Transgender healthcare bans create 'unnecessary burden on an already stretched system': Counselor

Recent years have seen a flurry of legislation aimed at blocking transgender people from receiving gender-affirming care.

To date, legislation restricting transgender care has been signed into law in at least 18 states, with dozens of similar bills still being considered by lawmakers across the nation.

Becker's interviewed behavioral health leaders on what impact this trend could have on the behavioral health industry, and some said it could mean increased stress on a system already pushed to its limits. One leader felt the opposite could happen: mistrust in the system creating a chilling effect on those who would otherwise seek needed mental healthcare.

Note: Responses have been edited lightly for clarity and brevity.

With recent legislation across the U.S., should behavioral health leaders expect to see more patients suffering from gender dysphoria-related mental health issues? If so, are we equipped for such an influx?

Ian Schroeder. Director of Behavioral Health at Prism Health-Belmont (Portland, Ore.): I feel like this can be equated to seeing an increase in hypertension if we took away access to blood pressure medications or an increase in diabetes related illnesses if individuals were denied insulin. You would not necessarily see an increase in newly diagnosed folks, you would see an increase in symptoms due to a lack of access to affirming care and life saving medication. We are certainly not equipped to support the influx of folks who will need ongoing support for symptoms related to anxiety, depression, and trauma related diagnoses.

Rodney Villanueva, MD. Psychiatry Clerkship Director, Associate Director of Psychiatry Residency, Co-Medical Director of Behavioral Health Advanced Clinical Practitioner Fellowship at Atrium Health (Charlotte, N.C.): It is possible that mental health providers will see more patients with gender dysphoria. However, I am also worried about less individuals coming to mental healthcare because of mistrust of the healthcare system. Transgender youth may be reluctant to seek mental healthcare because of a fear that the providers will have to report them to their parents or caregivers. In order for the mental health system to be prepared for any increase in patients, we must give medical providers the necessary education to care for transgender patients and we need more medical professionals to become advocates for their transgender patients on the local, state and national levels.

Tara Chandler. Co-owner, Appalachian Counseling and Psychological Services (Asheville, N.C.): I don't know that more patients will suffer from gender dysphoria, as denying care doesn't create gender dysphoria. I do however feel that patients who are denied access to gender affirming care will experience increasing comorbidities such as anxiety and depression. As many of these patients are going to present at outpatient clinics and hospitals, many of whom are already at capacity, I feel it will put an unnecessary burden on an already stretched system.

Jessica Clodfelter. Outpatient therapist at Thriveworks (Lynchburg, Va.): With the recent legislation across the United States, which has 30 states either already restricting access to gender-affirming care or considering laws that would do so, I think it is fair to say that the number of people seeking help for mental health issues stemming from gender dysphoria will rise. It is important to remember that gender dysphoria itself, while in the DSM-5, is not a mental health issue. The depression, anxiety, substance abuse, eating disorders and self-harming behaviors that people experience as a result of feeling gender dysphoria, however, are.

Gender dysphoria can also cause low self-esteem and self-worth, which can contribute to the aforementioned mental health and substance abuse issues. I also think there will be an influx in youth who seek therapy, as many of the new anti-trans laws are targeted towards restricting or denying gender-affirming care for this population. 

I wish I could say that the mental health providers in this country are prepared for an influx in clients who struggle with gender dysphoria, but I do not think that, as a system, we are. Many therapists have little to no experience working with people who experience gender dysphoria, and though they may have experience working with clients who struggle with the mental health and substance abuse issues that stem from it, the experiences of clients who struggle with dysphoria are very different than the experiences of clients who do not. 

I think the country does not have enough providers who are comfortable enough or who have enough training to work with clients who experience gender dysphoria, and the therapists who do are going to have caseloads so full that they cannot accommodate the number of clients seeking care. If the number of states across the country that are in support of denying care to clients who are struggling is indicative of anything, it shows us how uncomfortable people are with things that are outside of their personal experience. I hope that more therapists seek training and education on how to work with the LGBTQIA+ community, and specifically transgender people, so these clients can receive the mental health support they will need. 

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