APA Calls for Protection of Transgender Rights After Supreme Court Allows Military Service Ban

APA has denounced a Supreme Court decision handed down earlier this week that gave a green light to the U.S. military to restrict service by individuals who are transgender.

A sharply divided high court handed the Trump administration the victory for its policy banning transgender military service by a vote of 5-4, without discussing the merits of the case. In response, APA issued a statement calling for the protection of transgender individuals’ civil rights and expressing great disappointment in the decision to lift the injunctions on the transgender service ban imposed by a lower courts.

After President Donald Trump signed the ban last March to disqualify individuals who are transgender from military service except under certain limited circumstances, four federal courts issued preliminary injunctions to block it. The Supreme Court decision lifts the injunctions and allows the ban to take effect while the cases challenging the policy continue to wind their way through the courts.

“We are extremely concerned that the military will discriminate against transgender Americans who want to serve their country while these lower court cases are being decided,” said APA President Altha Stewart, M.D., in a statement issued to the media. “Banning transgender service members from serving our country harms not just those transgender Americans who have dedicated themselves to service of others, but it unfairly casts a pall over all transgender Americans. And as psychiatrists, we know all too well the negative impact that discrimination has on the mental health of those targeted.”

“Losing highly qualified transgender military personnel does not benefit the military or the nation,” added APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We firmly believe the United States should be more inclusive and stand against discrimination of any minority group.”

Trump’s policy bans individuals who have transitioned from their gender assigned at birth from joining the military. It also requires current troops to serve as members of their gender assigned at birth, with an exception for those who began a gender transition under Obama administration rules. Trump cited “tremendous medical costs and disruption” as reasons for the ban when he first announced the policy, by tweet, in July 2017.

The Supreme Court decision effectively reverses an Obama administration decision in June 2016 granting transgender service members the right to serve openly. The decision had also allowed transgender servicemembers to undergo gender transition if they were diagnosed with gender dysphoria. The reasons cited for the decision were the need to recruit and retain the best talent, provide clearer guidance to existing service members who are transgender, and a matter of principle.

A Rand Corporation review commissioned by the Obama administration in 2016 estimated the cost impact of providing gender transition services to service members who are transgender would be minimal, largely because there are so few, only about 2,500 to 7,000 of the 1.3 million of those on active duty.

For related information, see the Psychiatric News article “APA Opposes Ban on Transgender Military.”

(Image: Kim Seidl/Shutterstock)

---

Have You Voted in APA’s 2019 Election Yet?

If not, take a moment to do so now: Voting closes on Thursday, January 31. Learn about this year’s slate of candidates, their priorities, and backgrounds at the APA elections page and watch video interviews of the candidates for president-elect and secretary. Click here to vote now and be part of the process.

Follow Psychiatric News on Twitter!

AMA House Backs Ending Ban on Transgender Individuals Serving in Military

There is no medically valid reason to exclude transgender individuals from service in the U.S. military, and transgender service members should be provided care according to the same medical standards that apply to nontransgender personnel. So declared the AMA House of Delegates this afternoon during its 2015 annual policymaking meeting by approving a resolution introduced by the Section Council on Psychiatry in coordination with several other groups.

The resolution was widely supported during reference committee hearings and approved without debate during the meeting of the House today. “This resolution is about ending the blanket ban that prohibits transgender people from military service and transgender military service members from equal access to care,” said psychiatrist Brian Hurley, M.D. (pictured above), a delegate to the Section Council on Psychiatry from GLMA: Health Professionals Advancing LGBT Equality. (The latter is the full name of the group formerly known as the Gay and Lesbian Medical Association.)


“There is a difference between having a transgender identity and having gender dysphoria, and there is no reason that transgender status alone should exclude anyone from military service or equal access to care,” Hurley said. “This resolution asks the AMA to state that there is no medical justification for this blanket ban, and in doing so, empower military physicians and commanders to assess readiness to serve on a case-by-case basis.

“We don't exclude gay people from military service or treat gay people and straight people according to different standards of care, so there is no justification for a continuing ban that treats transgender people different from cisgender people,” Hurley said. “There are over 15,000 transgender service members who remain closeted as a matter of policy, so it is urgent that the AMA weigh in now to affirm that there is no medical justification for this discriminatory policy.”

For related information, see the Psychiatric News article “Newest AMA Section Council Member Brings Focus on LGBT Health.”

(Image: Mark Moran)

APA Protests New Policy Against Transgender Military Service Members

APA is protesting the implementation of a ban that goes into effect on Friday, April 12, on transgender individuals serving in the military. As of that day, the Department of Defense (DoD) is requiring transgender service members to follow the standards of their biological sex or be removed from service.

DoD policy under former President Barack Obama allowed transgender service members to seek treatment; now DoD intends to discriminate against those who came forward, APA said in a statement released yesterday.

“APA has long fought against discrimination against any patient population,” said APA President Altha Stewart, M.D. “This ban perpetuates discrimination and stigma against transgender people. Furthermore, this ban harms the military by depriving the service branches of willing and capable members.”

President Donald Trump signed the ban last March, which disqualifies individuals who are transgender from serving in the military except under certain limited circumstances. In response, four federal courts issued preliminary injunctions to block it. But in January, a 5-4 Supreme Court decision lifted the injunctions and allowed the ban to take effect while the cases challenging the policy continue to wind their way through the courts.

“As physicians providing treatment for mental illness and substance use disorders, we affirm that being transgender or gender diverse implies no impairment in judgment, stability, reliability, or ability to serve in the military,” APA said in its statement. “We urge the administration to eliminate this policy and instead work with our organization to ensure policy decisions are informed by medical evidence.”

A position statement first approved by the APA Board of Trustees in 2012 and re-approved last year opposes discrimination against transgender and gender-diverse individuals and urges the repeal of laws and policies that discriminate against these individuals.

For related information, see the Psychiatric News article “APA Opposes Ban on Transgender Military.”

(Image: iStock/PeopleImages)

Follow Psychiatric News on Twitter!

APA Issues Official Positions Supporting Access to Care and the Rights of Transgender and Gender Variant Persons

At its July meeting, APA's Board of Trustees voted to endorse two proposed position statements in support of access to care and civil rights for transgender individuals. In doing so, APA joins other organizations, including the AMA and American Psychological Association, in endorsing strong policy statements deploring the discrimination experienced by gender-variant and transgender individuals and calling for laws to protect their civil rights.

Access to Care for Transgender and Gender Variant Individuals concerns access to medical care and its impact on the mental health of these individuals. It explains why it is crucial to remove barriers to care and to support public and private insurance coverage for gender-transition treatment.

Discrimination Against Transgender and Gender Variant Individuals concerns the pervasive discrimination transgender individuals face. It puts APA on record supporting laws that protect their civil rights and describes the mental health consequences of discrimination and lack of equal rights in areas such as health care, employment, housing, and licensing.

See also a recent report from the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder published in the American Journal of Psychiatry.

(Image: Ashley van Dyck/Shutterstock.com)

Support at Home, in Community May Protect Against Emotional Distress, Substance Use in Transgender Youth

Transgender and gender-diverse youth who feel close with their parents are less likely to experience emotional distress and engage in substance use compared with those reporting less connected relationships with parents, according to a study in the American Journal of Preventive Medicine. The study also found that youth who feel safe at school and have stronger relationships with teachers and other adults are less likely to experience depression, suicidality, and engage in substance use.

“Given that transgender and gender-diverse [TGD] youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender-diverse−friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use,” Amy L. Glower, Ph.D., of the University of Minnesota and colleagues wrote.

For the study, Glower and colleagues examined data from the 2016 Minnesota Student Survey—a survey that asks students about school climate, bullying, out-of-school activities, health and nutrition, emotional and mental health, relationships, substance use, and more. As part of the survey, students in the ninth and 11th grades were asked, “What is your biological sex?” (response options: male/female) and whether they “identify as transgender, genderqueer, genderfluid, or unsure about their gender identity” (yes/no).

The researchers examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender.

Of the 2,168 included in the analysis, 57.9% met the cutoff score for additional depression screening using the Patient Health Questionnaire-2, 44.9% reported suicidal ideation, and 16.7% reported a suicide attempt; substance use ranged from 11.2% (binge drinking) to 25.9% (any nicotine use). Feeling more connected to parents was related to significantly lower odds of all indicators of emotional distress and substance use relative to those reporting less connected relationships with parents, the authors reported.

“Given that TGD youth report less connectedness with their parents than their cisgender peers, increasing investment in programs offering support and guidance to parents of TGD youth and linking parents to existing supports (e.g., through health care, schools, religious institutions) may be effective ways to bolster the development of these caring relationships,” the authors concluded.

For related information, see the Psychiatric News article “Psychiatrists Need to Prepare to Care for Gender-Variant Patients” and the Psychiatric Services article “Affirming Gender Identity of Patients With Serious Mental Illness.”

(Image: iStock/PeopleImages)

Follow Psychiatric News on Twitter!

Transgender Individuals Say They Need Better Access to Mental Health Care

Transgender individuals need improved "access to mental health and social services that affirm transgender identity and promote reslience," Walter Bockting, Ph.D., of the New York State Psychiatric Institute, and colleagues assert in the May American Journal of Public Health. Bockting was recently named codirector of Columbia University Medical Center's LGBT Health Initiative. They came to this conclusion after surveying online more than 1,000 male-to-female and female-to-male transgender individuals about their mental health.

Survey respondents reported a high prevalence of depression (44 percent), anxiety (33 percent), and somatization (28 percent). The social stigma that the respondents experienced was associated with psychological distress. However,  they indicated that support from other transgender people decreased such distress.

More information about the challenges facing transgender individuals and what can be done to help them can be found in Psychiatric News here and here. Information for psychiatrists and other clinicians who treat LGBT individuals can also be found in American Psychiatric Publishing's The LGBT Casebook.

(Image: Yuriy Vlasenko/Shutterstock.com)

Youth Who Transition to Another Gender Not Likely to Transition Back, Study Finds

Youth who socially transition to a gender other than the sex they were assigned at birth are likely to continue identifying as that gender five years later, according to a study published in Pediatrics.

“These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way,” wrote Kristina Olson, Ph.D., of Princeton University and colleagues. “Nonetheless, understanding retransitions is crucial for clinicians and families to help make them as smooth as possible for youth.”

Olson and colleagues used data from the Trans Youth Project, a longitudinal study involving 317 youth aged 3 to 12 years old. All participants were recruited between July 2013 and December 2017. Prior to joining the study, the youth had to have socially transitioned to a gender other than their sex assigned at birth—a process that typically involves changing their pronouns, first names, hairstyles, and clothing.

The authors used reports from youth and their parents to determine whether the youth retransitioned (meaning they transitioned again after their initial transitions) or if they continued to identify as their transitioned gender several years later. Participants were classified into three categories based on the pronouns they used: binary transgender (the child identified as the transitioned gender), nonbinary (the child used they/them pronouns), or cisgender (the child again identified as the sex they were assigned at birth).

An average of 5.37 years after their initial transitions, 94% of participants were living as binary transgender, 2.5% identified as cisgender, and 3.5% identified as nonbinary. The rate of retransitions among the participants was 7.3%, and four participants (1.3%) had retransitioned twice, to a nonbinary then back to transgender. Most retransitions occurred before the youth reached age 10. Youth who initially socially transitioned before age 6 were more likely to be living as cisgender five years later compared with youth who transitioned at age 6 or later.

Concerns that youth will experience regret after transitioning, particularly after starting hormone therapy, has led some physicians and even legislatures to question the ability of minors to consent to gender-affirming treatment, wrote Christina Roberts, M.D., M.P.H., of Children’s Mercy in Kansas City in an accompanying editorial. The “stability of transgender identity” five years after the initial transition, as evidenced in Olson’s study, should reassure physicians when recommending gender-affirming treatment, Roberts wrote.

She continued: “The low risk of regret should also inform the actions of legislators attempting to substitute their judgment for the judgment of patients, parents, and providers by denying transgender adolescents access to this evidence-based and potentially life-saving treatment.”

For related information, see the Psychiatric News articles “Record Number of Anti-Trans Bills Filed in States This Year” and “Psychiatrists Need to Prepare to Care for Gender-Variant Patients.”

(Image: iStock/Vladimir Vladimirov)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Young Transgender Children With Family Support Show No Rise in Depression

Young children who identify as transgender and are supported by their families are no more likely to have symptoms of depression and only marginally elevated levels of anxiety than nontransgender children in the same age range, said researchers from the University of Washington.

“These data suggest at least the possibility that being transgender is not synonymous with, nor the direct result of, psychopathology in childhood,” wrote Kristina Olson, Ph.D., an associate professor of psychology at the University of Washington in Seattle, and colleagues, in an article published online today in the March Pediatrics.

The researchers used a community-based sample of 73 prepubescent children aged 3 to 12 “who persistently, insistently, and consistently identify as the gender identity that is the ‘opposite’ of their natal sex.” These children were socially transitioned—using the names, personal pronouns, hair length, and clothing associated with their affirmed gender. Social transition is a reversible, nonmedical intervention. About 70 percent were non-Hispanic white children, and 85 percent came from families with incomes above $75,000.

Depression and anxiety symptoms were reported by the parents. Transgender children’s symptoms of depression were not greater than those of the population average. Anxiety symptoms were slightly above national averages but still lower than preclinical or clinical thresholds.

“[T]his finding is crucially important to professionals who work with these children, as well as their families, in showing us that they are not likely to suffer any additional harm and may benefit from early social transition,” wrote pediatrician Ilana Sherer, M.D., of the Palo Alto Medical Foundation in Dublin, Calif., in an accompanying commentary.

For more in Psychiatric News about transgender youth, see “SAMHSA Report Calls for End to‘Conversion’ Therapy for Youth.”

(Image: istock/PeopleImages)

APA Commends President Obama’s Call to Ban Reparative Therapy for LGBT Youth

President Obama on Wednesday called for a ban to therapies aimed at “repairing” gay, lesbian, bisexual, and transgender youth in response to the recent death of a transgender youth by suicide following what she reported were efforts by her therapist to convert her back into a boy.

In a White House statement posted on Wednesday alongside a WhiteHouse.gov petition that was started following the death of 17-year-old transgender youth Leelah Alcorn, President Obama's senior adviser Valerie Jarrett wrote, “As part of our dedication to protecting America’s youth, this Administration supports efforts to ban the use of conversion therapy for minors.”

APA has long recognized the dangers of so-called reparative therapies. In a 2000 position statement, the Association reaffirmed its opposition to “any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, that is based on the assumption that homosexuality per se is a mental disorder or is based on the a priori assumption that the patient should change his or her homosexual orientation." APA noted that there were “sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of ‘reparative’ therapies.” Moreover, these therapies are at odds with APA’s position that sexual orientation is not a mental disorder.

“We applaud President Obama for his principled and scientific stand," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. "LGBT individuals deserve treatment, when they seek it, that meets the highest standard of evidence, and APA has long recognized that so-called reparative therapy doesn't meet that standard and can, in fact, be hazardous. We are pleased that the White House shares our concern about this issue, and we support the President's call for a ban on reparative therapy.”

Yesterday, in an early report in the New York Times, the newspaper had stated that President Obama was calling for an end to “psychiatric therapies" aimed at "repairing" gay, lesbian, and transgender youth. APA reacted quickly to the erroneous statement that reparative or conversion therapies are “psychiatric therapies" by contacting The New York Times. The newspaper posted an updated report by mid-evening that dropped the reference to “psychiatric therapies."

(Image: shutterstock.com/Drop of Light)

Gender-Affirming Hormone Therapy Poses No Significant Health Risks in Youth, Study Finds

Many transgender youth undergo hormonal therapy so their physical gender more closely aligns with their gender identity. However, little is known about the safety and impact of gender-affirming hormones in youth, and some caregivers are cautious about using hormone therapy in transgender adolescents.

A study in the April issue of the Journal of Adolescent Health reports that hormonal therapy significantly alters many lab values in transgender youth, such as levels of potassium and hemoglobin. However, during the roughly two-year period of this study, almost none of these changes led to any clinical safety concerns.

“To our knowledge, this is the first prospective study examining the physiologic changes that occur among minors and young adults undergoing treatment with gender-affirming hormones, for the purpose of … gender transition,” wrote Johanna Olson-Kennedy, M.D., of Children’s Hospital Los Angeles and colleagues. 

Olson-Kennedy and colleagues enrolled 101 youth aged 12 to 23 who were planning to undergo gender transition at Children’s Hospital’s Center for Transyouth Health and Development and followed them for 21 to 31 months. At the end of the follow-up period, data were available for analysis on 59 participants (25 transfeminine and 34 transmasculine).

The transfeminine youth showed statistically significant changes in the levels of high-density lipoprotein (HDL), aspartate aminotransferase, potassium, prolactin, and hemoglobin at follow-up. Transmasculine youth experienced statistically significant changes in blood pressure, HDL, triglycerides, aspartate aminotransferase, alanine aminotransferase, potassium, and hemoglobin levels. None of these changes required any clinical intervention, with the exception of blood pressure elevation in some of the transmasculine youth that warranted hypertensive drugs.

“As the demand for care continues to exponentially increase across the United States, much more data are needed about the impact of hormonal therapy on both physical and mental health in transgender adolescents,” the authors concluded.

To read more on this topic, see the Psychiatric News article “Resident Helps Young People in Gender Transition Find Their Way.”

(iStock/FotoCuisenette)

Follow Psychiatric News on Twitter!

Impact of Racism Across Generations Discussed at APA Town Hall

The adverse effects of structural and interpersonal racism persist across generations, said panelists last night in the third online town hall meeting hosted by APA’s Presidential Task Force to Address Structural Racism Throughout Psychiatry.

“This is a period of turbulence in our country, and we are all being forced to confront the disparities in the treatment of Black, indigenous, and people of color,” said moderator, task force member, and APA Trustee-at-Large Michele Reid, M.D. She is a clinical assistant professor in the Department of Psychiatry and Behavioral Neurosciences at Wayne State University in Detroit and the chief medical officer of CNS Healthcare. “The COVID-19 pandemic has highlighted long-standing inequities caused by race, ethnicity, and income.”

Chuan-Mei Lee, M.D., an assistant clinical professor in psychiatry at the University of California, San Francisco (UCSF), and a child and adolescent psychiatrist at UCSF Benioff Children’s Hospital, spoke about the long-term, epigenetic effects of adverse childhood events (ACEs) that may occur as the result of structural and interpersonal racism.

“Experiences of discrimination produce the type of chronic stress that increases allostatic load, sets off cortisol production, shortens telomeres, and methlylates DNA,” Lee explained.

Ebony Dix, M.D., an assistant professor in the Department of Psychiatry at Yale University School of Medicine and an inpatient geriatric psychiatrist, discussed how structural racism affects Black adults on a daily basis. She cited differential treatment of patients in the emergency department due to their race, as an example.

“Take an African-American male who is 50 years old and a white female who is 50 years old presenting to the same ED with the same psychotic symptoms,” Dix said. “I’ve seen time and time again that the full … work-up will be given to the white woman, but for the Black man the first things at the top of the differential is substance abuse or schizophrenia.”

Peter Ureste, M.D., an assistant clinical professor in the UCSF Department of Psychiatry and Behavioral Sciences, discussed how structural racism affects Latinx and LGBTQ populations, including transgender people of color.

“Transgender and gender nonconforming individuals face extraordinarily high rates of social and health inequalities, including poverty and discrimination by employers. They are [more likely to be] victims of violence, and they face higher rates of family rejection and homelessness than their cisgender peers. I would say this is even more so for transgender people of color,” Ureste said.

At the end of the discussions, Reid gave an update on the task force’s work. Highlights include the following:

• A website resource, psychiatry.org/TaskForce, that offers a recommended reading list, educational content, and a glossary of terms approved by the APA Board of Trustees.
• Three mini-surveys issued to guide the task force’s work and engage APA’s membership.
• A report by the task force’s Assembly work group that outlined eight actions to improve diversity and inclusion and reduce structural racism in the Assembly, actions that have since been approved by the Board of Trustees.
• Feedback sessions with APA councils and committees.
• Presentations made at the Kentucky, Missouri, North Dakota, Ohio, Utah, and Virginia district branches.

The next town hall will take place on February 8, 2021, from 8 to 9:30 p.m. ET.

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

APA, Medical Partners Protest Proposed Rule That Could Deny Care to LGBTQ, Women Patients

APA and five other medical specialty organizations issued a statement today protesting a proposed rule by the U.S. Department of Health and Human Services that would weaken nondiscrimination protections for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals under Section 1557 of the Affordable Care Act.

Section 1557 prohibits discrimination in health coverage and care on the basis of race, color, national origin, sex, age, and disability in health programs and activities that receive federal funding. These include most health care facilities, including hospitals and physician offices, and most health insurance companies. Under a 2016 rule from the Obama administration, discrimination on the basis of sex includes gender identity.

In addition to weakening protections for LGBTQ patients, the rule would allow religious exemptions that could restrict women’s access to reproductive health care and weakens requirements that have enabled millions of patients with disabilities and limited English proficiency to access services, the groups noted.

“Rolling back gender discrimination protections as the rule proposes would impede access to care and sanction discrimination against already vulnerable patient populations,” APA and its coalition partners said. “We oppose any laws and regulations that discriminate against transgender and gender-diverse individuals. We oppose any medically unnecessary restrictions placed on women’s access to reproductive health care. Instead, we urge the administration to eliminate this policy change and work with us to ensure patients have access to the quality care they need.”

The five other groups are the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and the American Osteopathic Association. The coalition represents nearly 600,000 physicians and medical students nationwide.

For related news, see the Psychiatric News article “APA Opposes Ban on Transgender Military.”

(Image: iStock/monkeybusinessimages)

Follow Psychiatric News on Twitter!

Don't Miss Your Chance to Hear Lectures From National Experts

There is still time to make plans to attend the APA Institute on Psychiatric Services (IPS) October 30 to November 2 in San Francisco and take advantage of a program that will explore in depth critical topics in mental health care today. One of the highlights will be a forum on Thursday, October 30 from 6 p.m. to 8:30 p.m., devoted to issues affecting the mental well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals.

Titled "Achieving Wellness in the LGBT Community: Mind, Body, and Spirit," the free forum will be open to the community and features a keynote address by Darlene Nipper, deputy executive director to the National Gay and Lesbian Task Force. Among the roster of speakers and panelists are Annelle Primm, M.D., M.P.H., deputy medical director of APA; Dan Karasic, M.D., a clinical professor in the Department of Psychiatry at the University of California, San Francisco (UCSF); Robert Cabaj, M.D., medical director of San Mateo Behavioral Health and Recovery Services; Dr. Jei Africa, health equity initiatives director of San Mateo Behavioral Health and Recovery Services; Jamison Green, Ph.D., president of the World Professional Association for Transgender Health; and Lori Thoemmes, L.M.F.T., director of the UCSF Alliance Health Project. The forum is being organized by the APA Division of Diversity and Health Equity.

The IPS program will also feature lectures by some of the mental health field's nationally recognized experts who will address critical issues in patient care and psychiatric practice. The impressive lineup includes Howard Goldman, M.D., Ph.D., on "Implementing First-Episode Psychosis Services: Policy Issues," Tanya Luhrmann, Ph.D., on "Hearing Voices in Three Cultures: A Comparison With Implications for Recovery," Charles Marmar, M.D., on "How Biomarkers for PTSD Will Advance Diagnosis and Treatment," David Pollack, M.D., on "Doin' the Community Waltz: A Saging and Raging Trip With the Walts: i.e., Whitman to White (With Visits to Kelly and Cronkite on the Way)," and Altha Stewart, M.D., on "Blacks and American Psychiatry: After 170 Years of APA and 50 Years of Civil Rights, What's Next?"

Click here to learn more about IPS program highlights and registration information.

California Insurance Law Linked to Increase in Gender-Affirming Surgery

Individuals with gender dysphoria who lived in California were significantly more likely to undergo gender-affirming surgery following the 2013 implementation of a state law prohibiting insurance discrimination against gender-affirming care compared with those living in Arizona and Washington, where no such law exists. That was the finding from a study of 25,252 transgender and gender-diverse patients in California, Washington, and Arizona that was published yesterday in JAMA.

The increase appeared significant among patients with private insurance or Medicaid, but not patients paying out of pocket.

“The findings suggest that the legislation, which prohibited insurance denial of health care benefits based on patient sex, gender, gender identity, or gender expression, facilitated access to gender-affirming surgery among insured patients with a diagnosis of gender dysphoria,” wrote Anna Schoenbrunner, M.D., of The Ohio State University and colleagues.

The researchers compared the number of gender-affirming surgeries from January 1, 2005, to June 30, 2013 (prior to implementation of California’s Insurance Gender Nondiscrimination Act) and July 1, 2013, to December 31, 2019 (after implementation of the law), for 17,934 individuals with gender dysphoria in California and 7,328 individuals with gender dysphoria in Arizona and Washington.

In California, 2,715 admissions (15.1%) had at least one gender-affirming surgery within the study period. In Arizona and Washington, 203 (2.8%) patients underwent at least one gender-affirming surgery. Patients’ median age at time of surgery was 34 years in California and 39 years in Arizona and Washington; 51.2% identified as female, 46.2% as male, and 2.5% as unknown.

Before the implementation of the Insurance Gender Nondiscrimination Act, 66 California sites performed a median of one gender-affirming procedure per site; after implementation, 106 sites performed a median of two procedures per site. In both Arizona and Washington, the number of sites performing gender-affirming procedures dropped in the same period.

After the implementation of the California law, there was an increase of 5.7 surgeries per quarter in the state compared with 0.41 surgeries per quarter in Arizona and Washington. The law was associated with a 12.1% increase in the probability that a patient with gender dysphoria would receive gender-affirming surgery in California compared with Arizona and Washington.

“These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients,” the authors wrote.

For related information, see the Psychiatric News article “APA Joins Amicus Against Arkansas Law Banning Gender Affirming Therapy.”

(Image: iStock/ArLawKa AungTun)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

AJP Editors Identify Top Studies in 2022 That May Have Significant Impact in Psychiatry

At the end of each year, members of the American Journal of Psychiatry (AJP) Editorial Board select the studies they found particularly impactful in the previous 12 months. The nine studies selected for 2022 have expanded the understanding of the impact of stress hormones on brain development, revealed new insights into how and when the brains of infants who go on to develop autism diverge from their peers, exposed the long-term cognitive effects of cannabis use, and more.

“There were outstanding papers selected this year that showcase some of the cutting-edge tools and ideas … in psychiatry,” said Ned Kalin, M.D., AJP editor-in-chief and the Hedberg Professor and Chair of Psychiatry at the University of Wisconsin School of Medicine and Public Health.

Kalin’s selection was the study that utilized brain organoids to assess how stress hormones, such as cortisol, affect brain development. “We know that early life stress is a very large risk factor for psychiatric illness later in life,” he said. “Cerebral organoids are like living test tubes that enable researchers to recreate these aspects of these early life stressors and observe how developing neurons are impacted.”

Other 2022 editors’ picks included the following:

• A clinical trial of a new protocol for transcranial magnetic stimulation that obtained impressive results in only five days for patients with treatment-resistant depression. The protocol, named the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), was subsequently cleared for use by the FDA.
• A brain imaging study that revealed that the brains of children with autism spectrum disorder appear to diverge from other children between 6 and 12 months of age, pointing to a key period when early intervention may have a strong impact.
• A longitudinal study tracking more than 1,000 individuals from age 3 for 40 years in New Zealand that found that chronic cannabis users had more significant declines in processing speed, memory, and attention over their life than non-cannabis users. Long-term cannabis users also had greater declines in these cognitive areas compared with long-term drinkers and smokers.
• AJP Residents’ Journal editor Danielle W. Lowe, M.D., Ph.D., spotlighted two articles on transgender care from a special thematic issue in 2022 on minority mental health and the importance of respecting patient identity. The articles included a case report highlighting the impact of gender dysphoria on the development of eating disorders and a piece on improving dialogue with transgender patients to reduce discrimination and stigma.

To learn more about these and the other selected studies, see the Psychiatric News article “2022 AJP Editors’ Picks Showcase Innovation, Long-Term Studies” and the AJP article “2022 Articles of Import and Impact.”

---

Voting Opens Today for APA’s 2023 Election

APA invites all APA voting members to participate in its 2023 election. Please take the time to learn about the candidates and cast your ballot. Your vote has an impact on the future of APA and psychiatry.

VOTE NOW

Few Mental Health Programs Specifically Geared Toward LGBTQ Youth, Report Finds

Evidence suggests that youth who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to experience mental health problems than those who identify as heterosexual and cisgender. Yet, a report in JAMA Pediatrics has found that few U.S. mental health facilities that offer services for youth include treatments or groups specifically tailored to LGBTQ youth.

“Compared with heterosexual or cisgender youth, LGBTQ youth have 3 times higher prevalence of depression and anxiety, and 42% have considered suicide,” wrote Kristen R. Choi, Ph.D., R.N., of the University of California, Los Angeles, and colleagues. “Fifty-four percent of LGBTQ youth reported wanting mental health care but not receiving any, partly due to adverse experiences with clinicians and perceptions that clinicians do not understand sexual or gender identity–related mental health needs.”

To determine the availability of LGBTQ mental health services for youth in the United States, Choi and colleagues relied on data collected by the National Mental Health Services Survey. The authors specifically focused on how those surveyed responded to the following question: “Does this facility offer a mental health treatment program or group that is dedicated or designed exclusively for clients [who are] lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ)?” From this information, they calculated the percentage of mental health facilities for youth that offered LGBTQ-specific services in 2020, as well the number of youth mental health facilities with LGBTQ-specific services per 100,000 children, which the authors noted is “a broad indicator of child access to care.”

A total of 12,275 facilities were included in the 2020 sample. Of the 8,077 facilities that offered services for children or youth, 2,294 (28%) offered LGBTQ-specific services in 2020, Choi and colleagues reported. 

“Although some states had relatively high levels of LGBTQ service availability as a percentage of facilities, many of these states had few facilities available to children per capita. Public mental health facilities were less likely to offer LGBTQ-specific mental health services, a concern given that the cost of care is a barrier to services,” the authors concluded. “The [f]indings suggest a need to expand availability of LGBTQ services for youth in underserved geographic areas and in public mental health care.”

For related information, see the Psychiatric News articles “Starting a New Presidential Year With Pride” and “Special Report: Evolving Controversies in the Treatment of Gender Dysphoric/Incongruent Minors.” 

(Image: iStock/SDI Productions)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Americans Anxious Over Current Events, But Most Rate Their Overall Mental Health as Good

Significant percentages of Americans report feeling anxious about current events at home and abroad—especially inflation, gun violence and the Russia-Ukraine war, according to an APA poll released today.

The findings are from APA’s Healthy Minds Monthly Poll, conducted by Morning Consult between May 27 and 29, 2022. The poll included a nationally representative sample of 2,210 adults.

Nearly 8 in 10 Americans (79%) reported feeling very or somewhat anxious about inflation, while 68% reported anxiety about gun violence and 63% reported anxiety about the Russia-Ukraine War. Smaller but still sizeable percentages said they were very or somewhat anxious about climate change (52%), COVID-19 (49%), the future of reproductive rights (48%), the midterm elections (47%), and the future of LGBTQ+ rights (31%).

“It’s not surprising that Americans find the news anxiety-inducing, given everything we are facing as a country at the moment,” said APA President Rebecca Brendel, M.D., J.D. in an APA news release. “It’s obviously important to stay informed, but from time to time you need to take a break, particularly if you find yourself overwhelmed. Watching repeated scenes of violence in a 24/7 news cycle doesn’t help and can even make symptoms worse.”

These concerns varied by demographic group. For instance, women were more likely than men to report feeling anxious about gun violence, the Russia-Ukraine War, climate change, and the future of reproductive and LGBTQ+ rights. White people were more likely than Black or Hispanic people to report anxiety over inflation, and less likely than those of other ethnicities to report anxiety over gun violence. People who identified as LGBTQ+ (62%) and transgender (61%) were nearly twice as likely as adults overall to say they felt anxious about the future of LGBTQ+ rights.

Despite these specific worries, more than a quarter (26%) of those surveyed rated their overall mental health excellent and 46% rated it as good. Younger adults (aged 18 to 35) were more likely to rate their mental health as fair or poor than older adults, and those with an income under $50,000 were more likely to rate their mental health as fair or poor than those earning more income. About half of LGBTQ+ and transgender adults rated their mental health as fair or poor.

The arrival of summer may help to explain the positive feelings about overall mental health, with large percentages saying aspects of summer would improve their mental health, such as spending time outdoors (71%), taking a vacation (67%), longer amounts of daylight (66%), and attending social gatherings (60%).

For some people though summer brings concerns about body image, and 45% said the summer makes them feel pressured to lose weight or change their body.

“It’s good to see some Americans taking positive emotions from summer traditions, during a time when we really need them,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in the release. “But it stands out that half want to change their bodies. For some, that may come from being exposed to images of unattainable ideals on traditional and social media. It’s important to monitor your feelings and actions around these issues and if necessary, seek help.”

For related information, see the Psychiatric News Alert “Americans Have Mixed Feelings About Social Media, APA Poll Finds.”

(Image: iStock/akoppo)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Pentagon Expands Mental Health Care for Troops, Families

The Department of Defense yesterday issued a final rule broadly expanding access to mental health and substance use disorder treatment for military service members. The rule covers services for 9.4 million active and retired military service members and their families under TRICARE.

The rule eliminates quantitative and nonquantitative limitations on mental health and substance use disorder care. All inpatient mental health day limits were eliminated, as were annual and lifetime limitations on outpatient services and substance use disorder treatment.

Copayments for mental health visits were cut from the current $25 to $12, the existing standard for general medical and surgical care.

Also, substance use disorder treatment will now include outpatient medication-assisted protocols, enabling qualified TRICARE contract providers to use buprenorphine and other medications.

The rule also now permits coverage of all non-surgical care in treatment of gender dysphoria, a development arising from the decision to permit transgender people to serve openly in the armed forces.

Overall, the new rule represents a step forward for service members and their families, but their effects need to be documented better, said former U.S. Army psychiatrist Charles Engel, M.D., a senior scientist at the RAND Corporation in Boston.

“What works for those in uniform may be in tension with what is best for non-uniformed military health system beneficiaries,” said Engel. “There are lots of complex pieces to these changes, but there has been little large, independent health care services analysis of the system.”

More information on this topic can be found in the book Care of Military Service Members, Veterans, and Their Families from APA Publishing. APA members may purchase the book at a discount here.

(Image: iStock/forever63)

APA, Pa. Psychiatric Society Announce Support for Rachel Levine, M.D., as Assistant Secretary of Health

APA and the Pennsylvania Psychiatric Society today urged the Senate to move swiftly to confirm the appointment of Rachel Levine, M.D., as assistant secretary of health in the U.S. Department of Health and Human Services (HHS).

Since 2017, Levine served as the secretary of health for the Commonwealth of Pennsylvania. In this role, she signed a standing order for naloxone, enabling pharmacies in Pennsylvania to dispense this life-saving treatment to thousands, and headed efforts to establish opioid-prescribing guidelines and prescribing education for medical students. She also led COVID-19 response efforts in the state.

“Dr. Rachel Levine’s work fighting the opioid epidemic in Pennsylvania [has been] tremendous,” said APA President Jeffrey Geller, M.D., M.P.H., in a press statement. “The United States will be well served by her leadership as we navigate COVID-19 and its impacts on mental health.”

Levine is also a professor of pediatrics and psychiatry at the Penn State College of Medicine and serves as president of the Association of State and Territorial Health Officials. She has been a leader at promoting the interconnection between physical and mental health as well as a staunch advocate for the LGBTQ community. In 2018, APA awarded Levine the Jacob J. Javits Award, given to a public servant who has made significant contributions to the field of mental health and worked to better the lives of people with mental illness and underserved populations.

“Dr. Rachel Levine’s credentials as a leader in medicine are impeccable,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in a press statement. She will be an important voice in the Biden administration for everyone in the country, including members of the LGBTQ community and those with mental health and substance use disorders, he continued. “We urge the Senate to confirm her appointment as soon as it has the opportunity.”

“Working closely with our society, [Dr. Levine] has made it her mission to reduce stigma and advance the availability of evidenced-based, holistic, and affordable mental health treatment and services for all individuals seeking assistance,” added Pennsylvania Psychiatric Society President Richard R. Silbert, M.D.

If confirmed, Levine would be the first transgender person confirmed by the Senate as a federal official.

---

Today Is Last Day to Vote in APA’s 2021 Election

You have until 11:59 p.m. ET today to vote in APA’s 2021 election. Review the individuals running for office, watch candidate videos, and learn more about the election process at psychiatry.org/elections. If you are a voting member of APA, just go to APA’s website at psychiatry.org/election and click on “Vote Today.”

VOTE NOW

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

California Outlaws "Reparative Therapy"

Over the weekend, California became the first state with a law banning so-called reparative therapy, a discredited intervention that claims it can turn homosexuals into heterosexuals. Gov. Jerry Brown signed the bill into law, outlawing the practice of reparative therapies in youth younger than age 18. Brown said he hoped this law would relegate conversion therapy to "the dustbin of quackery," noting that the practice has led to depression and suicide among young people distressed by the realization that they are attracted to people of the same gender. The law takes effect January 1, 2013.

APA has an official position condemning conversion therapies for being "at odds with the scientific position of APA, which has maintained since 1973 that homosexuality per se is not a mental disorder." It notes as well that "The potential risks of 'reparative therapy' are great and include depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by [a person seeking this therapy]."

Jack Drescher, M.D., president of the Group for the Advancement of Psychiatry and a past chair of APA’s Committee on Gay, Lesbian, and Bisexual Issues, is concerned, however, that the law only applies to licensed therapists, and most people doing conversion therapies are unlicensed. In addition, Drescher said that the promised legal challenge claiming the law violates free-speech rights, if upheld, "would provide an opportunity for conversion therapy proponents to trumpet their victory and further market these harmful services."

APA's 1998 and 2000 position statements on reparative therapy are posted at www.psychiatry.org under "Position Statements." For a comprehensive review of mental health issues affecting gay, lesbian, bisexual, and transgender individuals see The LGBT Casebook, new from American Psychiatric Publishing. (Drescher is a co-editor of the book.)

(image:prospero/Shutterstock.com)