After he returned from a tour in Iraq in the fall of 2006, Ramond Curtis wanted to get as far away from the Army as he possibly could. He was mentally checked out far before his contract ran up in 2009, and he sought comfort in various drugs to quell symptoms of what would later be diagnosed as post-traumatic stress disorders.

By 2012, things were bad. “For nine months, I was in New York, living in a bedroom without a door, a bed on a floor and a clothing rack,” he said. “Everything else stayed in my suitcase. I didn’t have a checking account, my cash was in my suitcase. I lived that way [for nearly a year], just drinking and smoking pot every day, getting into aggressive altercations at work.”

At the suggestion of a friend, he went to a Veterans Affairs clinic in 2013, to seek treatment for a skin condition. “I ended up going to the VA because I didn’t have any money or medical care,” he said. Soon after, he also entered therapy and received his PTSD diagnosis.

Curtis, who recently finished his bachelor’s degree at Columbia University, said the VA treatment ultimately helped. But over the course of his time in care, he’s seen three different psychologists. Two of them, he says, didn’t seem to understand the particular trauma he was working through as a gay veteran.

‘A lot of veterans, even from my generation, aren’t comfortable being open’

“I would go into my sessions, and I could feel the standard treatment,” he said. “It didn’t match me. It wasn’t addressing my lived experiences, and I would have to steer the conversation.”

He had served under Don’t Ask Don’t Tell, the discriminatory policy that barred open service among gay and lesbians. “You can’t talk openly about your sexuality,” he said of the experience. “You have to constantly guard what it is that you’re saying. Every word out of your mouth, is this going to give me away?” These experiences didn’t exist in a vacuum, and they factored into his PTSD.

Curtis isn’t alone. Due to structural prejudices, the lingering stigmas of Don’t Ask Don’t Tell, and the ban on transgender service members, many LGBTQ veterans told me they don’t feel comfortable in veterans spaces. But they say they often feel isolated in civilian LGBTQ communities, as well.

Related: ‘Don’t Ask, Don’t Tell’ Is Gone, But Its Effects Still Haunt LGBT Veterans »

“A lot of veterans, even from my generation, aren’t comfortable being open about their sexuality and their sexual preferences at the VA,” said Curtis. “A lot of people may still have that fear that was ingrained in you. Like, what if I lose my VA benefits? There’s just not that clarity of safety.”

When I asked the VA about this lingering stigma, Lexi R. Matza, a field coordinator for the LGBT health program at the Department of Veterans Affairs, told me that the VA “never had a policy prohibiting care for gay, lesbian, and bisexual Veterans or transgender Veterans and it has a patient nondiscrimination policy that also includes sexual orientation, gender identity, and gender expression.”

Substance abuse has been on the rise among veterans, who are more likely to suffer from post-traumatic stress disorder if they have spent time in a war zone. According to the VA, approximately a third of veterans seeking substance abuse treatment have PTSD, and more than a quarter of veterans with PTSD also have a substance abuse disorder.

For veterans who are also members of a minority group, these numbers tend to be higher. “It’s a multiplier,” said Curtis. “Everything is compounded.”

According to the Substance Abuse and Mental Health Services Administration, people who identify as gay, lesbian or bisexual are about four times as likely to use methamphetamines, three times as likely to use heroin, and twice as likely to use prescription sedatives as those who identify as heterosexual.

‘We will hopefully be known as a safe place for the LGBT community and veterans’

The VA established an LGBT Health Program in 2012, but there’s still a large and unfulfilled need for for mental health and substance abuse treatment programs specifically designed for LGBTQ servicemembers, and some are organizing their own care network.

Strive Health, an outpatient clinic network based out of the northeast U.S., is trying to fix that disconnect, one group therapy session at a time.

In a new partnership with OutServe-SLDN, an LGBTQ resource group for veterans and members of the military, Strive will provide mental health and substance abuse counseling tailored for LGBTQ vets and their families.

Strive Health currently operates five outpatient treatment centers for substance abuse disorders and co-concurrent mental health issues. Through the newly announced partnership, OutServe-SLDN will create a referral system and access point for individuals looking for substance abuse treatment at Strive.

Strive’s health centers, like this one in Pennsylvania, plan to offer counseling tailored to LGBT veterans’ needs.

The advocacy organization will also provide cultural competency training for all of Strive’s staff, including administrators and corporate staff members. Clinicians are already trained in military cultural competency, and the centers offer therapy programs designed for veterans, according to Eric Frieman, co-CEO of Strive.

“For a group for civilians, for example, we wouldn’t have a survivors guilt group,” said Frieman. “But we absolutely would have that for a veterans and first responders group.”

Matt Thorn, president and CEO of OutServe-SLDN, said the joint program will be “the first of its kind to offer treatment from qualified professionals that are culturally competent in the unique needs of our LGBTQ military and veteran communities.”

“People are reluctant to get treatment in general, especially if they don’t know if where they’re going is going to be a safe place in terms of the culture,” said Frieman. “We will hopefully be known as a safe place for the LGBT community and veterans.”

Frieman said Strive is an in-network provider with most major insurance companies, including TriCare. Both he and Thorn said cost should not be a barrier to entry for any potential patients.

The core of Strive’s treatment model is intensive outpatient therapy clients that meet approximately three to five times a week, with about three hours per group session, according to Frieman.

‘The VA is not necessarily prepared to do that’

Curtis said that kind of group treatment program, if offered specifically for LGBTQ veterans, would go above and beyond the care he’s received at the VA. Cultural competency training might also have prevented some of the disconnect he felt with his previous therapists, he said.

“You have to have established protocols around things like this that teach medical professionals what to ask and how to act,” said Curtis. “The VA is not necessarily prepared to do that.”

Matza said the VA has two directives that “help guide staff in creating a welcoming environment for sexual and gender minority veterans” and that online educational training on LGBT cultural competency is available to clinicians the VA, although this training is not required. Every VA facility has at least one LGBT veteran care coordinator, according to Matza.

“VA trainings about LGBT Veteran health have recommended that clinicians routinely assess substance use, depression and suicidality among patients with LGBT and related identities and provide appropriate follow up,” Matza said.

Curtis said Strive’s approach, layering military cultural competence with LGBT cultural competency to meet the needs of LGBT veterans, is “exactly what we need.”

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