A quartet of Republicans want the Department of Veterans Affairs to explain a recent decision to offer In Vitro Fertilisation services to veterans who are unmarried or in same-sex relationships, citing “a plethora of ethical concerns and questions” raised by the announcement.
In a letter to VA Secretary Denis McDonough, Representatives Matt Rosendale, Bob Good, Mary Miller and Josh Brecheen call IVF — a procedure in which human embryos are fertilised in a laboratory setting and implanted in a woman’s uterus — “morally dubious” and say it “should not be subsidised by the American taxpayer”.
Davids is currently fighting to win her fourth term this November — a tough battle, as her district’s demographics have changed to become less Democratic-leaning, andRepublican opponents are lining up to challenge her. But she has also been fighting another very important battle: the fight for increased access to mental health care.
Davids has co-sponsored bipartisan legislation to fund mental health programs in local clinics, schools, and law enforcement centers, as well as a bipartisan bill tohelp people recovering from substance abuse reenter the workforce. She has also supported dozens of bills to bring down the costs of health care and prescription drugs and introducedthe Pride in Mental Health Act — legislation that would improve data collection and resources for at-risk queer youth.
For Davids, mental health strikes an especially personal chord since she’s part of two distinct groups with disproportionately high rates of suicide: Native Americans and young LGBTQ+ people. Native Americans die from suicide at higher rates than any other racial or ethnic group, according to a 2022 reportfrom the Centers for Disease Control and Prevention (CDC). Another recent CDC study found that LGBTQ+ young people are over four times more likely to attempt suicide than their cisgender and heterosexual peers.
Davids believes increasing access to mental health care isn’t merely “putting a Band-Aid on a broken arm.” Rather, she sees such access as an integral part of improving people’s overall emotional well-being.
“I think it’s like an all-of the-above approach, where we do need to be thinking about the most severe and sometimes acute issues happening around mental health or mental illness,” Davids says, “but we also need to be doing that long-term work that helps prevent things like bullying, helps prevent things like young people who are in the foster care system not having anyone around who understands, who has never gotten the training to understand what they’re going through as part of the LGBTQ+ community.”
“If what we’re doing over time is helping people understand how to cope, how to recognize the impacts of trauma, or help people interact with people who are experiencing those things,” she continues, “then I wouldn’t call that a Band-Aid. I would call it the necessary work for keeping people healthy and safe.”
Because many Americans have loved ones who have struggled with mental health, she’ll often watch her conservative colleagues’ committee hearings or press conferences to listen for an opening to reach across the aisle and engage them on this issue.
“There are folks who care about youth mental health and emotional well-being in a way that it probably just doesn’t cross their mind to think about the LGBTQ+ impact,” she says. Some of her conservative colleagues are “often surprised” when they find out about the aforementioned CDC statistics. These discussions can sometimes lead to larger conversations about LGBTQ+ civil rights.
Praising David’s bill to improve data collection on the mental health of queer youth, Melanie Willingham-Jaggers, executive director of the LGBTQ+ student advocacy organization GLSEN, said, “Being excluded, erased, and further stigmatized — by discriminatory policies, peers, and by adults who should protect young people — harms LGBTQI+ youth’s mental health and overall well-being.”
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Davids says, “A lot of times, [my conservative colleagues] might not be aware of how often discriminatory practices [against LGBTQ+ people] are allowed under the law. It’s not right, and it’s not fair, and it doesn’t align with the values that, as Americans, we want to see and that we’re all constantly striving for,” she says.
The mental health disparities facing the LGBTQ+ community are just one part of the institutionalized discrimination experienced by queer people.
Studies suggest that when queer people have the same legal protections as their cisgender and heterosexual peers, their mental health improves, alleviating the anxiety and depression that otherwise accompany worries about discrimination. When Davids points out to colleagues that people can be rejected from a jurybased on their sexual orientation or denied housing based on their gender identity, she notes that she’s not trying to give “special rights” to people based on their unique identities — she’s just trying to make sure that all individuals are afforded the same rights, protections, and responsibilities as other citizens under the law.
Questioning the 2024 election’s long-term impact
The NYC Protect the Results Coalition gathered for a rally and march to demand that every vote be counted before a state can be “called” for a candidate, after Trump’s alleged intention to claim a victory before the results were tabulated. November 4, 2020. Photo by Erik McGregor/LightRocket via Getty Images.
Since arriving in Congress, Davids has noticed Republicans increasingly targeting LGBTQ+ rights amid their attacks on diversity, equity, and inclusion (DEI) initiatives.
Last year, Rep. Marjorie Taylor Greene (R-GA) and members of the far-right Freedom Caucus demanded the removal of LGBTQ+-inclusive DEI policies from 12 appropriation bills to effectively fund all U.S. government agencies. She and other Republicans claimed that policies are “woke,” are anti-American, waste taxpayer money, and make the nation less safe.
Similar criticisms have especially accelerated now that it’s an election year.
“There’s a shift, we’ve seen it, and we’re also seeing it in state legislatures that there’s a ‘two steps forward, one step back,’ ” she says. “There’s a ‘one step back’ happening in quite a few places on a number of different types of issues.”
“We have responsibilities to the people who come after us, but also to the people who came before us.”Rep. Sharice Davids
Polls have indicated that voters aren’t enthusiastic about a rematch between President Joe Biden and former President Donald Trump. Davids urges voters to not only consider the immediate issues facing their communities but also the long-term impacts of the policies we support, something her Native American identity as a member of the Ho-Chunk Nation has taught her to do.
“I ask questions about the long-term impacts — not for political purposes, but because it’s just kind of how I think about things,” she says. “We have responsibilities to our family, to our community, to our tribe; we have responsibilities to our country; and we have responsibilities to the people who come after us, but also to the people who came before us.”
Editor’s note: This article mentions suicide. If you need to talk to someone now, call the Trans Lifeline at 877-565-8860. It’s staffed by trans people, for trans people. The Trevor Project provides a safe, judgement-free place to talk for LGBTQ youth at 866-488-7386 or text “start” to 678-678. You can also call the National Suicide Prevention Lifeline at 988.
Elishea Jones has lived in Alabama her entire life, but since the state’s highest court ruled that embryos are legally children last week and three major fertility clinics halted in vitro fertilization procedures because of the potential legal liability, Jones is questioning everything.
“It’s not a political issue. They claim that we’re about saving the babies and what’s good for the children. This is what makes children happen for some families,” said Jones, who attended a rally outside Alabama’s State House on Wednesday to advocate for IVF protections.
Jones, 34, and her wife, Paige, 41, live in Alabaster with their 4-year-old son, Fendley. The couple conceived Fendley through IVF in 2020 and froze three more embryos in the hope of having another child in the future.
Elishea Jones, left, and her wife, Paige, after Elishea’s egg retrieval on Oct. 21, 2019.Courtesy Elishea Jones
Last week, Katherine Robertson, the chief counsel for Alabama Attorney General Steve Marshall, said in a statement that Marshall “has no intention of using the recent Alabama Supreme Court decision as a basis for prosecuting IVF families or providers.”
Jones said the statement did not give her much comfort: “I don’t trust that.”
One day after the attorney general’s assurance, an explosive device detonatedoutside Marshall’s office. No one was hurt, but Alabama authorities released a video of the suspect Wednesday in an effort to identify them.
For many same-sex couples, the events of the last week have felt deeply unsettling.
While IVF and other assisted reproductive technology procedures are not unique to same-sex couples, such couples rely on them more than heterosexual couples if they are trying to conceive children biologically.
“Making IVF services off-limits or of uncertain legality disproportionately affects LGBTQ parents,” said Mary Ziegler, a professor at the University of California Davis School of Law whose expertise includes the history and politics of reproductive rights.
Research published in the American Journal of Obstetrics & Gynecology in 2019 — which reviewed pregnancies of more than 230,000 women in same-sex and opposite-sex marriages from 2012 to 2016 — found 34% of women in same-sex marriages used assisted reproductive technology, including IVF, compared to only 4% of women in opposite-sex marriages.
The IVF process for Jones — including sperm, medications and her egg retrieval procedure — cost upward of $25,000 and took a significant toll on her body.
“It was one of the toughest things I’ve ever been through, like mentally, physically,” she said, but she said with a shrug, “It was the only way to have kids.”
Jones has explored moving the embryos out of state but worries about the legal implications.
“Could I get in trouble if I try to move them?” she asked. “As soon as I can get them out of the state, I will.”
Carrie McNair, of Mobile, holds a sign at a rally advocating for IVF rights outside the Alabama State House in Montgomery on Wednesday.Stew Milne / AP for The National Infertility Association
Polly Crozier, the director of family advocacy for GLAD, an LGBTQ legal rights group, said the Alabama Supreme Court’s ruling adds to the many challenges already facing LGBTQ parents in the state.
“It is an environment where it is difficult to protect your legal parent-child relationship, even when your children are born,” she said. “So I think that LGBTQ people see a ruling like this, and I think it really strikes terror in their hearts.”
“This IVF case is obviously a very clear sign that the anti-abortion movement really has its sights set much broader than abortion,” Crozier added. “For some out-there activists, the vision is the only real family is a mother and a father who have created their children through sexual intercourse and are genetically related to them.”
On Thursday, the state House and the state Senate passed bills that would grant legal protections to IVF providers and patients. Both chambers of the Legislature would need to vote on a unified bill before it could make its way to Gov. Kay Ivey. Critics say the bills fail to address whether or not an embryo created via IVF should be considered a child under state law, the core issue raised by the state Supreme Court ruling.
Caroline Veazey is not waiting to see what happens with the state legislation. Veazey, 30, went through one unsuccessful round of IVF last year before she tried again and successfully froze six embryos last summer. The process cost her over $20,000.
When the Supreme Court decision was reported, she launched a GoFundMe campaign and started frantically searching for ways to transport her embryos out of state.
“I literally Googled ‘how to move embryos out of a state’ or ‘how to ship embryos’ and started getting quotes,” said Veazey, who splits her time between Birmingham and Woodstock, Georgia. “You can prepare for all the money for IVF; you cannot prepare for ‘Oh, my gosh, I need to get my embryos out of Alabama immediately.’”
Kandis Pulliam, left, and her fiancée, Caroline Veazey, after Veazey’s egg retrieval on July 20.Courtesy Caroline Veazey
For Veazey, becoming a mother would be a dream come true. “As someone who identifies as a lesbian, I knew at some point — partner or no partner — that I was going to go through IVF,” she said.
“I have a really rough relationship with my mother, who is unaccepting of my sexuality,” said Veazey, a licensed counselor with many LGBTQ clients. “And I could only hope and dream of having a baby who I could give complete acceptance and support to. That is my goal. It’s what I’ve always wanted.”
Though moving the embryos to a storage facility near Woodstock would seem like a natural solution, Veazey is not confident something similar would not happen there. “Georgia is a red state. It can go both ways, and I need to get them to a safe state,” she said.
On Wednesday, Veazey signed paperwork waiving her IVF clinic’s liability so it can release the frozen embryos to a company that will transport them to a storage facility in Washington state.
Former state Rep. Patricia Todd, who in 2006 made history as the first openly gay lawmaker elected to the Legislature, worries about Alabama’s future.
“I think that a lot of younger same-sex couples will decide to leave Alabama,” said Todd, who now works on LGBTQ advocacy across the state. “They don’t want to live in a state that’s this regressive.”
Moving is something Elishea Jones has begrudgingly started to question. Vermont is too cold. Colorado is too far from family. She gets emotional thinking about how she will explain all of this to her son one day.
“I fought so hard to have him, so I’m going to fight for him. If s— goes down, we’re gone,” she said, wiping away a tear, and then laughed. “I’ll protect his embryo-siblings.”
The first at-home cervical screening device is currently under clinical trial to become FDA-approved in the USA, and we think it’s about time for a change.
For women and those with uteruses, undergoing a regular pap smear to prevent cervical cancer can be an unpleasant experience thanks to the speculum used.
The outdated device used in pelvic appointments to separate the vaginal walls can be cold and uncomfortable. The clamp-like instrument was invented in the mid-19th century and hasn’t adapted much since its origins.
The new device called Teal Wand, designed by women-led company Teal Health, is an at-home cervical cancer screening device. The brand explained in an Instagram post that the at-home screening device “follows the American Cancer Society’s cervical cancer guidelines and runs the samples on approved primary HPV assays”.
Teal Health’s initial study of the device revealed that 97% of women said the at-home cervical cancer screening device was easy or very easy to use. Meanwhile, 92% of participants said they would choose self-collect over the current standard of care with a clinician collecting, while 87% said they would be more likely to get screened if the Teal Wand was an option.
In the US, the Centres for Disease Control and Prevention estimates that around 4,000 women and people with uteruses die of cervical cancer a year. Self-collected cervical screening tests are already an option in other countries and actively reduce the barrier for women and LGBTQ+ people facing healthcare-based discrimination.
The Australian Government introduced such tests in July 2022. The home kit tests “allow privacy and help break down barriers for thousands of people who have never screened – including women who have experienced sexual violence, LGBTQIA+ people and culturally and linguistically diverse and First Nations communities”, the Department of Health and Aged Care website reads.
“Australia has always punched above its weight when it comes to cervical cancer, and now Australia is on track to be the first country in the world to eliminate this deadly disease,” said the assistant minister for the department The Hon Ged Kearney.
Unsurprisingly, the original device has bleak origins. In 1945, Dr James Marion Sims performed surgeries on enslaved women without anaesthesia or pain relief, in a bid to understand the reproductive system. He invented the instrument to allow himself – and largely Cis male doctors – the ability to better look at the vagina and cervix, GE HealthCare explains.
The U.S. syphilis epidemic isn’t abating, with the rate of infectious cases rising 9% in 2022, according to a new federal government report on sexually transmitted diseases in adults.
But there’s some unexpected good news: The rate of new gonorrhea cases fell for the first time in a decade.
It’s not clear why syphilis rose 9% while gonorrhea dropped 9%, officials at the U.S. Centers for Disease Control and Prevention said, adding that it’s too soon to know whether a new downward trend is emerging for the latter.
They are most focused on syphilis, which is less common than gonorrhea or chlamydia but considered more dangerous. Total cases surpassed 207,000 in 2022, the highest count in the United States since 1950, according to data released Tuesday.
And while it continues to have a disproportionate impact on gay and bisexual men, it is expanding in heterosexual men and women, and increasingly affecting newborns, too, CDC officials said.
A tissue sample with the presence of the bacterium responsible for causing syphilis.Skip Van Orden / CDC via AP file
Syphilis is a bacterial disease that can surface as painless genital sores but can ultimately lead to paralysis, hearing loss, dementia and even death if left untreated.
New syphilis infections plummeted in the U.S. starting in the 1940s when antibiotics became widely available and fell to their lowest by 1998.
About 59,000 of the 2022 cases involved the most infectious forms of syphilis. Of those, about a quarter were women and nearly a quarter were heterosexual men.
“I think its unknowingly being spread in the cisgender heterosexual population because we really aren’t testing for it. We really aren’t looking for it” in that population, said Dr. Philip Chan, who teaches at Brown University and is chief medical officer of Open Door Health, a health center for gay, lesbian and transgender patients in Providence, Rhode Island.
The report also shows rates of the most infectious types of syphilis rose not just across the country but also across different racial and ethnic groups, with American Indian and Alaska Native people having the highest rate. South Dakota outpaced any other state for the highest rate of infectious syphilis at 84 cases per 100,000 people — more than twice as high as the state with the second-highest rate, New Mexico.
South Dakota’s increase was driven by an outbreak in the Native American community, said Dr. Meghan O’Connell, chief public health officer at the Great Plains Tribal Leaders’ Health Board based in Rapid City, South Dakota. Nearly all of the cases were in heterosexual people, and O’Connell said that STD testing and treatment was already limited in isolated tribal communities and only got worse during the pandemic.
The U.S. Department of Health and Human Services last year convened a syphilis task force focused on stopping the spread of the STD, with an emphasis on places with the highest syphilis rates — South Dakota, 12 other states and the District of Columbia.
The report also looked at the more common STDs of chlamydia and gonorrhea.
Chlamydia cases were relatively flat from 2021 to 2022, staying at a rate of about 495 per 100,000, though there were declines noted in men and especially women in their early 20s. For gonorrhea, the most pronounced decline was seen in women in their early 20s as well.
Experts say they’re not sure why gonorrhea rates declined. It happened in about 40 states, so whatever explains the decrease appears to have occurred across most of the country. STD testing was disrupted during the COVID-19 pandemic, and officials believe that’s the reason the chlamydia rate fell in 2020.
It’s possible that testing and diagnoses were still shaking out in 2022, said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention.
“We are encouraged by the magnitude of the decline,” Mermin said, though the gonorrhea rate is still higher now than it was pre-pandemic. “We need to examine what happened, and whether it’s going to continue to happen.”
Large numbers of queer young people of colour in the US believe they have a low life expectancy compared with their white peers, a new study has found.
The research for LGBTQ+ youth mental-health charity The Trevor Projectshowed that, overall, 58 per cent of young queer people believe there is a high chance they will live to at least the age of 35, while 34 per cent view their chances as low. The remaining respondents were unsure.
The report, which surveyed 28,524 LGBTQ+ people between the ages of 13 and 24, found that 59 per cent of young LGBTQ+ people of colour think they will live to 35 and beyond, while 69 per cent of their white peers think there is a high chance they will live to the same age.
That disparity was even greater for transgender and non-binary people (53 per cent), compared with cisgender people, with 79 per cent of those surveyed believing they would live at least that long.
Steven Hobaica, a research scientist at The Trevor Project, told Advocate that as well as factors such as supportive parents and access to gender-affirming care, people who expressed high levels of “life purpose” were more likely to expect to live longer.
“We found that white LGBTQ+ young people were more likely to endorse a higher chance of living past 35 compared [with] their peers of colour, possibly due to generally having less stressful life experiences,” Hobaica said.
“It is well documented that youth who hold multiple marginalised identities, such as LGBTQ+ youth of colour, report higher rates of both stressful life events and mental health problems than their white LGBTQ+ peers, which may help explain these findings.”
‘Change is needed’
In addition, the research showed that queer people who believed they had a lower life expectancy were also more likely to have had recent bouts of anxiety(82 per cent) and depression (77 per cent).
This group also reported higher rates of self-harm in the past 12 months (77 per cent), suicide consideration (69 per cent), and suicide attempts (28 per cent) compared with respondents who thought they would lie longer (41 per cent, 24 per cent, and six per cent, respectively).
These latest figures in particular led The Trevor Project to highlight the need for investment in LGBTQ+ mental health care.
“Systemic policy change is needed to address the mental health of LGBTQ+ youth,” Hobaica said.
Several factors compounded this, with Black trans and non-binary youth experiencing higher levels of depression, anxiety, homelessness and discrimination.
“Simply put, the mental health of Black transgender and non-binary young people is a public-health crisis,” Dr Myeshia Price, a senior director of research science at The Trevor Project, said at the time.
Suicide is preventable. Readers who are affected by the issues raised in this story are encouraged to contact Samaritans on 116 123 (www.samaritans.org), or Mind on 0300 123 3393 (www.mind.org.uk). Readers in the US are encouraged to contact theNational Suicide Prevention Line on 1-800-273-8255.
Gender dysphoria diagnoses in the United States increased in all but one state in recent years, suggesting that a growing number of transgender people are seeking health care.
Gender dysphoria “refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity,” according to the American Psychiatric Association.
Not all transgender people experience dysphoria. Treatment can include social shifts, such as wearing different clothing or going by a different name, or medical affirmation, which can involve puberty blockers, hormone treatment, and surgery. Medical treatment — gender-affirming care — typically requires a diagnosis from a health care professional before patients can receive it.
Despite a growing number of states seeking to ban gender-affirming care for minors and restrict the care for adults, more people are beginning to seek it by receiving a diagnosis, a recent report from Definitive Healthcare found.
Virginia, Indiana, and Utah were the states with the greatest increase in diagnoses between 2018 and 2022 The only state to see a decrease was South Dakota, which banned gender-affirming care for minors in 2023.
South Dakota lawmakers had attempted to pass legislation banning care in 2020, which the report stated likely had “the dual chilling effects of reduced access to sympathetic providers and the self-directed seeking of care in states where long-term access was protected.”
The report also noted that “other states with bans on gender-affirming care for youth have seen year-to-year dips in gender dysphoria diagnoses, too,” though this does not necessarily indicate that less transgender residents are seeking care, but rather “possibly indicating that shifting social and political climates have pushed young patients and their parents to seek diagnoses in states that are friendlier to trans people.”
For patients under the age of 18, gender dysphoria diagnoses increased from 17.5 percent to 20.4 percent during the four-year period. The report notes this could be reflective of transgender identities becoming “more accepted by society,” in spite of the legislators pushing health care bans.
The Williams Institute estimates that 1.6 million people in the U.S. are transgender, nearly 20 percent of them being between the ages of 13 and 17. Among transgender youth, 35.1 percent (105,200 total) live in states that have restricted access to gender-affirming care, according to the Human Rights Campaign.
Out Massachusetts Gov. Maura Healey (D) has proposed legislation to grant LGBTQ+ military veterans coverage for in-vitro fertilization (IVF), something the federal Veterans Administration (VA) only allows for heterosexual couples.
Healey first introduced the legislation – dubbed the HERO Act – in November, and according toThe Boston Business Journal a hearing on the proposal is set to be held this month before the Joint Committee on Veteran and Federal Affairs.
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“Our veterans have sacrificed so much for our country, and this transformative legislation marks an important step toward ensuring that Massachusetts supports them in return,” Healey said in a press release after introducing the legislation.
Calling the bill “historic,” she added, “From day one, our administration has been committed to revitalizing veterans’ services in Massachusetts and ensuring that every one of these heroes receives the benefits, resources, and support that they deserve.”
The bill would no doubt have a massive impact, as veterans in same-sex marriages have made it clear the current policies affect them deeply. In August, Massachusetts veteran Ashley Sheffield filed a class action lawsuit against the VA arguing that the denial of fertility coverage to LGBTQ+ couples is unconstitutional.
“We are entitled to equal treatment and we should no longer be treated as second-class citizens,” Sheffield reportedly said when she filed the suit.
In addition to granting IVF coverage to same-sex couples, the HERO Act proposes a myriad of other benefits, including expanded access to mental health care treatment, an increase in the tax credits small businesses receive for hiring low-income and chronically unemployed veterans, an increase in flexibility for veteran property tax exemptions, and an expanded definition of a veteran dependent.
In November 2022, Healey became the first out lesbian governor in the country, as well as the first woman elected governor in her state. Before that, she was the country’s first out lesbian state attorney general.
As AG, she championed non-discrimination protections for trans people in Massachusetts and pushed for gender-neutral markers both federally and for the state. And as civil rights chief in the AG’s office, Healey brought the first successful challenge to the Defense of Marriage Act, helping to lay the groundwork for marriage equality nationwide.
After she won the Democratic primary, she stood before a raucous crowd of supporters and told them, “I am so proud to be able to stand before you tonight as your Democratic nominee for governor of Massachusetts.” She nodded to the sound of her latest title and added, “That sounds good.”
The former professional basketball player and captain of her team at Harvard describes herself as a “baller” and was clear-eyed about the work ahead in her remarks that night: “I ask you, as a former point guard, to leave it all with me on the court.”
Four days of waiting under the flickering fluorescent lights of UNC Hospitals’ emergency room left Callum Bradford desperate for an answer to one key question.
The transgender teen from Chapel Hill needed mental health care after overdosing on prescription drugs. He was about to be transferred to another hospital because the UNC system was short on beds.
With knots in his stomach, he asked, “Will I be placed in a girls’ unit?”
Yes, he would.
The answer provoked one of the worst anxiety attacks he had ever experienced. Sobbing into the hospital phone, he informed his parents, who fought for days to reverse the decision they warned would cause their already vulnerable son greater harm.
Although they initially succeeded in blocking the transfer, the family had few remaining options when a second overdose landed Callum back in UNC’s emergency room a few months later. When the 17-year-old learned he was again scheduled to be sent to an inpatient ward inconsistent with his gender identity, he told doctors his urge to hurt himself was becoming uncontrollable, according to hospital records given by the family to The Associated Press.
“I had an immense amount of regret that I had even come to that hospital, because I knew that I wasn’t going to get the treatment that I needed,” Callum said. “That moment of crisis and shock and fear, I would wish anything that that hadn’t happened, because I truly think that I took a step backwards from where I was before in terms of my mental health.”
As the political debate over health care for transgender youth has intensified across the U.S., elected officials and advocates who favor withholding gender-affirming medical procedures for minors have often said parents are not acting in their children’s best interest when they seek such treatment.
Major medical associations say the treatments are safe and warn of grave mental health consequences for children forced to wait until adulthood to access puberty-blocking drugs, hormones and, in rare cases, surgeries.
Youth and young adults ages 10–24 account for about 15% of all suicides, and research shows LGBTQ+ high school students have higher rates of attempted suicide than their peers, according to the Centers for Disease Control and Prevention.
Some transgender teens say the negative rhetoric popularized by many Republican politicians in recent years has become too much to bear. In North Carolina, legislators enacted new limits to gender-affirming care for trans youth this year while barely discussing flaws in the psychiatric care system. It’s one of at least 22 states that have passed laws restricting or banning gender-affirming medical care for transgender minors. Most face legal challenges.
North Carolina lacks uniform treatment standards across hospitals and runs low on money and staff with proper training to treat transgender kids in crisis. That means the last-resort measures to support patients like Callum often fail to help them, and sometimes make things worse.
Sending a transgender child to a unit that does not align with their gender identity should be out of the question, no matter a hospital’s constraints, said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, and a researcher of quality care barriers for trans youth in inpatient facilities.
“If you don’t validate the trans identity from day one, their mental health’s going to get worse,” Turban said. “Potentially, you’re sending them out at a higher suicide risk than they came in.”
When North Carolina lawmakers allocated $835 million to shore up mental health infrastructure earlier this year, none of the money was specifically allocated to the treatment needs of trans patients. Though the funding may benefit everyone, a lack of direct action has left trans youth at the mercy of a system ill-equipped to help them when they need it most.
Callum Bradford, center, and his team, carry their boat to the ramp as they get ready for a rowing club practice at Jordan Lake, in Apex, N.C., on Oct. 6, 2023. Erik Verduzco / AP
A nationwide dearth of pediatric psychiatric beds was compounded by the COVID-19 pandemic, which saw an unprecedented number of people seeking emergency mental health services, according to a report by the American Psychiatric Association. Demand has yet to return to pre-pandemic levels.
A “dire shortage” of at least 400 inpatient psychiatric beds for North Carolina youth has left UNC with no choice but to send patients to other facilities, even those that cannot accommodate specific needs, said Dr. Samantha Meltzer-Brody, chair of the UNC Department of Psychiatry.
Emergency rooms are not designed for boarding, nor can they provide comprehensive mental health treatment. That creates an immediate need to place patients left waiting in the ER for days or even weeks before a bed opens up, Meltzer-Brody said.
While UNC’s own inpatient program assigns all children to individual rooms on co-ed floors, it sends overflow patients to some hospitals that don’t make such accommodations.
“We have no choice but to refer people to the next available bed,” Meltzer-Brody said of the University of North Carolina-affiliated hospital. “If you’re talking about the LGBTQ+ community and seeking trans care, you may be sent to a place that is not providing care in a way that is going to be most optimal.”
Callum exploded when he was told about plans to place him in a unit for girls, his records note. He shouted and cried hysterically until he ended up in an isolation room. Doctors later found him banging his head against the wall in a trance-like state.
“It was almost as if sort of my brain had turned off because of such a shock,” he recalled. “I had never acted on such severe self-harm without even realizing that I was doing it.”
UNC declined to comment on Callum’s case, despite the family’s willingness to waive its privacy rights. But Meltzer-Brody did broadly address barriers to gender-affirming treatment for all psychiatric patients.
The public hospital system’s policy on gender-designated facilities recommends inpatient assignments based on a patient’s “self-identified gender when feasible.” But with the ER overrun in recent years, Meltzer-Brody said meeting that goal is a challenge.
The issue extends beyond transgender youth, affecting patients with autism, addiction and acute psychiatric disorders who are sometimes sent to facilities unfit to provide specialized care.
It doesn’t help, she said, that there is no national standard for how psychiatric hospitals must cater to transgender patients.
The LGBTQ+ civil rights organization Lambda Legal has outlined best practices for hospitals treating transgender patients under the Affordable Care Act. The organization says denying someone access to a gender-affirming room assignment is identity-based discrimination, based on its interpretation of the law.
But such cases rarely end up in court, because the burden falls on families to advocate for their rights while supporting a child in crisis, said Casey Pick, law and policy director at The Trevor Project, a nonprofit focused on LGBTQ+ suicide prevention.
“These are circumstances that are themselves often inherently traumatic, and adding a layer of trauma on top of that in the form of discrimination based on an individual’s gender identity just compounds the issue,” Pick said. “The last thing we should have to do is then add the additional trauma of going to court.”
Dan Bradford, left, and his son Callum, at their home in Chapel Hill, N.C., on Sept. 14, 2023. Erik Verduzco / AP
Parents including Callum’s father, Dan Bradford, describe feeling helpless while their children are receiving psychiatric care involuntarily, which isn’t uncommon after attempted suicide. Callum’s involuntary commitment designation also temporarily stripped his mother and father of many parental rights to make medical decisions for their son.
A psychiatrist himself, Dan Bradford always has supported his son’s medical transition, which began with puberty-blocking drugs, followed by a low dose of testosterone that he still takes. Eventually, Callum underwent top surgery to remove his breasts. Irreversible procedures like surgery are rarely performed on minors, and only when doctors determine it’s necessary.
“In Callum’s case, the gender dysphoria was so strong that not pursuing gender-affirming medical treatments, like pretty quickly, was going to be life-threatening,” his father said, wiping tears from his eyes. “Any risk that might be associated with the treatments seemed trivial, quite frankly, because we were afraid we’re going to lose our kid if we didn’t.”
North Carolina law bars medical professionals from providing hormones, puberty blockers and gender-transition surgeries to anyone under 18. But some kids like Callum, who began treatment before an August cut-off date, can continue if their doctors deem it medically necessary.
Although he retained access to hormones, Callum said it has been brutal seeing the General Assembly block his transgender friends from receiving the treatments he credits as life-saving.
“When these public policies are discussed or passed, that sends a really strong message to these kids that their government, their society and their community either accepts them and validates them or doesn’t,” said Turban, the researcher at UC San Francisco.
His research has found that many medical providers still lack training about LGBTQ+ identities and make common mistakes, such as printing the wrong gender designation on a hospital wristband or placing a transgender patient in a single-occupancy room when everyone else has a roommate.
Fearing the plan to place his son in a girls’ ward would be deeply traumatizing, Dan Bradford secured a spot at a residential treatment center in Georgia. He pleaded with UNC to release Callum early and convinced the North Carolina hospital that was supposed to take him to reject the transfer.
The teen then spent 17 weeks in an individualized treatment program in Atlanta, recovering from the circumstances that landed him in the ER and the added trauma he endured there. He has since returned home and is taking care of his mental health by playing keyboard and rowing with his co-ed team on the calm waters of Jordan Lake. For the first time in years, Callum said he’s thinking about his future.
There are some positive developments on the horizon for North Carolina youth facing mental health crises.
The new state funding for mental health services approved in October has enabled UNC Hospitals to open a 54-bed youth behavioral health facility in Butner, 28 miles (45 kilometers) north of Raleigh. State Department of Health and Human Services Secretary Kody Kinsley said the facility should alleviate some barriers to individualized care, including for transgender patients. And UNC has announced plans to open a freestanding children’s hospital within the next decade.
Leaders of the Butner facility, which began its phased opening this month, have promised to take a whole-family approach so parents are not shut out of their child’s treatment plan. Nearly every patient will be placed in an individual room on a co-ed floor.
The new facility and funding will allow more patients to stay in single-occupancy rooms at UNC, but overflow patients may still be sent elsewhere, Meltzer-Brody said. The hospital system has not changed its policies on transgender patient referrals, and other facilities across the state that receive those patients still lack uniform standards for treating them.
Although Callum said his experiences eroded his trust in the state’s inpatient care network, he is optimistic that the new resources could give others a more gender-affirming treatment experience, if they are paired with 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.”
When talking about myths of people with disabilities, Katherine Allen says there’s more to deafness and blindness than people think.
“Just about everything [is on] a spectrum,” said Allen, who is visually impaired.
Allen, 68, is active in the Philadelphia-area disability and LGBTQ+ communities. She is an accessibility consultant for Philly Touch Tours, an organization that provides “equal opportunities in cultural settings for people with vision loss,” as per the organization’s website.
In collaboration with Trish Maunder, creative director and co-founder of Philly Touch Tours, Allen trains the staff of local museums and cultural institutions how to welcome people with disabilities as visitors to their establishments.
“This is a kind of sensibility, busting myths,” Allen said. “The hands-on training [is rooted in the question] ‘how would you guide or help a blind person? What’s the proper way to do that?’”
Allen and her colleagues often begin the conversation or title a presentation for these training sessions with the line, “It’s OK to say ‘nice to see you’ to a blind person.”
“People are afraid and blindness is one of the disabilities that really kind of freaks people out,” Allen said. “It makes them uncomfortable. They don’t know what to do or say.”
On the flip side, all of the blind people that Allen knows, especially those who use a cane, have been “accosted by well-meaning people that won’t take no for an answer,” she said. When people on the street ask a blind person if they need help, they just grab their arm without waiting for them to respond.
Debunking these misconceptions and missteps is part of the work that Allen does through Philly Touch Tours. She also facilitates activities and tours to help people who are blind or vision-impaired experience Philadelphia in an engaging way.
“We have a multisensory tour through the Italian market and we visit a group of vendors that are really open and friendly and cool with our people,” Allen said. “We work with a couple of the Ben Franklin [impersonators] doing history tours.”
Philly Touch Tours occasionally brings groups of people who are visually impaired to visit Philadelphia’s Magic Gardens, a space with an outdoor mosaic sculpture garden, rotating exhibits, and an exterior that’s laden with mosaic art.
“What’s so great about having Katherine on the team is that she herself has a disability. She has low vision,” Maunder said. “When we’re talking about training or we’re talking about making things accessible for people who are blind or [have] low vision, when she speaks, it’s a completely authentic voice. Mine is too because I have a daughter who’s 37, who’s blind.”
Separate from Philly Touch Tours, Allen and Maunder organize a monthly meetup group for blind and visually impaired people in Philly, the majority of whom are 50 and above. The group gets together to go to the beach, visit a local cathedral or simply go out to dinner. Allen and Maunder organize an annual holiday party for the group, which Allen will host for the second time in the community room at John C. Anderson Apartments (JCAA), where she lives. JCAA is an LGBTQ+-affirming apartment building in Philly for queer and trans people who are 62 and older.
Hosting the holiday party at JCAA “is especially nice because, especially [for] people that are blind, transportation access is really tough,” Allen said. “This is a Center City location. It’s a building that’s well-lit. It’s in-and-out.”
When Allen moved into JCAA, she met people from all walks of life, said her friend Eileen Plato, who owned the popular gay spot Judy’s Cafe in Philly, which opened in 1974 and has since closed.
“[Katherine] had a whole new community of folks with disabilities, without disabilities, [people who are] older, and multicolored and multi gender,” Plato said. “Anderson has all kinds of folks – straight, gay, trans.”
Allen’s work in the disability community is vital “because not that many people are involved,” Plato added. “It’s hard for somebody who has sight to plug into a community that doesn’t. Katherine’s able to get in there and make things happen, whether it’s taking people somewhere that they’ve never ever been and can’t imagine how they could get there, or going to a party with 30 blind people.”
“Katherine’s able to get in there and make things happen, whether it’s taking people somewhere that they’ve never ever been and can’t imagine how they could get there, or going to a party with 30 blind people.”Eileen Plato
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When Allen isn’t working at Philly Touch Tours, organizing outings for the meetup group for the blind and visually impaired, or working in the garden at JCAA, she’s listening to a book on tape, reading The New York Times or the magazine published by AARP.
“[Katherine] doesn’t sit still,” Plato said.
AARP is the largest nonprofit in the U.S. that advocates for and empowers people who are 50 and older as they age.
Allen lost a significant part of her eyesight due to a macular incident in her 30s, she said. Nonetheless, she continued on as the art director for a magazine at Nielsen Publishing at the time. She was not immediately open about her low vision.
“[Katherine] will often talk about how it took her longer to come out as a low-vision person than it did to come out as gay,” Maunder said. “In that way, she makes sure it’s part of our framing and that immediately levels the playing field for everybody. She’s very warm. She’s very welcoming.”
In terms of how her vision impairment intersects with her identity as a lesbian, Allen said that blindness is her superpower.
“Because we don’t make visual judgments,” she said. “I can see, so I say ‘we,’ but especially [with] blindness, it puts you at a different point of view. You’re judged by the character you keep. [Having low vision] just gives me a better view.”
