Today is a good day for Emile Fox.
Sipping on their iced coffee inside a hip coffee shop near downtown Orlando, Fox says they’re not 100%, but at least depression and psychosis didn’t steal this day.
“It’s OK. I’m OK.” Fox says.
The 29-year-old barista and community college radiology student identifies as nonbinary. They say this journey has been marked by depression and confusion from the start.
“Once I hit sixth grade, depression hit because I realized that I was different,” Fox said.
Fox says that while their family was supportive of their transition, they've had to figure the rest out on their own. Fox says they often felt left out of the LGBTQ community, too, and repeated incidences of isolation and depression over years spiraled into psychosis.
Fox said they weren’t violent or intending to harm themselves or others, yet their family had them involuntarily held in a mental facility multiple times last summer under Florida’s Baker Act.
“I went into eight facilities within four months,'' Fox says. “Whenever you go into those places, it's awful. They take your clothes from you; you're wearing gowns; it's dirty.”
Fox said they now suffer from post-traumatic stress disorder due to their experiences in these facilities.
“No one asks, ‘What do you need? How can I help you?’ All they think is, ‘How can I medicate you?’ ” Fox said.
During their time in these facilities, Fox said they fell behind in school and lost relationships and self-confidence. Ultimately, they lost trust in their family.
“It destroyed so much,” Fox said. “They think they know what's best for me, but it's so funny how they'll send you to a place that they don't even know what it looks like inside. None of them have ever been to a facility like that. They don't know what it feels like.”
The individual experience aside, during hospitalization, Fox went through something many LGBTQ+ people say they have experienced: a lack of necessary health care. Fox said they were denied access to gender-affirming treatment.
“I had trouble at every facility to get my testosterone shot. Once, I thought that I had finally gotten somebody to listen and give it to me — but they actually just gave me an antipsychotic. They tricked me,” Fox said. “I cried immediately after (the nurse) told me.”
Barriers to LGBTQ-affirmation
Fox’s story provides a snapshot of what mental health problems can look like for LGBTQ+ people in Florida.
In general, according to the Florida Department of Health, the number of adults who report poor mental health has increased over time. But the agency reported that the numbers for depression, anxiety and suicidal behavior are even higher in the LGBTQ+ community.
In 2007, 9.7% of Florida adults reported poor mental health, but by 2020 that number had increased to 12.3%. In February 2023, that number was closer to 32%. LGBTQ+ youth are at a higher risk.
The latest data from the suicide prevention nonprofit the Trevor Project shows 73% of LGBTQ+ youth reported mental health concerns, while 45% considered suicide.
The report clarifies, however, that mental health illnesses are not inherent to LGBTQ+ people. Instead, this community is at higher risk due to harm from mistreatment and marginalization.
This is what Roberto Carlos Katz, a mental health counselor and trauma specialist with the Orlando Counseling and Therapy Group, said. Stigma and discrimination are at the root of it.
"From a very early age, you see how you're judged and criticized, and you go through the process of not being accepted, including at home. But even if you come from a supportive home, you're going to be hearing negative messages about who you are in other outlets, whether it's at school, work or media. This affects your sense of self. You wonder, ‘What's wrong with me?’ ” Katz said.
These systemic issues are why, Katz said, many LGBTQ+ individuals don’t seek out help, and when they do it is often not affirming care.
“Historically, LGBTQ clients are not empowered,” he said. “Unfortunately, here in Florida, something that has been a medical matter got politicized. And that's what started to create those barriers."
It’s a chain of events. Katz said a lack of social acceptance can turn into mental health stressors that ultimately show up in physical and material ways, such as substance use disorder and self-harm. These require a specialized kind of provider care that is not always available, which can lead people to struggle with education, relationships, retaining gainful employment and even finding suitable housing.
“And until those structural social problems are fixed, you can compile all the resources in the world in order to make them accessible, they have to be also LGBTQ-welcoming,” he said.
Fox has been estranged from their family since the hospitalizations, which has left a void.
Peer Support Space
Today is a good day because Fox found help. As the need for LGBTQ+ support grows bigger and more urgent in Central Florida, one local peer support group has stepped up.
Peer Support Space is a peer-led organization that was born out of the Pulse nightclub massacre about five years ago. During the aftermath, the members decided the community needed a place where people could feel safe and help each other heal.
Just off of Mills Avenue in Orlando, about a month ago, the group opened the doors to Eva's Casita, a peer support respite place focused on the care of marginalized communities. Fox has already been a guest twice and said it was just what they needed.
“I wanted to be there, I didn't want to leave. Honestly, it was so nice,” Fox said.
Respite means to rest and take a break from stressful factors. Peer support, while not clinical or medical, is defined by the U.S. Department of Health’s Substance Abuse and Mental Health Services Administration as a range of activities between people who share similar lived experiences that promote social connection through a mutuality of support, or “peerness,” not usually found in other professions.
Executive director Yasmin Flasterstein put it this way: adults on the brink of a mental health crisis can come to Eva’s Casita and trust they will be cared about by someone who knows what they’re going through.
“This is communal healing. To feel like there are people out there who don’t know me but care about me, you know, that is lifesaving,” she said.
The home is run and operated by a diverse LGBTQ+ staff. Flasterstein said the respite space is the first in Orlando to intentionally focus on underserved communities.
“I worked professionally in the mental health response (of Pulse), and what I saw was that there was a lot of difficulty finding culturally affirming resources for people that had intersecting marginalized identities,” Flasterstein said.
Eva’s Casita means Eva’s Little House, an homage to the Puerto Rican woman of the same name who, Flasterstein said, laid the groundwork that inspired the respite space.
Eva died about two years ago. Flasterstein said she first met Eva when she was responding to the Pulse shooting as a therapist. She said Eva was a gentle soul who held her heart when she spoke.
Eva left retirement to peer support full time. Although she had a Western medicine background, she traveled and researched for a long time in search of more holistic approaches, Flasterstein said.
“You know, therapy has helped me, medication has helped me, but there's so much more when it comes to mental health options,” Flasterstein said. “This just makes so much sense. Every single thing I've ever been upset about in the mental health system, peer support solves it in one way or another.”
Inside Eva’s Casita
Eva’s Casita is not a clinic. It’s a literal home in a neighborhood. Filled to capacity, it can hold up to three guests and one support companion, for a total of four people at a time. If there is space, the organization doesn’t turn anyone away.
Currently there is no wait list. Guests are welcome to stay at Eva’s Casita for up to six nights at no cost, once a month, prioritizing people who have not stayed before. As long as everyone is an adult and willing to uphold the guest agreement for overnight stays, people can stay in any of three rooms - all built with thought and intention.
There’s the Celestial Sky Room, with hundreds of painted stars that glow at night each representing a person who’s died or has helped in laying the groundwork for this project in one way or another. In the El Yunque room, it’s like guests are staying in the Puerto Rican mountains looking out at the rainforest. And then there’s the Mush room, which transports guests into a world of fantasy.
At Eva’s Casita, Flasterstein said, everything is voluntary. Guests can choose to engage (or not) in social and independent activities, such as games, crafts, one-on-one counseling. Or keep to themselves and do nothing at all.
“We've all been in a place where we just need to stare at a wall for three days. But if I did that at a mental health hospital, I might be noncompliant, right? So, the idea is I can come here, I can stay to myself if I want, I can interact with others if I want. … Everything is voluntary,” she said.
There is no treatment and guests are expected to take care of themselves, by cleaning up after themselves to the best of their ability, being independently mobile and administering their own medications, if they have any.
Flasterstein said that while medication and therapy absolutely have their place, Central Florida was in dire need of an addition like this.
Katz agreed. He said neither peer support nor the mental health care system are perfect. Both are always learning, always growing and always changing.
But he said that they work well together. Peer support, Katz said, is not in competition with mental treatment nor a replacement for it. They work in tandem.
“Let me reassure you that treatment works. It works better when it's LGBTQ-affirming. So, what we do is a little bit different from what peer support space does. It's actually two different things that complement beautifully,” he said.
Eva’s Casita is not quite done, Flasterstein said. Items, funding and donations are still coming in - and needed. The director said she hopes to add more resources to Eva’s Casita, such as wellness equipment, some organizational furniture, materials and tools for more activities, and even install a fountain and garden in the backyard where she hopes to eventually raise communal pets.
For now, people like Fox can have a place where they feel grounded, understood and whole again.
“(Eva’s Casita) felt like I had a real sense of having community but where it feels like family,” Fox said.
While it may not be perfect yet, at Eva’s Casita, that’s OK, too.
If you or someone you know may be considering suicide, contact the Suicide & Crisis Lifeline by calling or texting 988.
Lillian (Lilly) Hernández Caraballo is a bilingual, multimedia journalist covering housing and homelessness for Central Florida Public Media as a Report for America corps member.
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