Special considerations may be needed for transgender patients who are admitted to a psychiatric unit, to better assist with their care. These considerations should begin prior to the patient’s arrival. It is recommended that patients share a room with others of the same affirmed gender, and if that is not possible, a private room should be assigned. Many institutions room transgender patients with patients of the same assigned (by society to the individual at birth), but not affirmed (to which the individual has transitioned or is in the process of transitioning), gender. When this happens, it can feel invalidating, traumatizing, and discriminatory to the patient, as well as confusing to the roommate.
Staff should be aware of the patient’s desired name and pronouns, particularly when these do not align with the patient’s medical record. It is also important to note that withholding an outpatient hormone regimen can acutely worsen dysphoria for patients. If possible, affirming devices, such as chest binders or breast prostheses should be permitted, unless they pose a significant safety concern.
During the intake interview, it is crucial to have a basic understanding of the patient’s gender journey. Questions about their relationships and response to their identify in their social environment can assess for risk and protective factors. When a patient volunteers information, clarifying questions about their medical transition process should be asked. It is important to frame such questions in a manner which will enable the patient to understand the rationale of the question. It is important to remember that it is never appropriate to ask patients directly about their genitals. It is also important to phrase questions in a manner that does not assume the patient desires further medical intervention. Some individuals undergo social transitioning, while others undergo medical transitioning. Missed issues can be identified at the end of the interview by asking patients whether there is anything that can be done to make their stay on the unit more comfortable.
Throughout the patient’s hospitalization, it is important to follow up on how the patient’s gender identity has been affirmed on the unit. Finally, it is important to consider the patient’s psychiatric course prior to hormone therapy and whether something else might be driving the psychiatric presentation before concluding that the hormones are responsible for the decompensation.
Saw, C. (2017). Transgender patient care on the inpatient psychiatric unit. American Journal of Psychiatry Residents’ Journal.
James Bender, MA
WKPIC Doctoral Intern