Determined to overcome a cocaine addiction that had propelled him into a downward spiral of unemployment, sex work and life one step off the street, Erik Leiff contacted dozens of treatment programs.
In person, when he explained who he was -- a trans man, having medically transitioned from his birth gender to the only one he could live with -- office workers giggled and pointed: "It's like, 'Look at the freak.' "
On the phone, all said he would be housed with women. "If you saw me, that would have been ridiculous. I look nothing like a woman," he said. "The women in a program would have been just as uncomfortable as I would have been."
He eventually succeeded largely on his own. It was excruciating.
"I would have gotten clean a lot sooner if there had been a place where I could go and be understood and treated like a human being," he said.
Just that kind of place is expected to open in the coming weeks in Southwest Philadelphia. Morris Home, an eight-bed residential drug and alcohol treatment center specifically for transgender people, is believed to be the first of its kind in the nation. Leiff, 40 and clean since Jan. 15, 2005, is a peer specialist on staff.
Reaching out to a largely invisible trans population badly in need of services is one more way the city is making a mark with its innovative system of behavioral health care. Several years ago it began shifting to a grassroots recovery model that seeks to sustain progress by treating the whole person, not just the addiction, and recruiting entire communities for support.
About 100,000 people a year, most of them poor, receive addiction treatment and mental health services from the city, a small fraction of the number estimated to need them. In bits and pieces -- like the push to establish Morris Home -- the city is trying to fill some of the gaps.
Those eight adult beds at Morris Home will probably fill quickly. Trans people have high rates of depression, suicide, and catastrophic health problems, so it's no surprise they also have high rates of substance abuse.
People who identify themselves in ways that make no sense to most Americans -- a girl who knows she is a girl despite her penis -- describe lives of ridicule, rejection, and beatings, often from the moment they ask a question, typically during the wide-eyed innocence of childhood.
Baby sitters abused Leiff so badly that he later needed jaw surgery.
"Transgender people are at much more risk for physical, emotional and sexual abuse for violating social norms," said Jeanna Eichenbaum, a trans woman and psychotherapist in San Francisco.
Transgender people are diagnosed with HIV at quadruple the national rate, according to a survey last year by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. One in four black trans people had HIV, almost 40 times the national rate. More than 40 percent of trans people said they had attempted suicide.
Experts point to underlying reasons, found in the same survey: 50 percent had been harassed at work, and 26 percent had lost a job. Unemployment, homelessness, and lack of health insurance all run far above national rates.
"A lot of the folks we see who are unable to access care are living in an underground economy," said Sade Ali, a deputy Philadelphia commissioner of behavioral health.
It was Ali who championed the new center, forming an advisory board with people from the trans community. She made several key decisions early on:
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