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There is another variable in the Double Trouble jargon, usually used to describe issues of mental illness and substance abuse. To be Gay and be a patient in a psychiatric hospital is also double trouble. It entails double stigma and it entails double troubles.

There are many retrograde ideas about homosexuality within the population of psychiatric hospitals. There is also open homophobia and discrimination. To avoid unnecessary hassles, many gays who are out of the closet when in the community choose to be back in the closet during a psychiatric hospitalization. Why is that? Several reasons.

One reason is protection from verbal and even physical harassment. When your sexual orientation is known, that is usually the first thing that comes under attack when involved even in a petty argument about the dinner line or what channel to watch on the television. It is common to hear things like, "This f-g is this" or "this f-g is that." It never fails. If you are involved in a petty argument and your antagonist knows you are gay, you will probably have to endure an expletive about your gayness. In more extreme cases, your gayness could provoke such discomfort in others that you might end up being assaulted. In some twisted minds, it is not such a big thing to assault a gay person.

Other times, when your sexual orientation is known, you may be the target of theft of property. You become vulnerable to the biases of fellow patients who see you as a lesser person; a worthy and easy target.

Another problem is the fear you might induce on your roommates. Some will be extremely uncomfortable and threatened by having a gay roommate. I have heard many cases of patients who request to be moved from a room because they think their roommate is gay. Or they ask for a roommate to be moved from their room because he or she is thought to be gay. Just like that. Not because there has been any inappropriate behavior or unwanted advances, but because there is the notion that gays are sexual predators.

This comes from the misperception that just because you are gay you will want to become sexually involved with anyone regardless of looks, age, personality, etc. Many homophobes do not realize that gay people are as selective as straights when it comes to choosing partners.

In the process of keeping your sexual orientation a secret matter, you many times cannot be totally truthful with everybody. Your partner becomes your "brother" or your "cousin" or your "brother-in-law", etc. Moreover, your expressions of affection during a visit from your partner to your inpatient unit have to be somewhat reserved and, most of the time, lacking on spontaneity. In addition, when talking with your visitor, if there are other patients around, you many times end up talking about private matters in "word-codes." Though this can be amusing sometimes, it is not what gay people would prefer.

In a recent report by Alicia Lucksted, Ph.D., of the Center for Mental Health Services Research of the University of Maryland, she exposes several serious problems for Gays and Lesbians receiving mental health services. According to Dr. Lucksted the system is plagued with stereotypes, heterosexist programs, peer intolerance and lack of training on how to treat Lesbians, Gays, Bisexuals and Transgender consumers. There are also mistaken approaches like, for example, treating self-protectiveness or anxiety about homophobia as a sign of paranoia. In addition, she finds that often, consumer's emotional and sexual life in general is not addressed except as a problem.

It is not easy to be Gay and receive inpatient psychiatric care. And, in terms of how the Gay community itself deals with those gays and lesbians who have received a psychiatric diagnosis, I have heard conflicting opinions. Some state that given the fact that homosexuality was once considered a form of mental illness listed in the DSM (until the early 70's), Gays are generally understanding of consumer issues and hold benign and compassionate attitudes toward the mentally ill. Others state that some sectors of the Gay community tend to put excessive emphasis on youth and physical perfection and may not view mental illness with the best eyes due to the implications of accepting people who may be perceived as not being completely "perfect" or in total "control" of their lives. I personally have not yet explored which of these two descriptions is more accurate, or if the attitudes of the Gay community about mental illness resemble those of the "general" population—whatever those attitudes may be.

My best advice to fellow Gays and Lesbians receiving mental health services is to do their best to live through the system and to live with dignity and your head up high despite a psychiatric diagnosis. We have the double task of educating people about Gay, Lesbian, Bisexual and Transgender issues and of educating others about what it means to be G/L/B/T and living with a psychiatric diagnosis and receiving inpatient or outpatient mental health services.