For resources and support, call at 877-565-8860, at 866-488-7386 or the National Suicide Prevention Lifeline at 800-273-8255.
Roswell Gray, 17, has seen a lot of different therapists鈥� offices. They鈥檙e always some variation of black and white and gray, the muted tones matching the monotony of having to explain everything over and over again to a new person, in the hopes they鈥檒l be the right fit.
But Gray said walking into a new office, about an hour away from their home in Sherman, felt different.
鈥淚t was really simplistic, but there was a lot of beautiful art, a lot of different colors and stuff that made me smile,鈥� Gray said. 鈥淪he had a little mini fridge with snacks and drinks. And it was just like, super welcoming and inviting.鈥�
But beyond the fully-stocked fridge and the d茅cor, Gray鈥檚 therapist used their pronouns and asked about their gender identity. Their previous therapist 鈥渨asn鈥檛 great in many aspects,鈥� and they had been looking for a provider who was trans-affirming and could talk about their Mormon faith.
鈥淚 was partially nervous because a lot of people of faith aren't as accepting as I would like them to be,鈥� said Gray. 鈥淚t was really nice to hear her talk about how she's dealt with other clients like me, who are also queer.鈥�
Because of the drive to the office outside of Grayson County, gas prices and the pandemic, Gray hasn鈥檛 gone to therapy as often as they鈥檇 like. And it鈥檚 been hard to navigate the past few months, they said, as gender-affirming care has been caught up in a legal back-and-forth.
Lawmakers in Texas have increasingly tried to prevent access to gender-affirming mental health and medical care for trans youth since last year. Attorney General Ken Paxton and Gov. Greg Abbott have both targeted families providing medical care to their children. In addition, a bill the Texas legislature passed last year .
Repeated exposure to negative messages on trans identity in the media and from political leaders can lead to increased 鈥渄epression, anxiety, PTSD and psychological distress鈥� for trans people, as researchers found in a study in the . The Trevor Project, a national LGBTQ youth crisis services, advocacy and research organization, reported back in January that surveyed said their mental health was negatively impacted by hearing state lawmakers debate trans rights.
"Navigating Texas, with all the changes in laws and policies, has been really hard," said Gray. "Especially when I would go on to social media, and everything I would would see is like, the state is banning trans youth from playing sports. So I spend less time on social media just to distance myself from all of the negative things."
Gray and other trans youth are far from the only people feeling afraid and confused about the future of care in Texas.
As Texas leaders target gender-affirming care, psychologists鈥� work is caught in a legal back-and-forth
Mental health providers like Beck Munsey in North Texas are worried what statements from state leaders could mean for their work. Munsey is a clinician and educator who sees LGBTQ+ youth and adults. Part of Paxton and Abbott鈥檚 directives were that the Texas Department of Family and Protective Services, plus mandated reporters like physicians, mental health counselors like Munsey, and teachers, .
鈥淚t is scary, because there may come a time where Texas law says that I'm not allowed to provide affirming care,鈥� Munsey said. 鈥淎nd so I'll have to make a moral decision on what I do with that.鈥�
But clinicians and families are pushing back. Several families of trans youth, along with the Texas branch of the national advocacy organization PFLAG, . Doctors at UT Southwestern and Children鈥檚 Medical Center Dallas, which quietly closed its trans youth program GENECIS last winter due to political pressure and fear of lawsuits, are also currently in litigation to provide services to new patients.
Munsey said it鈥檚 affected his adult clients as well, who fear their access to care might be taken away next. It鈥檚 made finding a supportive therapist that much more important, but he knows how hard that can be in Texas.
鈥淲hen I was living in Central Texas, I was one of the few support groups for transgender and gender nonconforming adults, and I had people driving 100 miles to come to group because there was no other support group in their area,鈥� Munsey said.
A America ranks Texas last out of all states in terms of access to care. There are a lot of reasons for this, mostly around insurance, cost and workforce. The state did not expand Medicaid, which is the 鈥渟ingle largest payer in the United States for behavioral health services,鈥� .
Some insurance plans for adults and children don鈥檛 cover mental health service visits in Texas or are so expensive they create a barrier for those wanting to access care. Out-of-pocket costs for therapy in Dallas, for example, can vary anywhere between $80-$250 a session.
There鈥檚 also a lack of providers in the state, including providers with specialty training in treating trans youth patients. Federally, the Health Resources and Services Administration designates counties as Health Professional Shortage Areas (HPSA) when there鈥檚 a small amount of practitioners for the total population who might seek treatment. have been designated as HPSAs for mental health treatment.
鈥淭here are a lot of mental health counselors who have no understanding of this population,鈥� Munsey said. 鈥淪o even if they're allies, they might not know how to actually provide affirming care. I think that's a gap that we need to close as mental health professionals, is understanding where my ally hat ends and where my therapeutic skills actually begin.鈥�
And this is all too common鈥� done by the American Psychological Association (APA), said they were not knowledgeable or only slightly knowledgeable in treating trans clients. But the organization is working to change that.
New guidelines in treating trans and non-binary clients focus on client experiences
That same year, in 2015, a taskforce of providers created guidelines for the APA to help fill some of those knowledge gaps, focused on clients鈥� needs. Anneliese Singh, , was one of the task force chairs.
鈥淲hen I first became trained as a counselor, and then later as a counseling psychologist, there weren't actually any competencies or guidelines,鈥� Singh said. 鈥淧revious standards of care were really focused on gatekeeping and were more about how to access hormonal treatment and surgical care.鈥�
include information on foundational knowledge, like gender as a construct; and affordability; life span development for trans youth, therapeutic interventions, and recommendations for future education for practitioners.
鈥淚f you're in your standard counseling psychology or social work program, you're going to get a real overview of 鈥榟ey, trans and non-binary people exist,鈥欌�� Singh said. 鈥淲hat you're not going to get is when misgendering happens with your patients, that furthers distress and gender trauma. You're not going to get these things you need to do in terms of advocacy.鈥�
These APA guidelines, and , are one way to fill in the gaps. The organization currently has a panel working on updating the guidelines, but they're a couple years away from completion, according to Kim Mills, the senior director of communications for the APA.
Singh said in the end, training more people to treat trans clients is about saving lives.
鈥淚f trans and non-binary people can experience the support to the point where they can see that they have a future, that there's hope for them to live, they're going to live,鈥� she said. 鈥淯ltimately I would love our field to keep working towards trans and non-binary liberation, a world in which they get to be absolutely free.鈥�
Trans youth, , are at higher risk for suicide than their cisgender peers. 30-50% of trans youth attempt suicide at least one time in their lives, in .
Support systems mean better outcomes for trans youth as they grow up
Affirming health practitioners, supportive family and relationship structures, and are all a part of improving mental health outcomes as trans youth grow up. For example, 鈥渢ransgender youth who were able to use their chosen name in multiple contexts reported fewer depressive symptoms and less suicidal ideation and behavior,鈥� .
"I also struggled with my mental health in adolescence, and I had an amazing licensed professional counselor," Munsey said, who worked through depression and learned grounding techniques that inspired his practice now. "I want to help people like me and the struggles I knew at that age."
While states like Texas and , providers like Singh and Munsey are creating networks of support for other trans youth in Texas.
"I think that's another misconception that we're only dealing with trauma, or we're only dealing with negative thoughts," Munsey said. "We get to celebrate with our clients, as well, and talk about hopes and joys and successes."
Roswell Gray also wants trans youth in Texas to know they鈥檙e not alone. They are the president of their school鈥檚 Gay Straight Alliance, and started an organization in their church for queer youth of faith.
鈥淚t's important to remember that trans people are trans not for some agenda or to make your kids turn into demons or like some crazy thing like that,鈥� Gray said. 鈥淚t's just part of who people are. And that's really important.鈥�
四虎影院 is part of the鈥�, a group of newsrooms covering challenges and solutions to accessing mental health care in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in Arizona, California, Georgia, Illinois, Pennsylvania, and Texas.
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