The Best Time to Learn About Trans-Affirming Care was Yesterday.
By Jess Romeo (he/they)
Psychiatric-Mental Health Nurse Practitioner, Specialist in LGBTQIA+ Affirming Care
If you’ve been paying even cursory attention to the news for the past couple of years, you know it’s not a good time to be a gender-expansive child or adolescent—or a parent of one.
(For more context on my thoughts surrounding attacks on gender-affirming care for adolescents, check out this post.)
But it’s also a tough time for states that have pledged support for transgender people, because the healthcare system is being put to the test. Based on this, I wanted to offer why it’s important for mental health providers in ALL states, even supportive ones, to have more knowledge about gender-affirming care.
Restrictions on access to care create not only barriers for patients, but also create stress on existing systems that have to make space for patients across a broader geographical range.
The mental health impacts of these types of restrictions hurt kids in restricted states AND protected states, because trans kids (already twice as likely to attempt suicide) internalize the message that a lot of powerful people don’t seem to care whether they live or die, and might rather see them dead than trans & happy.
If you’re a mental health provider of any kind, and you’re not providing your services to the trans & gender diverse community, you should be.
There are people out there who are more than capable of helping you provide this care.
As mental health providers, we play a critical role in this battle for compassionate and affirming care. An August 2023 article authored by Jeff McMillan and Hannah Schoenbaum sheds light on the challenges faced by our gender-expansive kids & adolescents.
More than 89,000 trans kids aged 13 to 17 live in states with restricted access to gender-affirming care. Some have had to uproot their lives to find care elsewhere, only to face waiting lists of 9 to 14 months.
States pledging support to trans folks include California, Connecticut, Colorado, the District of Columbia, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, New York, Washington, and Vermont.
These states are now facing longer wait times for healthcare services, and systems already under attack are trying to make space for people from different areas in the midst of a changing legal landscape, and a climate where their programs have been threatened.
We all must advocate for trans-affirming care, educate ourselves, and oppose these harmful trends. Here’s a really great list, organized by state, of some organizations that could use your support:
List of Organizations Fighting Anti-Trans Legislation and Supporting Trans Folks
So, what's our role in the face of these challenges? We, as mental health providers, must stand together, regardless of our titles or roles. Though we may not be the ones able to prescribe the hormones, we play a critical role in buffering the toxic effects of this society, and mirroring the validity and inherent worth of those who are suffering at the hands of these attacks.
Having safe and affirming adults in trans kids’ lives provides them with immeasurable benefits, and helps fight against the shockingly high risks of suicide, self-harm, and other negative mental health outcomes.
We must monitor these trends, stay informed, and provide critically important support to a community in need of greater access to affirming mental healthcare.
If you don’t already know some best practices for working with trans folks, now would be an important time to do some more learning and get support for how to integrate these patients into your practice. I can tell you as a trans mental health provider, most of us who are part of the community are facing a lot of complexity in the face of this environment.
We can’t do all the heavy lifting here, for the following reasons.
There aren’t enough of us.
Some of us might also be struggling with the facts of this societal backlash, because it attacks us too. Laws restricting adolescents’ access to care stop just short of implying that trans adults are mentally ill, and that we’re free to mutilate ourselves however we wish, as long as we’re 18+.
Even if that’s not the message we internalize, we might be feeling echoes of homophobia we experienced growing up, and facing our own internalized transphobia from being in a society that only recently made positive strides in this area.
Supporting people who are struggling with this political environment is a difficult thing to do day in and day out. We need some cisgender providers to take the load off—BUT we need to be able to trust you not to cause unintentional harm to those most vulnerable in our community in arguably one of their greatest times of need.
If you’re a provider or a practice that hasn’t historically served this community but you want to help meet the need, the time has come for you to act.
If you’ve been:
Wanting to help but nervous about saying the wrong thing
Worried you’ll get canceled if you make a mistake
Feeling like you would need to do more learning before you could ethically take this on
