Man's story highlights issues for older LGBTQs

  • by Adam Echelman
  • Wednesday June 15, 2022
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Martin Alperen, 65, is struggling to navigate his mental health medication with his new Medicare plan. He walks at least five miles a day with his dog, Marley. One of his favorite destinations is Mission Dolores Park. Photo: Adam Echelman
Martin Alperen, 65, is struggling to navigate his mental health medication with his new Medicare plan. He walks at least five miles a day with his dog, Marley. One of his favorite destinations is Mission Dolores Park. Photo: Adam Echelman

In April, Martin Alperen had a breakdown. It wasn't the first time that his bipolar disorder had caused him to lose a job or spiral into depression, but it was the first time he had tried to navigate his mental health with Medicare. He had recently turned 65 and had switched to a new Medicare insurance plan provided through Brand New Day and Hill Physicians Medical Group. Now, his providers said there was no psychiatrist nearby. If he wanted help, they explained, he could admit himself into a psychiatric ward or try using a tele-health service.

What he really needed was a simple intervention, a psychiatrist who could meet with him in person and update the medication he's been taking for the past three years.

"I was terrified," he told the Bay Area Reporter. "I did not want to become another homeless mentally ill person on the streets of San Francisco."

Alperen isn't alone. A survey of 500 people from the city's LGBTQ Aging Research Partnership and Health Management Associates found that mental health counseling was the highest unmet medical need among LGBTQ adults 50 years and older. For many, the COVID pandemic fueled fears and post-traumatic stress from the early years of the HIV/AIDS crisis. These seniors reported that they were unsure where or how to access mental health services or felt that the system was too complicated to navigate.

"If this can happen to me, a good complainer, imagine what could happen to other people," Alperen wrote in an email. He is short and talks quickly with an accent that fuses Boston and Brooklyn. He's always on the move, running through colorful life stories with layers of his own commentary interspersed with the occasional tangent. He wakes up before dawn and walks at least five miles a day, always carrying a baseball cap, a pair of sunglasses, a sleek backpack, and a curious collection of flashlights. He pays $1,800 in monthly rent, but his Social Security only provides him $1,692 a month. In two months, his savings will run dry.

"I have 15 flashlights, but I have no preparedness for this," he said about his financial situation and smiles as he pulls out a slim flashlight from his pocket.

Martin Alperen was the first out gay police officer in Provincetown, Massachusetts and one of just two out gay police officers in the state in 1980. Photo: Courtesy Martin Alperen  

In 1980, Alperen was the first out gay police officer in Provincetown, Massachusetts, one of only two out gay police officers in the entire state. His ability to talk to anyone, the "gift of gab" as he likes to say, was an asset that made him many friends and gained him respect among locals and officers alike. Living between Boston and Provincetown in the 1980s, he kept a list of all his friends who had died of HIV/AIDS.

"At 15, I threw the list away," he said between heavy, gasping breaths. "I have no idea why I didn't die."

That feeling is so common it's called "survivor's guilt," explained Vince Crisostomo, 61, the director of aging services with the San Francisco AIDS Foundation. His clinic works with hundreds of gay, bi, and trans men across the city, many of whom have been living with HIV since the 1980s and struggle with unresolved trauma, isolation, and ageism — not to mention the challenges in navigating the health care system. "I don't think the country planned for us to live to these ages either," he said. Crisostomo's been living with HIV since 1987, when a doctor told him he had less than two years to live.

The mental health challenges for those who survived, both those with HIV and those without, are evolving as this generation reaches 65. Paul Aguilar, 58, is HIV-positive and recently received a referral from SFAF for a mental health provider, but after an initial assessment, the earliest appointment was in August or September.

"OK but my need is kind of now," he reflected. Meeting with a licensed psychiatrist, a medical doctor who can prescribe medication, can take even longer.

Aguilar has been working with HIV Advocacy Network, a part of SFAF, to lobby Mayor London Breed to increase the budget for mental health services for people who have been living with HIV for years. In 2020, the network requested $500,000 only to see those dollars get whittled down. This year, the mayor once again disappointed HIV advocates when she allocated $3 million, fewer dollars in her budget than they had requested, as the B.A.R. previously reported. The HIV Advocacy Network wants those dollars to support new licensed professionals and better coordination among providers who may help people quickly access the care they need.

Aguilar knows what might happen otherwise. He watched as his former partner struggled with bipolar disorder and schizophrenia before he passed away from a fentanyl-induced overdose at the age of 46.

Alperen used methamphetamine to cope with his mental health challenges, but by 2018, he was able to stop.

"My psychiatrist said it was because I got the right medication," he said. "My therapist said it was because I talked to him."

In truth, he isn't sure what allowed him to get better, but when his part-time job started to stress him out in February, he felt he needed medical help again. After failing to secure a new psychiatrist through his health care plan, he admitted himself into the hospital in April. (His health insurance providers, Brand New Day and Hill Physicians Medical Group, did not respond to requests for comment).

Alperen knew the hospital wasn't the right place for him — he wasn't in danger of hurting himself — but he didn't know where else to go. The UCSF emergency room physicians connected him with a social worker who offered to help him change his insurance plan so he could get a psychiatrist. After five months of phone calls and angry emails, he is optimistic that his new insurance company, which starts this month, will finally be able to offer him psychiatric support.

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