LGBTQIA+ Peer Respites: The Personal Is Political


Peer respites have great value. Affinity peer respites—such as an LGBTQIA+ peer respite—may have even more.

Affinity groups are basically groups of people who share a common interest. In this context, they refer to groups, supports, and services that are designed by and expressly for individuals from specific marginalized communities. This element has yet to be fully considered (beyond the obvious shared experience of having a psychiatric history) by any peer respite in the country. It’s time for a change.

Stranger Things

LGBTQIA+ sign: Trans Rights are Human Rights

You see, there’s this strange thing that happens with peer support. (Actually, there are many strange things, but only some of them relevant here.) Once someone has been designated “a peer” (a problematic term itself) within the psychiatric realm, they’re assumed to be a good match for just about any person receiving mental health services.

Diagnosed with schizophrenia because you hear voices? Well, let me introduce you to this peer supporter over here who has struggled with deep depression for the last few years! Sure, they’ve never heard voices and may even be a little freaked out by the fact that you have, but… peer! So anxious you can’t leave your home? I’ve got your perfect match! I say “perfect” because you haven’t been able to leave home comfortably for 20 years, and, well… they’re 20! What do I really mean by perfect match, you ask? Well, I guess I just mean they’re the only one available right now.

So much of what peer-to-peer relationships are truly about is related to common experiences of loss of power and psychiatric oppression, but that is too often absent from these conversations. Of course, in order to dig into that topic, systems would need to acknowledge their own power-taking ways in a much more forthright manner than they typically do, and so it makes sense that that’s a tough sell. But, we digress…

Furthermore, little thought seems to be given to the reality that the world of people with psychiatric histories (or experiences of emotional distress that could land them with one) is just as diverse as and exists within the same world as the general population. As such, not only do people often get mismatched or force-fitted together, but the peer support realm is just as vulnerable to all the same biases, discriminatory acts, and oppressive behavior as in society at large, even among “peers.” The idea that if someone experiences one type of oppression they’ll be better at recognizing the signs in all its other twisted forms is nice if were it true, but it just doesn’t pan out to reality.

For that reason, peer respites—as valuable as they are—not uncommonly still end up being inhospitable to people who experience multiple marginalizations including physical disabilities, racial identity, gender, and sexual orientation. Because we can’t focus on creating affinity spaces for all of them at once, we’re going to center on the latter for now.

A Prime Example

Many peer respites do their best to be welcoming to all people, including folks who identify as LGBTQIA+. However, sometimes (not infrequently) they fail. Consider the peer respite that—at least for a time—insisted that everyone coming to stay be asked to document their sex assigned at birth. (Yes, there was an actual peer respite that was doing this.) They claimed it was a requirement from their funder, which we can’t help but question. However, even if that’s true, there’s just some things to which you’ve got to be willing to take a risk and say “no, that’s a deal breaker. We’re not doing that.”

Now, some of you might be asking yourselves, “What’s the big deal about that?” That’s fair if you just haven’t yet really had a chance to think through or learn about the issues that most impact trans people in this world. In brief, unless you are a medical professional who will be engaged in medical treatment that could be impacted by various biological features, this is considered a highly invasive question. It is not only discriminatory in and of itself (as there are no similarly invasive questions routinely asked for no good reason and serving as barriers to needed resources for cisgender people), but also leaves someone especially vulnerable to further discrimination from that point on. It is precisely the sort of invasive and medicalized question that a peer respite should never be asking, and may significantly compromise someone’s physical and emotional safety in that space.

This would never happen in a peer respite run by and for LGBTQIA+ folks.

The Subtle (and Not-So-Subtle) Dance of Alienation

On a more day-to-day level, challenges with getting pronouns right and all sorts of other common microaggressions (words or actions—be they intentional or not—that convey the message someone does not belong) are also far more common in spaces that are not LGBTQIA+-led. These sorts of things can chip away at someone’s sense of personhood and connection to the world, and are exactly what some people may be trying to escape. Hopefully, all of us who believe in peer support overall can agree that the opportunity to feel accepted, free of judgement, and not alone is precisely what makes peer respite work for so very many people.

It’s also important to understand that trans folks in particular are often coming to peer respite after some pretty awful experiences in the conventional mental health system. Yes, many of us—trans or not—are here because we’ve had awful experiences in the clinical world. However, trans folks are experiencing all those same general harms on top of the ones that are specific to their gender identity. Consider these real-life examples:

    • A psychiatric facility that was willing to allow some local peer supporters to help a trans person being held on their unit to get a binder… until they realized that those supporters were talking about a garment to flatten breasts rather than a notebook full of information.
    • A clinical respite that was willing to allow a trans man to be appropriately roomed with another man… only if he told him what was in his pants (because forcing people to sleep around strangers when in their darkest moments is a fab idea anyway).
    • A psychiatric facility that routinely forced people to involuntarily and abruptly stop their hormone treatments because they supposedly had no way of accessing that medication (an excuse we’ve never heard when it comes to psychotropics).
    • The many psychiatric facilities where staff insist on referring to someone by their dead name or incorrect pronouns because they don’t want to “feed into their illness.”
Healing Forward

We live in a world where research already exists that tells us that gender expansive people are less likely to want to kill themselves if their stated names and pronouns are respected. (Side note: It is a feature of systemic oppression that we needed credentialed researchers to legitimize what trans folks already knew and have said over and over.) We live in a world where it’s getting more—not less—dangerous to be anything but cisgender and heterosexual. We say this now for particularly because of legislation like Florida’s recently introduced “Kidnapping Bill” S.0254 which is so named because it could legalized essentially kidnapping children from loving families. It stands to label gender affirming care for children as child abuse and could lead to loss of custody of kids seen as “at risk” purely for having a trans parent or sibling.

We also live in a world where we already know peer respite has tremendous potential for positive impact, including but not limited to:

But do LGBTQIA+ people have equal access to these healing environments that are making such a difference for some? No, not yet. And, on top of that, we also know that when people end up in the psychiatric system due to lack of other alternatives, that can be exactly what brings them to the attention of the systems that might then negatively impact future freedoms, child custody, housing, and more.

Fortunately, as legislation like S.0254 threatens to take hold and set precedent, we also have legislation like S.1238, An Act Establishing Peer-Run Respite Centers Throughout the Commonwealth (and its counterpart HD.1612) that opens the door to far more positive moves. In this case, these Massachusetts bills would support the expansion of peer respite to include one per county, and most importantly, the first LGBTQIA+ peer respites (two of them) in the world. These bills were developed by Wildflower Alliance’s director, Sera Davidow, Wildflower’s Peer Respite (Afiya) director, Ephraim Akiva, Mental Health Legal Advisor Committee’s attorneys, Sarah Yousuf and Mike Recco, and advocate, Thomas Brown, with the aid and sponsorship of senator Jo Comerford and representatives Linsday Sabadosa and Smitty Pignatelli. However, in order for them to have a real chance at being passed, support is needed.

Ephraim’s Love Letter: A Personal Note
“What part of yourself did you have to destroy in order to survive in this world?”
Alok Vaid-Menon, from their book “Beyond the Gender Binary”

I cried the first time I read this quote. Every day I’m reminded that I make people uncomfortable. I’ve contorted myself in so many ways to hold all of the shame heaped onto me by a transphobic and queerphobic society. The weight is unbearable. Everyone has always tried to make being trans the issue versus looking at the reality that this world trying to erase, murder and legislate trans and queer people out of existence is the real issue.

I’ve passed for cisgender in the vast majority of places I spend time in. I’m quiet and I take up very little space. I’ve been dying a little every day for as long as I can remember. I’ve lived in fear of other people’s reactions to me for so many years. There are people in my own family who regularly make jokes about trans and non-binary people on social media and none of their “peers” push back on them. Even in the peer support world, I’ve not felt that I have ever been particularly welcomed or that I belonged. I don’t hate being trans. I hate living in a world that won’t make space for me to live my life free of harassment, violence and shame. I hate living in a world that doesn’t believe that me and people like me deserve to exist, let alone experience joy.

One day a week I spend time in an LGBTQIA+ peer-to-peer support group that my co-worker, Sean Donovan and I co-founded more than 10 years ago, and within that community I have found myself again. We remind each other that we are deserving of everything that the world tries to tell us doesn’t belong to us. We create our own little mini LGBTQIA+ utopia in the space of 90 minutes once each week. This is what closed community and affinity spaces can do for marginalized folks. It may not sound like a lot and yet, to me and to others, it can mean everything. We need spaces to heal away from those who regularly harm us, whether intentionally or not.

This project is personal. This is deeply personal work for me. I will have worked at Afiya Peer Respite for 11 years this year. I know very well what peer respite can do for folks as an alternative to hospitalization and other coercive treatments. I know this model works and that it can work well. It’s long been my dream for us to have one in every single county in Massachusetts.

I used to write prolific love letters as a young person. It’s something that I was known for. I stopped writing them a long time ago. I listened to a world that told me that I was “choosing” a hard life, that I was not loveable and that joy was not for people like me. The LGBTQIA+ peer respite is my love letter to other trans and queer folks. You deserve to take up space. You deserve joy. You deserve love and care. You deserve to be seen and heard. You are valid. You deserve more than just survival. You deserve to have your own spaces that will hold this narrative with you. You deserve more than these words. You deserve action. I love you and this world is yours too, let’s recreate it together.

“How ironic that they think my queerness is what made me want to die. When it is the very thing that reminds me why I live.”
Alok Vaid-Menon
Action Steps

Help us make real change. If you live in Massachusetts, contact your legislator  by phone or in writing and tell them that you support the addition of LGBTQIA+ respites. If you live outside of Massachusetts, we still encourage you to make contact and let Massachusetts legislators know that they have the opportunity to help start a wave of change across the nation. (We will be determining the best point of contact in these instances, so feel free to e-mail us here!)

On this International Day of Transgender Visibility we urge you to act.

What is peer respite? Peer respite is an alternative to inpatient psychiatric hospitals and other more invasive interventions. Peer respite is created and entirely led by people whoCover of World Health Organization booklet on Mental Health Crisis Services themselves have faced life-interrupting challenges including trauma, psychiatric diagnosis, extreme emotional and/or mental states, problems with substances, and similar, and who have learned to use those experiences to support others on similar paths. It centers around the idea of turning what gets called “crisis” into a learning opportunity. Learn more about peer respite by reading the Peer Respite Handbook or watching this short (24-minute) peer respite film, both produced by the Wildflower Alliance. In 2021, the World Health Organization (WHO) also included Afiya as one of about two dozen exemplary, rights-based approaches. You can read more about that here.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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Sera Davidow
Tangible Intangibilities: Sera writes here to share her thoughts on how the language we choose and our apparent need to concretize the inherently complex is leading to violations of rights and humanity on a daily basis.
Ephraim Akiva
Ephraim has long dreamed of a community (and larger world) where queer and trans folks are not only able to survive and thrive but to truly connect with their capacity for queer and trans joy. As the director of Afiya Peer Respite and the co-founder of the Wildflower Alliance's LGBTQIA+ peer to peer support group, he is manifesting the nation's first LGBTQIA+ peer respite.


  1. Beautiful and powerful blog. I have already emailed you to find out how I can support the manifestation of the nation’s first LGBTQIA+ peer respite in the amazingly progressive “mental health” peer community of MA.
    The importance of this blog is still being absorbed in my body and mind, especially since I re-read my most recent blog (on peer-run respite) prior to reading your blog. Your vision and leadership here is so desperately needed not just in the US but globally as peer respites spread.
    We can count on change as a constant in our lives. The blog gives the reader specific examples of how we are hurting and oppressing not just the LGBTQIA+ community but each other as well. When we close our minds and our hearts, we hurt others but we also hurt ourselves and our community by letting fear and the past control our thoughts, emotions and our actions. Where does rationality reside? How do we measure our love, our ability to let the world into us, our inclusion of all people and our health as a community, as a family, as a world?
    Every human being has a right to BE, BELONG and BECOME (attribution to Thomas Hubl here). If we do not respect these rights we are committing attentional violence; We are judging people based on our own past – or might I say our unresolved trauma histories- and not believing in the tremendous potential, beauty and power within every human being.
    You blog is a siren that screams for us to remember our humanity. Please keep writing.

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  2. Consider the peer respite that—at least for a time—insisted that everyone coming to stay be asked to document their sex assigned at birth.

    I believe the atmosphere of intimidation surrounding critical discussions of trans ideology is the reason we don’t see more responses here. That doesn’t mean people — especially women — aren’t reacting among themselves, such as a friend who wrote to me “The more I read, the more speechless I am. It’s HARD to read…by the time I got to end I felt like – sure. If they want a trans meeting, fine…But if I want a women’s meeting, then I want a WOMEN’s meeting.”

    As Davidow states, there are already plenty of problems with the concept of “peerdom” itself. We don’t need to make them worse by making “peers” pledge allegiance to transgender ideology as a condition of acceptance into the “mad” club.

    And for the record, psychiatry itself still needs to go.

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    • yinyang,

      I suspect there’s not a ton of comments here because many peer-support specific pieces don’t tend to get a lot of response.

      That said, I will offer you the following:

      Your comment seems misplaced, even if not for its problematic nature.

      We’re not talking about trans only or women only spaces. It’s just not the conversation we’re having.

      And you’re misusing entirely the quote you’ve cited from this piece. That peer respite was open to any adult in psychiatric distress, and yet was asking that (and other invasive) questions. It wasn’t about them buying or not buying into anything… It was just an invasive question that was also discriminatory in nature.

      Given that we’re not having the conversation you’re attempting to have, it feels opportunistic to me to use that quote in the manner that you have and as an avenue to make the argument you’re making. I’m reluctant to respond to the actual argument you’re making because it’s not relevant here.

      That said, I will at least offer this: What you’re arguing for is not a ‘WOMEN’s meeting,’ but a ‘cisgender women’s meeting,’ and in order to ensure that you would actually need to be asking people some pretty invasive questions strictly for the purpose of excluding some people you might not have otherwise known didn’t meet your ‘criteria’ even after spending hours with them in groups…

      I wonder how different that really is from businesses (like retreat centers, etc.) that want to ask a person’s psychiatric history just so that they can exclude them, even if they wouldn’t (or haven’t) have known based on actual interactions with them…

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  3. My son is so lonely on this journey. We visited a respite so that he could break the spell of isolation, the male peer in charge looked at his skirt a number of times. My son did not end up going because he did not feel welcome. I am thinking of moving close to Wildflower just so he can get the support. We need more organizations like yours. Great work, it’s appreciated from New York suburbia.

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    • Hi Yvonne,

      I’m sorry I didn’t see this when you first wrote! I wish I could say that something being peer support made it magically somehow immune from any ugliness, bias, etc.. But of course, that’s just not the way it goes.

      I also worry about when people move to a particular place for a singular resource, because nothing is as magical close up up as it may seem at a distance. Sometimes it absolutely works, and sometimes people just find themselves uprooted from all that’s familiar and still not quite finding what they want.

      It’s so hard. Whether you and your son move or stay where you are, I hope you find the connection you’re both seeking!

      We do have some virtual family groups if you’re interested (though they’re focused more on hearing voices and related experiences) if you might be interested. Feel free to e-mail me if you are. 🙂


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