort of imagine over the course of somebody's life how the experience of being queer or trying not to be could lead to that internalized sense of shame. Minority stress is another good one, talking about, you know, and this isn't specific to the queer community. It's just the idea of being part of a marginalized or oppressed identity and how that, you know, not being part of the majority means that the services that exist, the systems that exist, they don't cater to you specifically. So the systems that you're trying to access or the services don't, aren't designed for you to access them.
Molly:There are inherent barriers there.
Annie:And those barriers influence policy.
Molly:Exactly. Yeah. So there's, I guess, two levels. There's that interpersonal level and then also the systemic level.
Annie:Yeah. Yeah. Would, Keiran, in the HIV community, would you say that that is still an ongoing issue?
Keiran:Oh, absolutely. I think, what do I find? Especially, I'm, I work at the Positive Living Center, and so, the nature of that drop in center, but, all our clients are HIV positive. Yep. Our biggest cohort is probably, older gentlemen who were had early diagnosis in the eighties nineties and, you know, survived when a huge majority of their friends didn't.
Keiran:And they experienced the stigma, the raw stigma of, you know, that first in the epidemic when it was just dire. You know? And,
Annie:When society was quite
Keiran:When when they didn't know and when you didn't know, like, how it was passed or, you know, the early, early days where, you know, and just treated horrifically by society Mhmm. In general. They still carry that. You know what I mean? That's Yep.
Keiran:That that that trauma doesn't leave you.
Annie:Mhmm.
Keiran:It's maybe, more so now with with new diagnosis, which we, you know, we see
Keiran:diagnosis every every week. Mhmm. It's at a lower rate, obviously, but, still, there's a stigma. And there that that stigma is, you know, can be, you know, from your background, if you're religious, if you come from, you know, other communities where it's, like, taboo and, you know, not even spoken of, those for those people to reach out, it always often takes a lot of courage, and, for the Positive Living Center to be there as a safe space where, you know, free of stigma, is yeah. It's a really vital resource
Annie:The name implies that,
Keiran:doesn't it? That's right.
Annie:Yeah. Yeah. These complex layers of stigma that people experience. Can you share a little of your journey and how being, part of this community is intersected with your experiences with substance use and mental health?
Keiran:Oh, absolutely. So I, my background in sex work when I, when I began, it was in, 2004. I, I was based in London
Annie:Mhmm.
Keiran:And I was, I was in a abusive relationship. It was quite, controlling.
Annie:Yeah.
Keiran:And I I fled from that relationship, and straight into the, arms of someone who wasn't great. And I had never tried, meth before, and, they very quickly said, well, if you're gonna be with me, I inject meth, so you're gonna have to too. And I had, no one else. I had no support network. I was in London.
Keiran:So, I, yeah, very quickly found myself, in a relationship the relationship was okay, but, yeah, the, questionable, where it led me. That was a 10 year road.
Annie:I'm sorry you had that experience.
Keiran:Yeah. Yeah. It it's I've worked through a lot of it. But the the addiction side of it was, it was a child by fire. I'd never tried meth before as well.
Keiran:That was so it was a real dove into that pool. And I to come out the other side, it was it was a 10 year thing, and it and it wasn't easy. But I found the the stigma of, IV meth use, and HIV, sex work, and it was a lot of it from within the gay community. You know, it was directed straight to the
Annie:Can you tell us why that would be.
Keiran:Oh, yeah. Well, the thing about, you know, just being being really plainly honest. A lot of, you know, a lot of gay guys are like, oh, meth. That's a terrible oh, I don't do meth. But then when their friends aren't looking, they are doing meth.
Keiran:And it's it's this, I don't know, judgy, you know, I'm, what you're doing is wrong, but or or they're, like, saying, oh, meth's bad, while I they do a line of Coke. Do you know what I mean? It's like, you know, that drug is bad. This drug is okay. Because So
Annie:it's them and us.
Keiran:It's very much that. And, I, I don't know. I I can't explain the the the process. No. However, it makes you far more resilient, and kind of like, oh, well, you know what? you know, I I very much I I I put a little shield around me, whereas, like, I don't have to, I don't have to experience your discrimination because if I just reject it, I'm in a better place, you know, mentally for myself. And so I very much became that person. I was like, oh.
Annie:Yep.
Keiran:You know? You know you know, no no, no skin off my nose. Yep.
Molly:I really feel like some of the in community sort of policing of behavior or judgment, comes from, like, comes from the same place. It's the same stigma. It's the same internalized shame of, you know, or or or trying to have, I guess, a proximity to what would be more acceptable, if you know what I mean. As it Yeah. Because it is such a stigmatized, thing.
Molly:Substance use in general. Yeah. Yeah. It's hard to sort of go to undo that thinking around good drugs versus bad drugs or, you know, as long as I'm not this type of person, then it's okay. So it's it's all undoing that that stigma and that that shame that even though they're projecting it outwards, it really is internalized.
Keiran:Of course.
Molly:Yeah. Yeah.
Annie:And that's part of being human. Mhmm. Is, yeah. It's it's it's you, but not me.
Molly:Yeah. And wanting to protect yourself, really, at the end of the day from from a form of discrimination. You know, I might get discriminated for this, but it won't be for that.
Keiran:Yes. Yeah.
Annie:Because you've got your own stuff going on. I'm really grateful for you sharing that, Keiran.
Keiran:Happy. Happy to.
Annie:Do you feel that the clinical or recovery community's been responsive to these unique needs that the community has when dealing with, substance use or mental health issues?
Molly:I think, there is a lot of a lot of change happening now. I I don't necessarily think, you know, the systems, the powers that be, or the individual orgs have been responsive up until this point. But, in the, you know, relatively short amount of time that I've been at Thorne Harbour, I've really noticed an increase in organizations reaching out to Thorne Harbour and wanting to know, how to how to, I guess, change in their org to make to make their spaces more safe and inclusive and how to support people.
Annie:I was just I'm just curious. Could you you know, are there services informed by or tailored for the queer community?
Molly:Not many. No. Just well, there's, ours. Mhmm. But then, you know, say there are, you know, smart recovery groups, NA and AA groups that are, you know, have specific groups based on gender and sexuality.
Molly:You know, there there are some services out there, but or or, I guess, factions of services out there, but it remains quite small, You know? And I think they're not always, like, built by and for community either. So it's hard for us to know if they are a safe resource or a safe support. There's a kind of a bit of work on our front to
Annie:yeah. So so how can the providers and support networks create this safe space?
Molly:It's on a number of levels, I think. You know, there's a systemic level that we sort of talked about, like a top down sort of consideration where, the world that we live in has never been built or set up to support, you know, people of marginalized identities. So there's an element of, like, advocacy and and changing policy and that sort of stuff that you know, individual orgs can't do much about. But what orgs can do is quite basic. You know, there's I even have a little list because I knew I would forget some things.
Molly:But, like, so visibility, is a simple one. Yep. You know, it can feel a little performative, like a rainbow lanyard or something like that, but sometimes that is enough to know that that person is really trying to be an ally. Yeah. Or posters on your website, you know, tell people that you are an inclusive space.
Molly:Training and education requirements for staff, employ or consult with, community, whether that's on a clinical level
Keiran:I think that's another vital one, is, peer work.
Molly:Absolutely.
Keiran:Having peers in places. It it really I I yeah. Can't emphasize enough how really vital that is.
Annie:Is there much space for, peers to influence policy and, this systemic change?
Keiran:Yeah.
Molly:And I think more and more. There's a lot more lived experience.
Keiran:It's far more recognized now the importance of peer work, I think especially in this sphere, and, you know
Molly:Mhmm. Yeah. And even simple so I just wanna add simple things around documentation, how you ask questions, are your intakes inclusive, do you ask for people's, like, preferred pronouns, or do you just ask them what their pronouns are? Because they're not preferred. You know, they're their pronouns.
Molly:Yeah. Do you ask, you know, there's a tick box. Are you queer? What does that mean? Yeah.
Molly:You know, how would you how would you like to be described? You know, how could how should I refer to you?
Keiran:Yeah. Yeah.
Molly:Just those sort of little things that show that the person on the other end isn't sort of making assumptions or isn't, like, completely unaware of of of the basics, I suppose.
Annie:Power of language.
Molly:Yeah. Exactly. So there's there's some really little things that make a big difference, and then there are also, like, a lot of big, broad things that probably need to be done as well.
Annie:And are there resources that that, you know, you share with the the clinical community around correct use of language sensitive, respectful language?
Keiran:That kinda comes from training. Yeah.
Molly:Like, you know, training. You know, email us. We can do that. Secondary consults, we know lately we've been having just a few meetings with with people from different orgs around, yeah, just having a chat about what they can do in their org or how they might work with us moving forward. Yeah.
Molly:I guess we don't have a a a straight resource to sort
Molly:of hand out, but I suppose we would like to be the resource. Mhmm.
Annie:Yes. Yes. I'm just thinking around members of the community who might be struggling with substance use or mental health issues, and those that are feeling quite stigmatized for whatever reason, one of those many layers of stigma, or feeling isolated, what what advice would you give them if if they approached you or you became aware of them? I'll give you the start.
Molly:Alright. Unless you'd prefer I
Keiran:I I sorry. I just went completely blank. I'll throw to Molly. I'll throw to Molly. That's okay.
Molly:I would I would advise them to to reach out to a support that feels safe. You know, not all not all queer people want to go to a queer organization. There's reasons why they might feel safer at a mainstream service. But yeah, I guess identify what feels accessible to you and just do that. Even if that's not reaching out to a service, instead it's just reaching out to a trusted person or a loved one or an acquaintance that you think might be cool or know something about it.
Molly:Just, I would just say talk to someone, so that you can start to get that sort of scaffolding, that wraparound support that starts, you know, in your community. And I think, you know, Keiran's work as a as a peer worker is instrumental for that to have a bridge between, you know, that that sort of stand alone out in the world to appear to somebody who gets it to being engaged in a more clinical potentially setting or whatever setting you'd like to be engaged in.
Annie:Well, you've you've given me a brilliant segue because I was gonna ask you, Keiran. As a peer worker, you know, what what's your role, in helping reduce the stress for these individuals who want to access services
Keiran:Sure. Especially, when I was doing my post group support through, from the re rewired program, it was that the the the most often thing that was said to me was, you get it. You you you get where I'm coming from. And, you know, whether or not they're they're, for example, seeing a therapist.
Keiran:And their therapist who, you know, might not be queer and just says, oh, well, you know, stop doing meth. You need to stop doing that. It's like, oh, okay. I'll just do that.
Keiran:Whereas you you're giving them a a a way in. Also, you're meeting them where they're at, and they you know, it's an understanding and, you know, if if I can do it, it's like, oh, I I've been where you are
Annie:Yes.
Keiran:And I did it. And, you know, we can these these are the tools that I have. Yeah. This is what I learned.
Annie:Yeah.
Keiran:I can, you know, I can offer it to you. This is what this is what worked for me. Mhmm. And so it's it's it's very much
Keiran:It's very much that. Yeah.
Molly:I think we put a lot of the onus and readiness on the individual as well. We say, well, just get support. Just stop.
Keiran:You know? Yeah.
Molly:But if you're feeling isolated, if you don't know where to start, or even if, like, you are trying, sometimes what enables people to feel ready to change is a sense of support and a sense of safety, and that they're not alone, you know? So I think peer work kind of there are there are many ways to do this, but I think peer work in particular, really addresses that sense of not feeling supported and being isolated and sort of goes, No, no, here's a leg up. You can you can do it. You know, resilience isn't it's not something you have to, like, carve out of yourself, you know? You can you can help people.
Molly:You can give it to them
Keiran:And even discussing things like, you know, someone who, is in a chem sex
Annie:Yes.
Keiran:You know? That and their sex is linked to that drug use. And they're like, well, how will I ever have sex again? You know? Is this you know, it's like, you know, you can say.
Keiran:Mhmm. Sober sex, you can do it. You know? Eventually, you just have to it's it's about reducing use and, you know, breaking out of your it's all, you know, in your mind that
Annie:So the process is not linear. Exactly.
Molly:Yeah. Hope and modeling. Right?
Keiran:Yeah. Yeah.
Molly:That you can still have this thing that's really hard to access for various reasons. You can still have it because here's the evidence.
Annie:Molly, if I could just ask you about the issues specific issues facing trans, and non binary people
Keiran:Mhmm.
Annie:In this space where mental health and, AOD issues can be quite overwhelming?
Molly:Absolutely. So one thing that jumps to mind immediately is especially the with the intersection of mental health and AOD and trying to access rehabs or detoxes or other residential facilities that are often gender segregated, or there's, you know, eligibility requirements there that, trans people struggle to sort of fit into that binary mold.
Annie:Relating to sobriety.
Molly:Relating to genuinely accessing the physical space, and if they if they're going to be safe there. Even just accessing, you know, going into your counselling session, does the organisation have a toilet that you can use? You know, it's it's it's just that extra sort of layer of, of that discrimination, of that stigma, of of barriers to access, that, you know, cisgendered, whether that's, you know, men or women, don't really face as much. But I guess that the thing is, is that the the community is so broad and there are so many different experiences within it. Like I said before, with that LGBTQIASB+ tick box, it's really hard to develop a picture of what an individual would need, and, at best, they're set up to service like a cisgender queer person.
Molly:Yes. But, yeah, it's just, you know, people might have an understanding of what it means to be generally gay or lesbian, but do they know what it means to be like a a trans masc lesbian who hasn't started their hormone therapy, who, you know, so it's just that added layer of of insight and knowledge that, you feel you're unlikely to come across, you know, when accessing support, especially from a mainstream org. So So that, yeah, there's a there's a lot of, you know, when we're sort of fighting for this inclusion and we're fighting to to create safe spaces and appropriate supports, but that sort of compounded stigma and marginalization happens within the community. So the most privileged identities within community are still the 1st people to access supports. Yes.
Molly:So, yeah, there does need to be that extra level of of work around, making spaces safe and appropriate for trans and gender diverse people.
Annie:So all the more reason to include lived and living experience people.
Molly:And as time goes on, the lines between sexuality and gender get more and more blurred. So, you know, it's really hard to just say this service is for gay men, gay cis men only, because there are a lot of masculine presenting non binary people or, you know, maybe even there's a lot of cisgender gay men who also love trans women or, you know, there's there's just so many different ways that, gender and sexuality can be can be varied that, yeah. It's just it's just really important not to, like, be rigid about the way you perceive people and the support that they need.
Annie:Be kind. Yeah.
Molly:Be kind. Be open minded. Be curious.
Annie:Curious. Yeah. Well, I think that's a fantastic place to end, and I'd really like to thank both of you. I'd I really appreciate you sharing your insights and experiences with us today. I've certainly learned a lot, and I'm sure that others will too.
Annie:It's really been great having you on the podcast.
Keiran:Thank you so much.
Molly:Absolute pleasure. Thank you.
Annie:Thank you for joining us on the Hamilton Centre podcast where we explore the thinking of leaders, service providers, workers, and people with living and lived experience shaping the landscape of integrated care in mental health and addiction services across Victoria. I'm Annie Williams, your host today, and we can't wait to share these insights with you. Visit our website, www.hamiltoncentre.org.au, and subscribe to our newsletter for a journey into transformative mental health and addiction care.