Just over a month ago, in August 2022, a statewide interdisciplinary group of mental health professionals with experience in gender-affirming care sent out a media release addressing their challenges to the Department of Human Services’ recently updated Husky policies on attitude towards gender-affirming health care .
Then we were surprised and horrified to see some of the content in the Sept. 8 article reported by the Connecticut Health Investigative Team, or C-HIT.org, in the Mirror, “Access, insurance still barriers to gender-affirming surgery in CT. “
While the article explores some of the barriers to gender-affirming care in Connecticut, it does readers a disservice by missing the very concerns this provider group raised in an Aug. 17 press release that described the additional barriers DSS has put in place for clients of Husky looking at gender-affirming care, namely the requirements for letters from mental health providers in support of the care request.
Our concerns begin with the professionals cited in the article. All quotes are from white cisgender trans care experts; the reporter did not consult with known transgender gender-affirming care providers in this state.
There is concern within our clinician group about training to be considered experts, as few providers have participated in Fenway’s Trans Echo (National LGBTQIA+ Health Education Center) or sought external training in transgender care. The professionals quoted had the opportunity to encourage the reporter to seek comments from trans gender-affirming health care providers on these policies, but did not. As a group of LGBTQIA+ gender-affirming health care providers who recently circulated a scathing critique of DSS/Husky policies to all media in Connecticut, none of us connected.
Additionally, the article supports DSS’s actions while failing to mention their recent increase in scrutiny through a policy change, creating barriers to those on Medicaid seeking gender-affirming care. It also fails to mention the insurmountable barrier for Medicaid clients who do not have thousands of dollars to pay out-of-pocket for care and are not allowed to pay out-of-pocket for care that Connecticut providers either do not provide or do not provide. provide accept payment with Husky.
As our group has come together over the past few days to review and discuss this article, we have also argued that the article ignores the issue of bodily autonomy. According to Dr. AJ Eckert, Medical Director of Anchor Health’s Gender and Life-Affirmative Medicine Program, “The story … continues the narrative of the mental health model of care as the standard of care for trans people—a model of care that is severely harmful and out of date for many years.” In fact, a psychologist quoted in your article, Laura Saunders, mentioned mental health letters but dismissed their nature as “they provide guidance in an area that can sometimes be very murky”.
Bodily autonomy is not a murky subject. The desire for bodily autonomy is not a mental health pathology. Individuals should not be required to enter therapy, let alone contact a second psychiatrist, to verify who they are. Asserting one’s identity is an internal process. Letters are invasive, expensive, time consuming and completely unnecessary. The only “approval” required should be based on the person’s informed consent and baseline medical ability to undergo the desired procedure, exactly the same process as a patient being screened for any other type of surgery.
The article states, “Medicare, Husky and many insurance companies follow widely accepted guidelines from the World Professional Association for Transgender Health (WPATH),” but Connecticut DSS has implemented rules that are not justified or supported by best practice recommendations or guidelines.
There is a growing evidence base that gender confirmation surgery alleviates mental health problems. Adding barriers to surgery is what makes mental illness worse. To tell the full story about healthcare access for transgender and non-binary people, the Mirror needs to expose the issues we’ve detailed.
Alison D. Platt, LPC/LMHC on behalf of the following: Alexandra Solomon, LCSW; Molly Conley, PsyD; Lauren Millard, LCSW; Kayti Protos, DSW, LCSW; Laura S. Dodge, LCSW; Rebecca Toner, LCPC; and Sarah A. Gilbert, LCSW.