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Senators urge Biden admin for guidance on mental health of transgender youth

The lawmakers sent a letter to Dr. Rachel Levine, the assistant health secretary, urging her and the Health Department to create national guidelines.
Rachel Levine speaks during her confirmation hearing in Washington on Feb. 25, 2021.Caroline Brehman / CQ-Roll Call, Inc via Getty Images file

A group of Democratic senators is urging Dr. Rachel Levine, the assistant secretary to the Department of Health and Human Services and the country’s first transgender federal official, to create national guidelines to address the mental health needs of trans and nonbinary children.

In a letter to Levine and Miriam Delphin-Rittmon, the assistant health secretary for mental health and substance use, several senators pressed HHS to “improve and communicate best practices” when caring for the vulnerable group of youths.

“There’s still clearly discrimination happening out there,” Sen. Chris Murphy, D-Conn., who led the effort, said. “This kind of guidance would also be a really important signal for the administration to send that we don’t just expect there to be a lack of discrimination. We expect there to be a culture of empathy and understanding and appropriate treatment for LGBT youth who are entering health care settings.”

The senators’ request comes as advocates and youth experts warn of unmet mental health needs of LGBTQ minors across the country. 

A 2021 survey by the Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization, found that more than half of trans and nonbinary youths seriously considered suicide last year. A similar survey conducted by the project in 2020 had nearly identical findings, with both surveys canvassing tens of thousands of LGBTQ youths. 

Advocates have also warned of an uptick in transgender and nonbinary youth seeking help for their mental well-being in states advancing anti-trans bills.

The Trans Lifeline, the country’s first transgender crisis hotline, saw a 72 percent increase in calls from Texas in May compared with May 2020, according to data from Trans Lifeline. In May, Texas lawmakers began to consider about a dozen bills aimed at limiting trans rights. 

Research also shows that trans Americans disproportionately report mistreatment by health care providers. A survey published in August by the Center for American Progress, a liberal Washington-based think tank, found that nearly half of transgender adults reported at least one form of mistreatment or discrimination within the year. 

“We know that trans people disproportionately experience mental health challenges because of a society that is unsupportive of them and that often takes place in medical settings,” Bri Barnett, the director of advancement at the Trans Lifeline, said. “Ultimately, having strong guidelines and having a supportive community that makes sure trans youth are being affirmed and get the care they need is the greatest intervention we can make to support the mental help of young trans people.”

HHS announced in May that it would bar health care providers and health-related organizations who receive federal funding from discriminating based on someone’s gender identity or sexual orientation. The move reversed a policy introduced under former President Donald Trump.

But to bolster the policy, the senators outlined recommendations for what Murphy called “basic things” such as making hospital front staff familiar with affirming pronoun usage, acknowledging patients by their chosen names and rooming trans youth in spaces that match their gender identity. 

“There’s a very low knowledge fund among clinicians and care teams regarding how best to serve transgender and gender-diverse youth,” said Dr. Alex Keuroghlian, who directs the National LGBTQIA+ Health Education Center at Boston’s Fenway Institute. “The more this can be standardized and codified nationally, the better equipped our clinicians will be, the better served transgender and gender-diverse youth will be as well.”

Keuroghlian co-wrote “Transgender and Gender Diverse Health Care: The Fenway Guide,” a textbook released this week that aims to address health care needs of transgender people.

Murphy told NBC News that his team had not heard back from HHS regarding the letter, but is “confident” that HHS will work to address the issue. 

HHS did not respond to requests for comment concerning the call for guidelines. 

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