Save a Transgender Mental Health Program!

[joannatsf]

San Francisco's Center for Special Problems has one of the oldest mental health care programs in the country that's focused on people with transgender identities.  In addition, many transfolk suffer a variety of other mental health issues like PTSD, depressive /bi-polar disorder, and substance abuse.

CSP's Transgender Program was founded 1n 1966 in the wake of the riots at Compton's Cafeteria.  In an effort to prevent more violence, CSP took on not only the mental health issues transfolk, it sought to solve social issues.  A part of the San Francisco Department of Public Health, CSP issued photo ID cards in the name and gender preference of the holder.  Now a TG person could write a check at the grocery store without having to "out" themselves.

Today the program is under threat.  The Mayor and Board of Supervisors have mandated drastic program cuts at the Dept. of Public Health to meet the revenue shortfalls caused by the current recession. SF DPH has ordered the Community Behavioral Health Service, which oversees all mental health care programs in the City, to cut 50% of spending by 30 June 2009.  The fat in the budget is long gone now.  The Mayor and Supes are cutting down to the bone of services.

CSP's Transgender Program can be saved for very little added expense.  It could be merged into CSP's HIV program dividing clinician's time between TG and HIV clients while maintaining a director of TG service who sees TG people only and gives direction to the program.

If you would like to support CSP's Transgender Program, please go to:  http://save-sf-csp.blogspot.com/ and send a few of the suggested letters to the officials whose email addys are located further down the page.

Post Merge: May 08, 2009, 12:21:45 AM
Okay, I want to keep this up for a while.

[Mister]

I have mixed feelings about this place.  They do good work, but every time I give someone a referral to the Center for Special Problems, we both cringe.  Since when is being TG/TS a 'problem'?  And a special one, at that?  Talk about stigma.

The ID thing is great and all, but the CA DMV will change your ID with one easy form.

[tekla]

Since when is being TG/TS a 'problem'?

Well, just to sample the posts here I would say that being TG/TS is, or can be, a problem in the following areas:
- financial, in finding and keeping a job
- health care, in finding, affording and sustaining the medical care required
- mental health, in terms of finding and affording appropriate care not only for TG/TS issues, but also for problems in dealing with other things that may be also be present, BPD, OCD and other things
- relationships and family (that's about every other post in here)
- higher risk factors and higher rates of STD, including, but not limited to HIV/AIDS
- higher risk factors and higher rates of substance abuse, and finding care, as many AA/NA and similar programs have not proved all that accepting all the time
- Housing, particularly in SF where rents are high, everyone wants a credit check with an application (so that's like what, $35 just to put in an application for an apartment?) and often TS/TG persons show up from other areas without the skills needed to compete in the SF market
- High rates of physical and mental abuse in relationships
- live skills, including presentation
- high rates of people working in the sex industry when they don't really want to
- trouble with government services, including INS
- problematic relations with law enforcement, courts and jails

hey, and that's just off the top of my head.

And yeah, the name seems strange, but it does fit the reality and vocabulary back in 1966 when this effort was not just years, but decades ahead of what other cities, or any other institutions were doing for this population.

[joannatsf]

Center for Special Problems is a strange name.  It was founded in 1963 and it's original focus was domestic violence.  Ithink it's location at the edge of Polk St. and the TL made it close to the transgender community and the gay community before Castro St.

A friend of mine (she interned at CSP) did her MSW thesis on violence in the TG community.  She found that 1 in 4 met the criteria for PTSD vs. 1 in 10 for the population as a whole.
Post Merge: May 08, 2009, 11:33:54 AM

I have mixed feelings about this place.  They do good work, but every time I give someone a referral to the Center for Special Problems, we both cringe.  Since when is being TG/TS a 'problem'?  And a special one, at that?  Talk about stigma.

The ID thing is great and all, but the CA DMV will change your ID with one easy form.

In 1968 it was not so easy to get an ID changed.  I believe there were still sodomy laws on the books as was a law that prohibited wearing clothing of the opposite sex.

[Mister]

I failed to say in my previous post that they were way ahead of their time back in '68.  But it's not '68.  You can't keep standing on the achievements of a forty years ago, especially when fund raising, when there are so many other non-profits in the city who need cash.  Non-profits change their name all the time  TRANS: Thrive was something else at one point so the CSP can make these changes to stay relevant. 

And Tekla, while your off the top of your head list was quite impressive, it's not being trans that's the problem in all those situations, it's the rest of the planet being ridiculous. 

[NicholeW.]

... it's not being trans that's the problem in all those situations, it's the rest of the planet being ridiculous. 

While I agree with the sentiment I am thinking that changing the light bulb while removing the house from it's foundation and turning it about enough times to first remove the dead bulb and then re-winding the new one isn't the most reasonable way to make the change.


As for organizations remaining relevant I quite agree. The past gives us a rich history and certainly provides a great platform to any organization as they remain relevant. But yes, remaining relevant is quite the important thing. Much moreso than changing a name, for instance so it meets all specific requirements of how an individual might feel.

If their programs are actually helping trans-folk then they should be supported and maintained. If they are providing out-dated services that are duplicated by state agencies then I can see reason in at the very least revamping the agenda.

Nichole

[Mister]

If their programs are actually helping trans-folk then they should be supported and maintained. If they are providing out-dated services that are duplicated by state agencies then I can see reason in at the very least revamping the agenda.

They're duplicated by at least three other non-profits in the city I can think of (so, triplicated?).  I'm all for keeping them around, but the name makes everyone cringe.

[joannatsf]

I failed to say in my previous post that they were way ahead of their time back in '68.  But it's not '68.  You can't keep standing on the achievements of a forty years ago, especially when fund raising, when there are so many other non-profits in the city who need cash.  Non-profits change their name all the time  TRANS: Thrive was something else at one point so the CSP can make these changes to stay relevant. 

And Tekla, while your off the top of your head list was quite impressive, it's not being trans that's the problem in all those situations, it's the rest of the planet being ridiculous.

CSP is a program of the SFDPH/CBHS.  It is fully funded by city tax dollars.  Government agencies don't have the ability to go out and raise money from alternate sources.  The program changes directors now and again.  The previous director was very focused on the TS and their road to surgery.  The present director broadned the program to help fulfill the mental health needs of other types of of TG.

Question:  Trans woman is attacked and brutally raped.  She presents all the symptoms of PTSD.  Is her mental health issue due to GID or PTSD?  Do you believe the issues can be treated separately?

[tekla]

I'd be all in favor of transferring the funding (thought I know its not possible) from the not for profit NGOs, to government administrated programs for the most part.  Not for profit NGO have a tendency to cater first to their own internal administrative needs (i.e. fundraising) and the real services are often an afterthought and sometimes seem more like window dressing than real services.

The number one job of most not for profit NGOs is to keep their major donors happy, and that's not a problem with trans organizations, but almost all NGOs.  So there are times when government based programs stick to the knitting a bit more, and will serve under-represented and marginal populations a bit better.

Not that it is going to make much of a difference in that the budget of the City and County of San Francisco is Thelma and Louise heading full speed off a cliff, and given a general economic climate I'm sure that NGOs are also having a hard time raising money.  There is a lot of duplication of services, but its easier for me to see the government being around a lot longer than the NGOs.

And I did not say that being trans caused those problems, but that the trans population of SF has problems in those areas, quite a different thing.

[SFTranny]

As a transsexual woman with AIDS who spent two years trying to access the Center for Special Problems in the late 1990s, I'm glad CSP will lose its gender program.  The clinic's staff was, in my experience, totally indifferent towards clients.

For example, HIV and gender programs, instead of providing actual services, repeatedly scolded me because they were unable to determine over the phone whether GID, PTSD from a violent anti-trans hate crime, or depression was my primary problem. (This would determine whether I should go to the HIV, gender, or trauma program.)  Deciding which program I should be in seemed to take priority over providing actual services.  Further complicating this was their inability to handle the billing for someone with Medi-Cal, Medicare, and Ryan White/CARE funding.

Similarly, the gender clinic's waiting list (16 weeks) was often longer than ACCESS line gave me for services (12 weeks).  As a result, I would be ineligible or nearly ineligible for services by the time of my intake and would need to repeatedly reapply to ACCESS for authorization to go to CSP.  The staff at CSP repeatedly stated that advising me what to do was not in their job description, or as the "officer of the day," they had no obligation to help prospective clients.  The gender clinic's head supported her staff, stating that to help me would have been "case management."  According to her, neither she nor her staff had any obligation to assist me with "case management" until I had been to three appointments. 

Finally, after the head of the gender program learned that SRS was medically contraindicated for me due to HIV, she made it clear I wasn't a good candidate for her program. There is more to being a transsexual woman to having SRS.

I fail to understand why they wouldn't say "Come to CSP, get some help, and let us worry about the paperwork."  In two years of seeking services, the only help I received was one bottle of antidepressants for the depression and PTSD.

So, hopefully the staff at CSP will find its self with a new job description: unemployment insurance seeker.

[joannatsf]

I'm sorry you had a bad experience, but that was nine years ago.  The woman in charge of the Transgender Program then, Barbara Anderson, is very much committed to the Harry Benjamin Standards of Care and was, I understand, somewhat inflexible.  She retired in 2004 and the new Director, Julie Graham, is far more flexible and recognizes gender to be more than a binary phenomenon.  While I wasn't a client (I was administrative staff), she helped me in making my transition with her counsel and advice during that time.  As for billing, well, it was part of my job and I can promises you CSP has billing under control.

[Vicky]

Regrettably, the real problem is not whether ONE program 300+ miles north of me survives our current financial idiocy that is going onhere in California,  The current political administrators will take the money out of anything without sufficient voice.  The worst program in the muck and mire of countercreation will survive if it has political voice.  The very best program in the world that cannot afford to buy its own politicians is doomed.  If this one has done ANY good, no matter how much bad it has done, its better to have it than what we will get.  I work for the state, and its worse inside than out. 

[Mister]

Regrettably, the real problem is not whether ONE program 300+ miles north of me survives our current financial idiocy that is going onhere in California,  The current political administrators will take the money out of anything without sufficient voice.  The worst program in the muck and mire of countercreation will survive if it has political voice.  The very best program in the world that cannot afford to buy its own politicians is doomed.  If this one has done ANY good, no matter how much bad it has done, its better to have it than what we will get.  I work for the state, and its worse inside than out.

This is a statement I can't get behind.  If the CPS loses their city funding, those dollars could be made available to a different organization that has a better approach to the same work.  Say, for instance, making less than 90% of New Leaf's clinical appointments staffed by interns.

[NicholeW.]

People tend to imagine that the programs they work for will be seen as "the best" or "one of the best." And that our programs can do the work better than others can do it.

I've felt that way many times with different orgs I have worked with. Of course, there's no "definite and objective" pov about such matters. In point of fact there's a good bit of self-interest involved with that, as well as the admiration and camaraderie one feels with his or her coworkers.

I've no idea which of the programs out there are "the best." Nor why CA is going through the difficulties it is. Whose fault, etc.

Whatever the result I hope it's a positive one for you guys who live there.

I suppose it's a pipedream, but what about a coalescence of programs where all are brought together and work as a single entity? I've never experienced that, but I've never experienced a depression until now either. My experience of non-profits though is that each is fiercely independant and that many duplicate services to a large degree.

One big union might be an idea for strengthening and saving some valuable orgs.

Just a thought, one I've had before and never have I seen any admins embrace that idea. No matter how much better we think we may be I think there's this sneaking suspicion in us all that we may find in such a case that someone else will have the job we think we shoud have.

N~

[tekla]

There is no way - LESS THAN ZERO - that this money would be transferred from a public sector deal to a NGO/NFP.  NONE.  We're broke.  This is about eliminating services, not moving them.  And, in this case at least, it ain't Arnold's fault, SF's finances are beyond surreal (in large part due to prop 13, but that's another argument).

[joannatsf]

There is no way - LESS THAN ZERO - that this money would be transferred from a public sector deal to a NGO/NFP.  NONE.  We're broke.  This is about eliminating services, not moving them.  And, in this case at least, it ain't Arnold's fault, SF's finances are beyond surreal (in large part due to prop 13, but that's another argument).

Thank you.  If you'll recall when the Governator took office he called in financial guru Warren Buffet to help solve the states fiscal problems.  After examining the problems he recommended that Prop 13 be substantially repealed.  "Thank you very much, Mr. Buffet, your flight to Omaha leaves in ten minutes!"  That was the last we heard of him. 

[tekla]

Yeah, what a lot of people don't get (because its been very obscured) is that corporations are also under prop 13.  And where people can hold property for a limited amount of time, a corporation can not.  So that... Bechtel, PG&E, Chevron, Southern Pacific, Macy's, Bank of America et. all. still pay 1970 taxes on their corporate property holdings, holding have have gone up 300% (at least) in value since prop 13.

[Vicky]

When the U.S. Supreme Court DID affirm California's "Prop 13" property tax limitation, one of the justices said that it was the people of the state's right to be idiots, but the Supreme Court could not invalidate the law just because of stupidity the way it had been done.  I loved reading the opinion since it made it clear that the justices would like to rub political noses in tne stink, but they had to clean up the mess.  Idiots do breed, and they have bred a whole new class of even lower idiots, who, damn it, are now voting age.

For non left coast USA folks, what Tekla is referring to is that most of us mere mortal Golden State people own our real property for less than thirty years and when we sell the property (until recently) at a profit, it gets reassessed at the new fair market valye, but corporations do not have the old "four score and seven" limit that their humans do, and as a result do not sell property or make other transactions that will "significantly increase its value".  Let Joe2jane homeowner put on new stucco and a patio, and the assessors can't hit it fast enough.

[tekla]

Idiots do breed, and they have bred a whole new class of even lower idiots, who, damn it, are now voting age.

Ummm, this law was passed in 1978, or over 30 years ago.  So it's obvious that a lot of idiots your age were voting too.

[Vicky]

Sadly you are right, the idiots my age ARE the ones who bred the current crop who have been able to vote for three prior presidents, the current governor and whoever else!!.  I was renting a hole in the wall apartment, and my landlord had let me know that even if the good people voted in the thing, my rent was still going up at the end of the month, unlike the hype going on elsewhere!!

My own story over the day that the Prop 13 thing was voted in is a little surreal, I was getting a little extra spending cash for a new family by working at the Los Angeles County Registrar Of Voters HQ as a supervisor for a team of ballot inspectors that evening.  For the whole evening from 6pm to 2am the next day, I got $28.50 before taxes for opening about 120 boxes of punched computer cards and checking to make sure they were going to go into the computer alright.  The team at the table near us let a box go through that caused an hour's downtime on one of the major number crunch machines.  Not enough cash for a night on the town, but two boxes of diapers did not cause me to bounce my rent check like they had the month before. The kid the diapers were for is now one of the voters, who voted for NONE of our current crop of state officials.  He made sure to tell me!!! 

Believe it or not Tekla, I'm on your side of this thing.