Saturday, Oct. 29
14:30 – 15:30 (1 hr)
Meeting Room: Chestnut (Mezzanine)
Timothy Guimond*, PhD, MD, FRCPC; Yvonne Bergmans, MSW, RSW, PhD
- Health Advocate
At the end of this session, participants will be able to: 1) Identify the two key needs this population acknowledged during community consultation as essential for GBMSM and trans peoples’ mental health care; 2) Identify suggested adaptations to care generalizable to sexual health clinic environments; and 3) Describe critical issues in treating methamphetamine use disorder when used in a sexualized context.
HQ is a new sexual and mental health clinic for gay, bisexual, other men who have sex with men (GBMSM), and trans people in Toronto. During its development, community providers, including family physicians and front-line workers at AIDS service organizations, identified the need for integrated mental health and substance use care alongside nonjudgemental, accessible, and rapid sexual health services. They named three priority areas for mental health: trauma therapy, methamphetamine use disorder treatments, and urgent access to specialized mental health assessment. Simultaneously, research suggests that untreated mental health and substance use concerns increase the risk of new HIV infections and suicide among sexual minorities, making widespread screening of mental health needs a high priority for the clinic. In this symposium, we will present three adaptations to increase access and cultural sensitivity in this clinical setting: a stepped-care approach to assessment and access to mental health services; a modification of cognitive processing therapy for post-traumatic stress disorder to address sexual beliefs; and a research project developing and studying a proposed new integrated intervention for methamphetamine use disorder.
S07a – A Stepped-Care Approach to Assessment and Access to Mental Health Services for Gay, Bisexual, Other Men who Have Sex with Men, and the Trans Community
Timothy Guimond, PhD, MD, FRCPC; Zhongyu Huang, BSc; David Lee, MEng, BHSc; Chantel Lim, BSc (Hons); Eliot Winkler, BSc, MSc; Matt Haaland, BSc (Hons), MD
At the end of this session, participants will be able to: 1) Understand the unique mental health needs identified for GBMSM and trans folks at a sexual health clinic; 2) Be aware of possible treatment offerings and modifications to deliver culturally sensitive care to the GBMSM and trans community; and 3) Appreciate the impacts of integrating a patient portal and electronic medical record to facilitate treatment matching and outcome surveillance.
HQs plan to develop mental health and substance use services began with a needs assessment conducted with front-line workers at AIDS service organizations and family physicians who work predominantly with LGBTQ2S populations in Toronto. They identified engagement, comfort, and sensitivity as crucial principles in delivering care. HQ prioritizes a low-barrier approach that encourages autonomy in identifying needs and uses the least intrusive methods to screen at each visit for sexual health. Simultaneously, the long waitlists for current mental health services targeted to the LGBTQ2S community led to the decision to use a stepped-care approach to stratify requests for assistance by urgency. There are three critical needs identified across settings: increasing access to trauma treatments, building new methamphetamine interventions, and increasing access to interventions for emotional dysregulation and impulsivity. The clinic has integrated a patient-facing kiosk system that screens for mental health needs, provides an online self-assessment for those requesting assistance, and then triages individuals to either self-help/self-management resources, group-based treatment planning interventions, or a rapid in-person multidisciplinary team assessment. Preliminary findings on the rates of screening and needs at HQ will be presented.
- Guimond T, Currie R, Lee D. (July 2020) HQ Mental Health and Substance Use Care: Unmet Need and Service Delivery Plan. Report to the Ontario HIV Treatment Network.
- Guimond T, Currie R. HQ Mental Health and Substance Use Care: Training and Implementation Plan. Report to the Ontario HIV Treatment Network.
S07b – Post-Trauma Sexual Beliefs: A Proposed New Module for Cognitive Processing Therapy Developed with LGBTQ2S Participants
Timothy Guimond, PhD, MD, FRCPC; Matthew Haaland, BSc (Hons), MD
At the end of this session, participants will be able to: 1) Appreciate the unique challenges faced by 2SLGBTQ patients with post-traumatic stress disorder (PTSD) and the impact these have on clinical care; 2) Distinguish the difference between sexual beliefs and those best understood in the 5 cognitive processing therapy modules of safety, trust, power/control, self-esteem, and intimacy; and 3) Recognize sexual beliefs essential to the assessment and treatment of PTSD.
Cognitive processing therapy (CPT) is an evidence-based, first-line treatment for post-traumatic stress disorder (PTSD). While CPT has demonstrated efficacy in people with a history of sexual trauma, many survivors of sexual trauma continue to experience enduring sexual dysfunction even after identification and resolution of beliefs in the five modules of safety, trust, power/control, self-esteem, and intimacy. No specific controlled studies have examined the use of CPT in a 2SLGBTQ population, although case reports suggest efficacy. Preliminary evidence suggests that minimal adaptations are needed for CPTs delivery in concurrent substance use disorder treatment settings. Clinically, in our publicly funded concurrent disorders group therapy program, we observed that patients in our 2SLGBTQ program had developed trauma beliefs that were strongly linked to their sexual or gender identity. This finding, and this distinction from their heterosexual peers, is consistent with observations by other teams working with 2SLGBTQ patients. The current CPT modules insufficiently address sexual beliefs. Specific attention to these distinct beliefs was integral in our patients recoveries. We defined sexual beliefs as beliefs related to self and others regarding sexual orientation, attraction/desirability, arousal, disgust, morality, rights/boundaries, touch, and sexual activities. In our group setting, we set out to collaboratively identify problematic sexual beliefs and co-create with our patients a sixth module to support a more comprehensive recovery from PTSD in 2SLGBTQ people. This module could be applied to other populations.
- Resick PA, Monson CM, Chard KM. Cognitive processing therapy for PTSD: a comprehensive manual. New York (NY): The Guilford Press; 2017.
- Peixoto MM, Nobre P. Dysfunctional sexual beliefs: a comparative study of heterosexual men and women, gay men, and lesbian women with and without sexual problems. J Sex Med 2014;11:2690-700.
S07c – MethID: A Research Study to Develop a New Integrated Intervention for Methamphetamine Use Disorder for Gay, Bisexual, and Other Men Who Have Sex with Men and Engage in ChemSex
Timothy Guimond, PhD, MD, FRCPC; Yvonne Bergmans, MSW, RSW, PhD; Adam Busch, MSW, RSW; Tanya Hauck, MD, FRCP, PhD; Bill OLeary, MSW, PhD; Christina Yager, MSW, RSW
At the end of this session, participants will be able to: 1) Identify the need for a new and integrated intervention for methamphetamine use in sexualized contexts for GBMSM; 2) Describe the current treatment options and their limitations for methamphetamine use disorder; and 3) List adaptations that MethID has studied and key findings to date.
The MethID (Methamphetamine Intervention Development) research project is developing an intervention for problematic methamphetamine use. The research team uses an iterative process to test adaptations of therapeutic approaches for inclusion. This process includes input from service providers and people with lived experience at all levels (from direct observation, post-session video reviews, and reflective discussion). The intervention draws from current best practices that integrate various therapeutic modalities and adapts them to the particular methamphetamine use patterns of gay, bisexual, and other men who have sex with men (GBMSM). This novel intervention integrates components of motivational interviewing, solution-focused therapy, community reinforcement approach, cognitive processing therapy, and skills for safer living, within individual and group-based contexts. Baseline characteristics of recruited participants and preliminary findings will be discussed.
- Grov C, Westmoreland D, Morrison C, et al. The crisis we are not talking about: one-in-three annual HIV seroconversions among sexual and gender minorities were persistent methamphetamine users. J Acquir Immune Defic Syndr 2020;85:272-9.
- Paulus MP, Stewart JL. Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: a review. JAMA Psychiatry 2020;77:959-66.