For transgender youth in crisis, hospitals sometimes compound the trauma
CHAPEL HILL, NC — A four-day wait in the psychiatric emergency room at UNC Hospital left Callum Bradford desperate for an answer to one important question.
With knots in his stomach, the transgender teen asked, “Will I be placed in a girls' ward?”
Yes.
The answer caused one of the worst bouts of anxiety Callum had ever experienced. Crying into the hospital phone, he informed his parents, who fought to overturn the decision they warned would cause greater harm to their son.
Although they managed to block the transmission, the family had little choice when a second overdose landed Callum back in the emergency room at UNC a few months later. When the 17-year-old learned he would be sent to a girls' ward again, he told doctors that the urge to hurt himself was becoming uncontrollable. The exchange is documented in hospital records provided to The Associated Press by the family.
“I deeply regretted even coming to that hospital because I knew I wouldn't get the treatment I needed,” Callum said.
As the political debate over health care for transgender youth in the U.S. has intensified, elected officials and advocates who oppose gender-affirming medical procedures for minors have often said that parents are not acting in the best interests of their children when they seek such treatment.
Major medical associations say the treatments are safe and warn of serious mental health consequences for children who must wait for access to puberty-blocking drugs, hormones and, in rare cases, surgery.
Youth and young adults between the ages of 10 and 24 are responsible for about 15% of all suicides, and research shows that LGBTQ+ high school students are more likely to attempt suicide than their peers, according to the Centers for Disease Control and Prevention.
North Carolina does not have uniform treatment standards in hospitals and has little funding or staff with the proper training to treat transgender children.
Sending a transgender child to a unit that does not reflect their gender identity should be out of the question, said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, and researcher on barriers to quality care. for trans youth in residential settings.
“If you don't validate trans identity from day one, their mental health will deteriorate,” Tulband said.
When North Carolina lawmakers allocated $835 million to strengthen mental health infrastructure earlier this year, none of that money was allocated to meet the specific needs of trans patients.
According to the American Psychiatric Association, the nationwide shortage of psychiatric beds for children has been exacerbated by the COVID-19 pandemic as an unprecedented number of people sought help from mental health providers. Demand has not yet returned to pre-pandemic levels.
North Carolina has a shortage of about 400 psychiatric beds for youth, leaving UNC no choice but to send patients to other facilities, even ones that can't meet specific needs, said Dr. Samantha Meltzer-Brody, chair of the UNC Department of Psychiatry.
“We have no choice but to refer people to the next available bed,” she said.
UNC declined to comment on Callum's case, despite the family's willingness to waive their privacy rights. But Meltzer-Brody has broadly addressed the barriers to gender-affirming treatment for all psychiatric patients.
Public hospital system policy recommends inpatient assignments based on the patient's “self-identified gender, if possible.” But with emergency rooms overwhelmed in recent years, Meltzer-Brody says achieving that goal is a challenge.
LGBTQ+ civil rights organization Lambda Legal says denying someone access to a gender-affirming room assignment is identity discrimination.
Parents, including Callum's father, Dan Bradford, describe feeling helpless as their children receive involuntary psychiatric care, which is not uncommon after a suicide attempt.
Dan Bradford, a psychiatrist himself, has always supported his son's medical transition, which began with puberty-blocking drugs, followed by a low dose of testosterone that he still takes. Ultimately, Callum underwent top surgery to remove his breasts. Irreversible procedures such as surgery are rarely performed on minors, and even then only when doctors determine it is necessary.
“In Callum's case, the gender dysphoria was so strong that if you didn't pursue gender-affirming medical treatment quite quickly, it would be life-threatening,” his father said.
North Carolina law prohibits medical professionals from providing hormones, puberty blockers and gender transition surgeries to anyone under the age of 18. Callum was able to continue with the treatment because he had started it before the August cut-off date.
He said it was cruel to see the General Assembly prevent his transgender friends from receiving the treatments he considers lifesaving.
“When these public policies are discussed or adopted, it sends a very strong message to these children that their government, their society and their community either accepts and validates it or it doesn't,” said Turban, the psychiatric researcher at UC San Francisco . .
Fearing that the plan to place his son in a girls' ward would be deeply traumatizing, Dan Bradford secured a place at a residential treatment center in Georgia. He begged UNC to release Callum early and convinced the North Carolina hospital that would take him to deny the transfer.
The teen then spent 17 weeks in a treatment program in Atlanta. He has since returned home and cares for his mental health by playing keyboard and rowing with his mixed team on the calm waters of Jordan Lake. For the first time in years he thinks about his future.
While he said his experiences have eroded his confidence in the state's inpatient care network, he is optimistic that new resources can provide others with a more gender-affirming experience if they are accompanied by policy changes.
“I'm still here, and I'm happy to be here,” he said. “That's all I want for all my trans friends.”
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