A little over a month ago, in August of 2022, a statewide interdisciplinary group of mental health professionals with expertise in gender-affirming care sent out a press release addressing their challenges to the Department of Social Services Husky recently updated policies regarding gender-affirming healthcare .
We were surprised and dismayed, then, to see some of the content in the September 8 reported by the Connecticut Health Investigative Team or C-HIT.org in the Mirror article, “Access, insurance still obstacles to gender-affirming surgery in CT.”
While the article does explore some of the obstacles to gender-affirming care in Connecticut, it does a disservice to the readers by omitting the very concerns this group of providers raised in an August 17 press release which detailed additional barriers enacted by DSS for Husky clients seeing gender-affirming care, namely the requirements of letters from mental health providers to support the request for care.
Our concerns begin with those professionals quoted in the article. The quotes are all from reportedly white cisgender experts on trans care; the reporter did not consult well known transgender providers of gender-affirming care in this state.
There is concern in our clinician group about the training to be considered experts, as few providers have participated in Fenway’s Trans Echo (National LGBTQIA+ Health Education Center) or sought external training on transgender care. The professionals quoted had the opportunity to encourage the reporter to seek out comments from trans providers of gender-affirming health care about these policies, and did not do so. As a group of LGBTQIA+ providers of gender-affirming health care, who recently disseminated a pointed critique of DSS/Husky policies to all the media in Connecticut, none of us were contacted.
Further, the article supports DSS’s actions while making no mention of their recent increase in gatekeeping through policy change, creating barriers to those on Medicaid seeking gender-affirming care. Additionally, there is no mention of 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 who do not accept Husky payment.
As our group met over the past few days to review and discuss this article, we also took issue with the article’s neglect of the issue of bodily autonomy. According to Dr. AJ Eckert, medical director of Anchor Health’s Gender & Life-Affirming Medicine Program, “The story…furthers the narrative of a mental health model of care as the standard of care for trans people — a model of care that is severely harmful and outdated by many years.” In fact, a psychologist quoted in your article, Laura Saunders, mentioned mental health letters but dismissed the gate-keeping nature of them because “they provide guidance in an area that can sometimes be very murky.”
Bodily autonomy is not a murky subject. Desiring bodily autonomy is not a mental health pathology. Individuals should not be required to enter into therapy, let alone contact a second psychiatric provider, to verify who they are. Affirmation of identity is an internal process. Letters are invasive, expensive, time-consuming, and completely unnecessary. The only “approval” needed 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),” yet DSS in Connecticut has implemented rules that are not substantiated or supported by best recommendations or guidelines.
There is a growing evidence base that gender-affirming surgery alleviates mental health concerns. It is the addition of barriers to surgery that exacerbates mental health conditions. To tell the full story about access to healthcare for transgender and nonbinary people, the Mirror needs to expose the issues we have detailed.
Allyson D. Platt, LPC/LMHC on behalf of the following: Alexandra Solomon, LCSW; Molly Conley, PsyD; Lauren Millerd, LCSW; Kayti Protos, DSW, LCSW; Laura S. Dodge, LCSW; Rebecca Toner, LCPC; and Sarah A. Gilbert, LCSW.