How a 100-Year-Old Clinic in Hamilton County is Connecting Adults with Gender-Affirming Mental Health Care

BY MADELINE FENING

This story contains topics related to suicide. If you or someone you know needs help, call or text 988 to get in touch with the Suicide and Crisis Lifeline.

Karla Perry gets lunch every week with her dad, but it’s not always the happiest of occasions.

“My dad says he’s doing his best to tolerate me,” Perry told CityBeat “I know he’s doing the best he can. I mean, he wants to go out to lunch with me.”

That’s because Perry’s dad is used to calling her “Cook,” the name she was born with, along with her original “male” gender assignment.

“I have always struggled to fit into the mold of a boy, it’s never suited me. I feel more comfortable when I think of myself as a girl,” she said.

Perry’s transition came at a time of already exasperated difficulties. She’s experienced a chronic illness that has required her to receive dialysis treatment since 2014 when she had a kidney transplant.

“When I got out of the hospital and started healing, that’s when I started really opening up to the possibility of thinking about my sexuality and my gender,” she said. “I had felt stuck my whole life; depressed and struggling with stuff.”

Perry was going through a lot at once — mind, body and spirit — all amounting to the need for professional guidance and support.

“I used to be called Cook, and that’s not a deadname for me because he got me to Central Clinic where I needed help,” she said.

100 years of Central Clinic Behavioral Health

Central Clinic Behavioral Health (CCBH), the clinic Perry credits with ultimately saving her life, turns 100 this year.

“We’re actually the oldest outpatient mental health clinic west of the Alleghenies,” said Nelly Rimini, a licensed clinical social worker and the director of adult services at CCBH.

When it was originally founded in 1923, CCBH was the first mental health nonprofit organization in Ohio and one of the only community clinics that served both children and adults.

“Obviously this was really early for what is called the ‘community mental health movement,’ which really started in the ‘70s, so we pre-date that by like

50 years,” said Rimini. “At that time there was a lot of stigma attached to folks. Treatment a lot of the times was just hospitalization, there was little outpatient services at the time.”

Hamilton County's first mental health program for trans people

Fast forward to 2015, CCBH again jumped ahead of the curve when the clinic began serving the transgender population through an innovative transgender wellness program.

“This was kind of the first program in our county addressing the needs of transgender folks,” Rimini said. “At that time, there was the beginnings of some services for youth and children, mostly around physical health issues through Children’s Hospital’s transgender center, but there wasn’t really much in terms of adult care other than peer support.”

Rimini said the program was started as a reaction to the prominent 2014 suicide of Leelah Alcorn, a King’s Mills teen who died after stepping in front of a semi truck on southbound I-71. According to a suicide note automatically posted on Alcorn's Tumblr page, she ended her life because she felt isolated and misunderstood by her devoutly Christian parents who had sent Alcorn to conversion therapy. The note’s signature includes the name Leelah, and also the name “Josh” crossed out.

“One of the big things that a lot of [the LGBTQ+ community] share in common is trauma,” Rimini said. “Not everybody, but there’s a lot of trauma. And a lot of anxiety, depression, things of that nature that come up. Because when you’re exposed to a lot of discrimination and misunderstanding that creates a real emotional burden.”

To help deal with the burden, Alejandra Serrano, a licensed clinical social worker and the coordinator of the LGBTQ+ program at CCBH, said the program connects participants with one another to process their experiences together.

“We have workshops every month for the clients to come in and build community through different activities, like making queer zines,” Serrano said. “We also provide a lot of training for other therapists and others in the agency who aren’t as familiar with gender-affirming care and LGBTaffirming care so that they can become more competent in the area and be able to treat our clients successfully.”

Serrano said the program started with about 25 participants, but has grown to around 200. Perry told CityBeat she joined the group in 2018. She’s felt welcomed from the start.

“That’s a dedicated space where I know I can go and there’s going to be a handful of people [...] and the people always accept me for who I am,” she said. “Sometimes we talk about hard stuff, sometimes we talk about fun stuff, but it kind of depends on the day.”

One of the harder things Perry said she’s been able to connect with others in the group over is using the bathroom in public.

“One thing about me that I struggle with the most is using public bathrooms. I’ve already decided that I don’t go in the women’s restroom anywhere because I’m 6’4 and almost 300 pounds. I don’t feel comfortable using men’s restrooms, but that’s where I go. I don’t use the women’s restroom because I don’t want any uneducated security guards deciding to use me as an example,” Perry said. “We just gotta pee like everybody else does.”

When politics enters the conversation

Bathroom use also radiates through group therapy talks about Ohio legislation. Along with gender-affirming care bills.

“We talk a lot about the latest legislation, it comes up all the time in our conversations because our clients are being directly affected by a lot of the different bans that are happening in the country,” Serrano said. “People have expressed real anxiety about what’s going to happen with their care. Am I going to be able to get surgeries? Should I get surgery quicker than maybe what I’m ready for because it might not become accessible for me? People have talked about putting away hormones because they’re afraid they’re not going to be able to get prescribed hormones.”

More than 490 anti-LGBTQ+ bills have been introduced in state legislatures across the United States since the start of the year, a new record, according to the ACLU.

In Ohio, five bills targeting trans rights focus squarely on children, including one bill, House Bill 68, which seeks to ban all forms of gender-affirming care for minors. The bill even bars doctors from providing care to patients from out state. CCBH’s LGBTQ+ program is for adults only, but Serrano said young adults are often at a place of intense need for therapy.

“That age between 18 and 22, with the LGBT community, I think there’s more difficulties because some of our clients have been kicked out of their homes or they’re isolated,” Serrano said. “Or they’re riddled with anxiety because they don’t feel safe walking down the street. We deal with a lot of folks who are depressed and anxious and unfortunately I think it is more difficult for our LGBT clients to go through the natural developmental stuff that a non-LGBT person would go through because they have so much stigma.”

Research across the board shows suicide rates are higher among LGBTQ+ people, both in youth and adulthood. Those in search of gender-affirming care are far less likely to end their life if they are able to access care, according to an article published in the National Library of Medicine.

Serrano said gender-affirming care means much more than just the surgeries and hormone therapy that have entered the mainstream political debate stage.

“Gender-affirming care could mean that when a client walks into our office that we are using their pronouns, that we are using their correct name. It could mean surgery, for us it could mean writing support letters, it’s very, very broad,” Serrano said. “It means understanding how discrimination and stigma have played a role in the development of our clients. It’s not uncommon for our clients to be misdiagnosed with borderline personality disorder or autism or other things, when in reality it’s more of a minority stress situation.”

Perry is still working through that stress, but told CityBeat she's proud of her progress thanks to CCBH.

“I’m trying to accept myself the way I am,” Perry said. “There are complications when you are seen as something that is not typical or is different. I’m proud of that, but there are still moments where I feel uncomfortable and maybe wish I had toned it down a bit, but I don’t want to tone myself down!”

How to get help

Using grant money, the LGBTQ+ program developed a list of community resources that connects folks with places where they will be treated with respect, understanding and empathy, mental health needs or otherwise. Interested participants just need to call the front desk at 513-558-5801 and ask for the LGBTQ program resource list.

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