Gay City, Seattle. Image: Google

On the Front Line of Seattle’s LGBT Health Crisis

In some ways, this story started on the streets of Seattle in 1984. It started with a community that was riddled and plagued with HIV and drug abuse.

A community that was struggling to find itself and understand its place in the world. In some ways, this story ends how it started.

In a house near Capitol Hill, a woman known only as Mindy, decided to open her heart — and her home — to this community in need. She gave all comers a place to stay, food to eat. She housed the homeless and gave a community fighting an AIDs and HIV epidemic somewhere safe to gather themselves, get on medication, learn how to look after themselves or to die with dignity.

That place was known as the Seattle Aids Support Group.

Before long, Mindy realised the people that were coming to her had been prematurely discharged from hospital because doctors were scared HIV was contagious.

HIV positive men were joined by a steady stream of women with children at the burgeoning Seattle Aids Support Group. Mindy started asking questions.

Chiefly, what do a homosexual man and a straight woman have in common? It wasn’t sex.

It was drugs.

HIV was spreading through shared needles.

In 2019 a large black and white photograph of Mindy, hangs on one of the walls of Peer Seattle (formerly the Seattle Aids Support Group). It shows her surrounded by the men and women that would become her family in the large multi-story house that she was photographed in front of.

Peer Seattle is one of Seattle’s most well known LGBT+ support providers.

“What Peer Seattle does is house 12 step meetings and not just for Alcoholics Anonymous or Narcotics Anonymous.” Timothy Dean, Peer Seattle’s Volunteer and Internship Coordinator, tells me in his small, dimly lit office in Peer Seattle, Bellevue Ave, Capitol Hill.

Dean is soft spoken and despite his office not having any windows, the soft orange light and high ceilings, combined with Dean’s soft, thoughtful, manner make the room’s grey walls feel comforting and secure.

“There is so much going on on Capitol Hill,” Dean continues. “There’s crystal meth, there’s speed, mental health issues…and when someone is on a mind altering substance and they also have a mental health diagnose [sic] and they mix the two, it turns very chaotic.”

It’s been more than 30 years since it started Peer Seattle is still committed to helping the LGBT+ community as it battles with mental illness, homelessness and addiction issues. It’s open from 9 am to 9 pm and houses meetings seven days a week. Unlike many other places, Peer allows its clients to turn up whenever they need to and spend time until their meeting.

“Most places don’t allow folks to show up, maybe more than half an hour before a meeting, so that means that folks are just wandering around town and killing time until a noon or three o’clock meeting.” Dean says. “When that happens, a lot of people get triggered because they start out with the purpose of doing something positive for themselves but, if they’re homeless, they’re still wandering in circles and sitting at bus stops trying to kill time…so Peer Seattle allows folks to come in hours before a meeting. If someone comes in they have to do something. If they come in first thing in the morning, they have to work on a resource computer, do something to better themselves.”

It’s hard to overstate the challenges that the LGBT+ community faces with addiction and mental health in Seattle but one of the biggest problems is a lack of insight into how many in the community need help.

Frank Couch is a Dedicated Crisis Responder. He speaks to me from his car, on the way to an appointment. Couch is the person that gets called when people are at breaking point.

“We’re the people who get called when people are homicidal, suicidal…or in grave danger.” Couch’s voice crackles down the phone. “We go out and assess whether or not they need to be detained for up to 72 hours so they can get the help they need.

“We see people when they’re at their absolute worst, when they’re decompensated from some mental illness or drugs and alcohol may be involved — that may be where the behaviour is coming from. For the most part, most of the folks that we see have some form of mental illness and are decompensated in some way — either they’re not able to meet their health and safety needs or they’re not in volitional control or they’re espousing that they’re thinking about committing suicide or some severe self harm or harm to others.”

Couch works with people all across the socioeconomic, cultural and sexual identity spectrum. He says that while he, and his colleagues, ask a person their sexual identity (in the instances of transgender people, protocol is that they’re made safe if they’re detained and that they receive treatment from clinicians that understand transgender issues) there is no tally in King County — the county which Seattle exists in — of how many LGBT+ are in the county or in need of care.

“I don’t know anybody that’s tracking how many gay people or bisexual people there are in the community.” Couch says, “I don’t see that data point anywhere…I don’t know where you would get that data point from.”

One of the biggest challenges with not keeping track of those numbers isn’t only that there’s no way of knowing how big the problem is, it also constrains resources.

“Currently,” Couch says thoughtfully, “we have one treatment centre that is focused on ‘sexual minorities’ — that’s what they say, that’s the term they use. If numbers were great then that might mean there would be a call for us to open more [treatment centres] and to really serve the needs of that particular population but no one is collecting that data.”

Gay City, much like Peer Seattle, has been around for a long time. It was formed at the height of the HIV/AIDs crisis in 1995 and one of its longest and enduring channels of support is the Wellness Centre that it funds and makes freely available to any and all LGBT+ people that need it — whether that be for health check ups, PreP information, STD/STI testing or helping people navigate an HIV diagnosis.

“I think its made such a huge impact on the community that we’re one of the top places.” Melvin Givens, Director of Marketing and Communications, tells me over video call.

Givens is sitting in one of Gay City’s large spaces — it’s also know for its art programme which has been giving LGBT+ artists a space to rehearse and perform for more than seven years. He has a thin moustache and small goatee and black rimmed glasses.

“We’re the leading HIV and STD tester in King County,” He continues. “We help folks to get tested and learn about their status and we’re a notable location that helps people if they learn they’re HIV positive. We help them understand what it really means to live with HIV and help them understand that with all the treatments that are available, there is so much more you can do in life. You’ll have a regiment of pills, sure, but you can live a long lasting life, make an impact and make your dreams come true.”

Back at Peer Seattle, Dean is talking about the complexities of the LGBT+ health crisis. He worked with the homeless population in Seattle for more than 10 years and, not unlike Couch, sees a lot of the worst things people are going through.

He knows that, despite awareness and support, the scale and difficulty of what Peer and other organisations are facing, is hard for people to comprehend.

“Imagine,” he says, in his soft and thoughtful way, as though he’s feeling the weight of each word, “being the first person where you live to have a tattoo on your forehead. When you go to the grocery story people will laugh and point or they’ll grab their kids and tell them not to get too close. Now, imagine you went into a certain coffee shop and they were like, ‘hey, how are you doing?’ And they gave you a hug. That’s where you would feel comfortable, right? That’s how it is here.”

Peer has its regulars. Dean says there are about five male identifying people that go in every day and are there before the doors open.

One of the challenges, Dean believes, is a lack of places for people to feel supported in what they’re going through.

“A lot of folks are still recovering from childhood abuse, either being molested sexually, verbally or emotionally abused. A lot of folks, before they’re willing to fill a prescription for pills, would rather talk about it. There’s a lack of agencies that will say, come on in and let’s talk. I can meet with you every week.”

Homelessness and abuse aren’t uncommon in the LGBT+ community. One of the things that Gay City does is allow homeless people to go in and rest their feet, have a snack and gather themselves. Givens says there have been many times where they’ve taken people to shelters and connected them with the right people at those shelters, especially transgender people to make sure they get the help they need from the right people.

Gay City, like Peer, doesn’t charge for any of its services.

“I think the services are here already.” Couch says, after a moment of pensive silence. “The problem isn’t that we don’t have enough services, the problem is that maybe, probably, they don’t have enough beds or the cost of the services for some of the private institutions are outrageous and not everyone can afford them, so not everyone gets the same kind of treatment.”

Dean agrees that there are mounting challenges with the cost of support services and capacity.

“…I talked with the Orion Centre, a relief agency, and they were saying that the numbers are going up,” Dean says. “A lot of homes and families don’t understand LGBTQ and a lot of the youth know there are different places that give free services…there are maybe three facilities in Seattle and they’re packed. They’re packed. With the youth, it seems like there is always strings attached, like having to go back to school to get your GED [General Education Diploma].”

Despite the progress it feels like the community is making with acceptance, Dean, Givens and Couch are seeing the brunt of what happens when that acceptance doesn’t always exist — including teenagers thrown out of the house for their LGBT+ identity.

“You get folks that are coming here and a lot of them, their parents, for whatever reason, threw them out of the house. A lot of folks, however they identify, don’t feel comfortable in shelters because crimes happen there.

“There is [sic] different degrees: either they’re on ground level and they got up and they’re showering regular and got into some type of programme or there are folks who, sad to say, are compromising their bodies for cash, clothes and drugs and that’s what you see around here.”

One of the biggest draws to Gay City, according to Givens, is not only its holistic approach, but the way its able to connect people to the services they need — whether it be mental health services or state or private health insurance — and those services continue to grow.

“We’re still in the early stages of our health insurance programme because we are right now in the midst of training so we can add onto our services and provide people with additional health plans that are beyond the ones we have right now.”

As the crisis deepens, organisations like Peer and Gay City are focused on collaborating and expanding to meet the growing needs of the community — they aren’t the only organisations that are doing this kind of work. Givens says that are more and more every other week and Dean knows that, without them, there would be noticeable gaps.

“I think there would be more lost people.” Dean says, thoughtfully. “I don’t know where folks would go for an honest 12 step meeting, especially the crystal meth meetings, because people are already driving in from the surrounding towns because not everyone accepts the non alcoholic meetings. I think people would be lost or trying to do it on their own or compromise themselves.”

Although it can be hard to see, things are looking up — slowly but surely. As services expand and more come up in further parts of Seattle, spanning from Everett to Tacoma.

But there is a lot of work to be done and Couch says that it can’t all fall to not for profits and community centres, as King County gears up for its next local election and the prospect of new leadership.

“I would hope they [new leadership] would look at the work force and pay the clinicians what they’re worth and keep them around, that’s what I hope to see. But then also, that we don’t tear down the systems that we’ve been building over the ramp up of the Affordable Care Act, because we’ve done a lot of work bringing a lot of systems together for comprehensive care and I would hate to see that torn down.”

Clinician pay and salaries is a challenge in King County. Couch says that climbing living costs are causing issues and Givens agrees — citing the increasing cost of housing and living in what has historically been the gaybourhood — Capitol Hill.

“To be a clinician in King County,” says Couch, “if you’re working with an agency, you’re getting underpaid in a region that has the highest cost of living. So you, as a clinician, as a care person, aren’t even able to care for yourself, at times. You can’t live in the community that you service in, for the most part, and that’s not acceptable. If we paid clinicians more, maybe they would stick around and be willing to do the work.”

A conversation that Givens says has been occurring with increasing frequency amongst the LGBT+ support networks and businesses in Seattle, is whether Capitol Hill remains a viable place for the gay community and its support networks.

“We’ve noticed that gentrification quite a bit.” Givens says, thoughtfully. “There’s a huge shift in Seattle [and] it has affected access to some services for folks. We don’t necessarily see a reduction in the number of queer folks that we see but we do hear about some pain points of travel — folks have a longer distance to travel or more time they have to add to come here to the queer establishments that have a major stake hold [sic] in the area.

“We’re definitely a people that are displaced and pushed out into the margins, into suburban areas and then beyond that into cities that are further away,” Givens says.