Health-care issues in the LGBTQ community

On this episode, we hear from Dr. Tim Guimond, the mental health director at HQ Toronto and Dr. Amy Bourns at family physician at Sherbourne Health Toronto, who discuss the impact of the pandemic on LGBTQ patients and ways care can be improved for this community.

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. 

I'm Georgia Balogiannis for the Ontario Medical Association. 

June is Pride Month. In this episode we highlight health-care issues in the LGBTQ community. 

Dr. Tim Guimond is the mental health director at HQ Toronto, a new medical clinic for men into men and trans and non-binary people in Toronto. He talks about the clinic’s approach to mental and sexual health.

And Dr. Amy Bourns a family physician at Sherbourne Health Toronto explains the impact of the pandemic on her LGBTQ patients.

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Dr. Tim Guimond: My name is Dr. Tim Guimond. I'm a psychiatrist and statistician I'm here at HQ today, this is a new clinic about to open and July 22 will be our formal launch and we are aiming to be a center of excellence for sexual and mental health care.

Dr. Tim Guimond: In for cis guys and the guys and all trans and non-binary people.

Dr. Tim Guimond: So we're going to be providing convenient downtown destination for HIV sexually transmitted infection and blood borne infection testing.

Dr. Tim Guimond: To increase convenience, the services have been designed with self service kiosks so people will be able to come in.

Dr. Tim Guimond: answer some questions collect their own samples and the availability of an onsite laboratory will mean that we are able to give rapid results texted to patients phones within four hours of their testing.

Dr. Tim Guimond: We think this is going to be a drastic shift, we also have a whole clinic on one side here that is going to have physicians and nurses and clinicians available to treat anyone whose.

Dr. Tim Guimond: test results come back positive on the same day, we know when they've done equivalent work in other countries it's reduced the HIV rates.

Dr. Tim Guimond: Because HIV transmission comes down as people know their status and they're able to get treated much more rapidly.

Dr. Tim Guimond: we're going to add on the things that people have done in the past by including assessment for eligibility for pre exposure prophylaxis.

Dr. Tim Guimond: And post exposure prophylaxis for HIV so somebody who comes in, has testing within 45 minutes, we should be able to get someone started on prep know their HIV status.

Dr. Tim Guimond: is very different than the system, right now, where you need to wait for the results to go to public health.

Dr. Tim Guimond: Come back for your doctor, to know that it, that we can now start the medications and so by bringing all of these windows down to shorter periods we're hoping to be able to address.

Dr. Tim Guimond: The sexually transmitted infections surge that we are expecting and to address this under testing.

Dr. Tim Guimond: We also think that, when we do this, it should be 15 or 20 Minutes it takes for standard visit to our clinic This is also going to be kind of revolutionary in efficiency and convenience for people, which we hope will drive up people having routine testing much more frequently.

Dr. Tim Guimond: All That being said, i'm a psychiatrist so i'm also interested in the fact that HIV other STI syphilis.

Dr. Tim Guimond: Those rates also tend to travel with individuals who are suffering from untreated mental health and substance abuse problems.

Dr. Tim Guimond: And so we've integrated an entire part of the clinic here that also deals with mental health and substance use concerns.

Dr. Tim Guimond: And so we will have a step care model where, if you come and you request a mental health help you'll do some self assessment and we will streaming to a level of service that matches.

Dr. Tim Guimond: The severity of the problems you're facing and support that with peer programming and recreational and social programs that appeal to people in the Community to make this a Center that helps fight the isolation.

Dr. Tim Guimond: So we know very well, that LGBTQ to as individuals have higher rates of mental health and substance abuse problems compared to their heterosexual insist gendered partners and that has increased during COVID.

Dr. Tim Guimond: We know that from one Canadian study by good year that about 25% of LGBTQ individuals report, increasing the alcohol consumption during the pandemic.

Dr. Tim Guimond: And 19% reported increasing their cannabis use and this is lead to additional problems so study by Sleeman that was done across our nation, but centered in Vancouver.

Dr. Tim Guimond: found by comparing 3000 adults early in the pandemic in the spring and later in 2020 in the fall that while cis and heterosexual individuals have stabilized in their increased needs.

Dr. Tim Guimond: Those of us in the LGBT community had continued increase needs and increased difficulties during COVID.

Dr. Tim Guimond: So much so that early on in the pandemic, it was 15% of sexual and gender minorities reporting suicidal thoughts and 23% nearly a quarter of the.

Dr. Tim Guimond: sexual and gender minority adults in this study were reporting suicidal thoughts with a pandemic so we're hoping to be able to innovate in this mental health sphere and to provide the services rapidly to people for sexual health and mental health. 

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Dr. Amy Bourns: I really wanted to first share a little bit of the sort of more personal experience of the impact of the pandemic that i'm seeing in my interaction with patients as a family physician on the 2SLGBTQ unit at Sherbourne health.

Dr. Amy Bourns: And so I mean you mentioned the barriers to care, and we know that that has been an issue for decades, but I think sometimes there's a tendency to.

Dr. Amy Bourns: focus on look Look how different things are Look how much better things are.

Dr. Amy Bourns: Oh there's a pride, you know sticker in my doctor's office and things like that, but I think we also need to recognize that there's still a long way to go, there's still a lot of discrimination stigma and barriers to care and impact on the health of our population.

Dr. Amy Bourns: And so we know.

Dr. Amy Bourns: That the pandemic has really created additional challenges for all marginalized populations.

Dr. Amy Bourns: And what I seen in my practice is that a lot of my patients had to make the difficult choice to actually move out of the urban Center out of Toronto.

Dr. Amy Bourns: Because of financial or occupational reasons or looking after family and lack of affordable housing they've had to move back into suburban.

Dr. Amy Bourns: or urban areas where access to their inclusive health care teams support services and social networks is impaired, so it is quite challenging and so that is definitely affected feelings of isolation and, obviously, therefore, mental health and wellness.

Dr. Amy Bourns: And you know, while the situation is improving, to some degree and accessing gender affirming treatments well.

Dr. Amy Bourns: providers are learning more all over the province about how to do this work, there are still significant gaps in care and when.

Dr. Amy Bourns: Trans folks are moving outside of the city they're often having a lot of difficulty finding a family physician that is able to meet their medical needs or familiar with their care so just wanted to highlight the impact on youth.

Dr. Amy Bourns: Because there are another subset that has been particularly hard hit the Youth in our Community.

Dr. Amy Bourns: Because I think for a number of reasons, but I think what during adolescence is that feeling of belonging, is so important to mental health and wellness at that stage of life and when you're coming out and and seeking.

Dr. Amy Bourns: You know mentorship and and peer support, and so the isolation that came from the pandemic restrictions often forcing youth sort of to spend time with potentially unsupportive family members.

Dr. Amy Bourns: so again, things are improving, in terms of acceptance of young people coming out in their families, and this is really very important in their well being we know.

Dr. Amy Bourns: But it's not the experience of every youth that they are that their families of origin are supportive of their identities.

Dr. Amy Bourns: So, having to move back home, having to spend more time at home, has been very difficult and the positive Community programs.

Dr. Amy Bourns: Those for example provided by organizations such as supporting our youth when they stopped having access to in person programming they stopped having access to war meals, the STI screening to mentors and to mental health support.

Dr. Amy Bourns: And you know even before the pandemic there's a study that came out this month actually in CMAJ based on data

Dr. Amy Bourns: It showed that trans and non binary youth read a five fold higher risk of suicidal ideation a 7.6 fold higher risk of suicide attempts and their cis gender peers.

Dr. Amy Bourns: and sexual minority youth were 2.5 3.56 times the risk of suicidal ideation versus heterosexual peers and two to 3.3 times the risk of suicide.

Dr. Amy Bourns: So clearly a population at risk.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org

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