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Supporting LGBTQ Adults Experiencing Mental Illness

May 11, 2016

Raymond J. Kotwicki, MD, MPH, Chief Medical Officer, Skyland Trail

Several aspects of our psychiatric treatment program make Skyland Trail an effective and welcoming environment for LGBTQ (Lesbian, Gay, Bisexual, Transgendered, Queer or Questioning) adults – including cisgender, transgender, agender, genderqueer, and gender questioning individuals – who are experiencing mental illness.

Foremost is our treatment philosophy. We encourage our patients to define their own values and establish their own goals. Our clinical team then helps each patient identify the best strategies for living a life true to their values, staying healthy, and achieving identified goals. Those strategies include an individualized mix of medications, stress management, skills building, nutrition and healthy living education, cognitive training, and social skills development.

Some patients are comfortable with their gender identity, gender expression, and/or sexual orientation. That’s just part of who you are, and it’s not an issue. In that case, we’re here to help you address the psychiatric symptoms and challenges that are causing you pain or disability, including anxiety, depression, suicidal thoughts, impulsivity, or self-harming behaviors while reaffirming your self identity.

Other patients may still be exploring their identity and how they express themselves in terms of gender or sexual orientation. They may be experiencing anxiety, depression, or other mental health symptoms as a result of that exploration, either from an internal conflict or from stress imposed by their environment - for example from their relationships or from barriers preventing them from participating fully in their community. We support these patients as they explore these questions. We help them build skills to manage stress and conflict as well as the resilience needed to live the life they choose.

Another important element of our treatment program is our commitment to ongoing education and training for our clinical professionals. As we identify needs in our client population, we work to find the best evidence-based strategies to address those needs. Our clinical team has received training on supporting LGBTQQIAAP individuals and meeting therapeutic needs that may be unique. For example, we are comfortable and have experience managing medications and conducting psychotherapy with individuals who are also taking hormone therapy. Our weekly schedule includes a group specifically for LGBTQQIAAP clients. We’ve also taken steps to make our facilities more welcoming, like offering all-gender restrooms.

Beyond our relationship with the individual patient, our holistic approach includes family therapy. Family therapy can be helpful for all our patients, and may include therapy with biological family members or chosen family members. While in treatment, our patients work hard to change their unhealthy thought and behavior patterns and adopt new perspectives and skills. If they return home to an environment that continues to reinforce the old unhealthy patterns, clients face a greater challenge in sustaining their recovery. Family therapy can help change the family dynamic and improve communication so that families can better support one another and prevent conflict and relapse.

Finally, Skyland Trail includes humanitarianism as a key element of our treatment program and healing community. For someone dealing with a mental illness, it can be difficult to shift your focus outside of yourself to instead focus on what you can do to help others or how you can contribute to your community. We emphasize the importance of showing kindness and practicing empathy. This creates a welcoming community of peers for all of our clients; they are met with empathy and acceptance. Our focus on humanitarianism also is therapeutic. By practicing empathy and engaging in purposeful activities, our patients help redefine their place in their world and discover the value they add to their communities.

Bottom line, we meet clients where they are. We offer expert psychiatric care and a holistic path to wellness. Each week, patients participate in a structured schedule of evidence-based therapeutic groups matched to your diagnosis and symptoms, as well as groups focused on creative expression, healthy living, social skills, and community engagement. No matter where you view yourself on a spectrum of gender or sexual orientation, if you are struggling with mental illness, we will help you grow, recover, and live a life worth living.


Ray Kotwicki, MD, MPH

Chief Medical Officer

Dr. Ray Kotwicki is the chief medical officer of Skyland Trail. Located in Atlanta, Skyland Trail is a nationally recognized nonprofit mental health treatment organization serving adults ages 18 and older. For 26 years, Skyland Trail has been inspiring people with mental illnesses to thrive through a holistic program of evidence-based psychiatric treatment, integrated medical care, research and education. Before joining Skyland Trail as full time chief medical officer, Dr. Kotwicki served as an associate professor the Department of Psychiatry and Behavioral Sciences at Emory University’s School of Medicine, and as an associate professor at Emory University’s Rollins School of Public Health. He remains on adjunctive faculty at the Emory University School of Medicine, as well as at the University of Miami Miller School of Medicine. Dr. Kotwicki is a Diplomate of the American Board of Psychiatry and Neurology, and has been elected an officer of the Georgia Psychiatric Physicians’ Association. Dr. Kotwicki received his undergraduate and medical degrees from the University of Wisconsin Medical School, and completed post-graduate training at Harvard Medical School, the Boston University School of Medicine, and Emory University, where he also earned a Master’s degree in public health.

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