Gender-affirming care in CT and antiquated notions of mental health

A little over a month ago, in August 2022, a nationwide interdisciplinary group of mental health professionals with expertise in gender-affirming care sent out a press release addressing their challenges to the Department of Social Services. Husky recently updated the Gender-Affirming Health Care Guidelines.

We were therefore surprised and dismayed to see some of the content in the September 8 issue reported by the Connecticut Health Investigative Team or in the Mirror article: “Access, insurance still barriers to gender-affirming surgery in CT. ”

While the article examines some of the barriers to gender-affirming care in Connecticut, it does readers a disservice by omitting the very concerns this group of providers saw in a 17-January press release on gender-affirming care, namely the requirements of writing from Mental health providers to support the request for care.

Our concerns begin with the professionals cited in the article. The quotes are all from supposedly white cisgender transgender care professionals; The reporter has not consulted any known transgender providers of gender-affirming care in this state.

In our group of clinics, there are concerns about training as professionals, as few providers have participated in Fenway’s Trans Echo (National LGBTQIA+ Health Education Center) or received external training in transgender care. The professionals cited had opportunities to encourage the reporter to seek comments from transgender gender-affirming healthcare providers on these guidelines, and did not. As a group of LGBTQIA+ gender-affirming health care providers who recently launched a harsh critique of DSS/Husky policy to all Connecticut media, none of us have been contacted.

Additionally, the article supports DSS’s actions but fails to mention the recent increase in gatekeeping from policy changes, creating barriers for those receiving Medicaid seeking gender-affirming care. Additionally, there is no mention of the insurmountable hurdle for Medicaid customers who do not have thousands of dollars to pay out of pocket and are not permitted to pay out of pocket for care that Connecticut providers provide either don’t offer or who don’t accept Husky payments.

When our group met to review and discuss this article over the last few days, we also criticized the article’s neglect of the issue of bodily autonomy. according to dr AJ Eckert, medical director of Anchor Health’s Gender & Life-Affirming Medicine program, “supports the story … the narrative of a mental health treatment model as the standard of care for trans people — a treatment model that is severely harmful and has been outdated for many years.” In fact, a psychologist cited in your article mentioned Laura Saunders’ letters on mental health, but dismissed their gatekeeper nature because “they offer guidance in an area that can be very murky at times.”

Physical autonomy is not a somber subject. The desire for physical autonomy is not a mental health disease. Individuals should not be required to seek therapy, let alone go to a second mental health provider to verify who they are. Identity verification is an internal process. Letters are invasive, expensive, time-consuming and completely unnecessary. The only “permission” required should be based on the individual’s informed consent and basic medical ability to undergo the desired procedure, exactly the same process as a patient being evaluated for any other type of surgery.

The article states that “Medicare, Husky, and many insurance companies follow generally accepted guidelines from the World Professional Association for Transgender Health (WPATH),” but DSS in Connecticut has established rules that are not justified or supported by best practice or guidance.

There is a growing evidence base that gender-affirming surgery alleviates mental health concerns. It is the addition of obstacles to surgery that make mental illness worse. To tell the full story of access to healthcare for transgender and non-binary people, the Mirror needs to uncover the issues we’ve detailed.

Allyson D. Platt, LPC/LMHC on behalf of the following: Alexandra Solomon, LCSW; Molly Conley, PsyD; Lauren Millerd, LCSW; Kayti Protos, DSW, LCSW; Laura S Dodge, LCSW; Rebecca Toner, LCPC; and Sarah A. Gilbert, LCSW.

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