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​A new multi-disciplinary team at Oregon State Hospital is leading the way in providing a holistic approach to gender-affirming care for psychiatric patients at state hospitals.

The Gender Expansive Care and Organizational Support (GECOS) team provides support and guidance to help ensure gender diverse and transgender patients receive care that supports and affirms their gender identity.   

“Gender-affirming care is life-saving care. It greatly reduces suicidal ideation in transgender and gender-diverse people," said Dr. Sara Walker, OSH chief medical officer.

Walker shared information reported by the Trevor Project that 46% of transgender men and 42% of transgender women have attempted suicide, compared to 4.6% of reported suicide attempts among people who do not identify as transgender men or women.

“There's such a need," said Nina Perard, OSH diversity liaison. “The LGBTQ+ community is disproportionately represented in the hospital. Gender-affirming care is necessary for ensuring patients have what they need to go through their journey of recovery and that staff have the tools needed to help."

The 14-member team represents nearly every area involved in a patient's care team – psychiatry, psychology, medical, social work, nursing, and treatment services – to create wrap-around care for patients. The team's role is to provide assessment, treatment and support to patients who are transgender or gender diverse.

“As a team, we're pioneering this and creating a system with the idea that other state hospitals can learn from us," said Danielle Shallcross, an OSH psychologist who is co-leader of the GECOS team.

The team began its work in April, after completing extensive training and certification through the International Transgender Certification Association. GECOS team members are continuing training through the World Professional Association for Transgender Health, an organization known for setting best practices in transgender health.

Clinical team members assess a patient's ability to understand and consent to gender-affirming care. Patients may be referred for gender-affirming hormonal treatment which they can receive at OSH. The team also helps with referrals to OHSU's transgender health program for gender-affirming surgery.

“Part of our work is advocating for the patient to ensure they have what they need while they're here and when they return to jail or the community," Shallcross said.

Currently, the team is working with 12 patients who are interested in transitioning. Each is in a different stage of the process.

“It's a complicated process when we assess patients with severe and persistent mental illness," Shallcross said. “We have individuals with an array of diagnoses, so being able to work through the factors that go into someone's identity is more complex. It comes down to the individual having the capacity to consent and understand the risks and benefits."

One patient, who wished to remain anonymous, began hormone treatments in May. “It's something I've known I wanted to do for a couple of years."  

The patient shared past experiences of bullying and discrimination for expressing themselves as another gender. For them, the change brings hope for the future: “It's important to me because it means I can be myself."

For some of the patients receiving gender-affirming care, it may be the first time that they feel someone believes them when they say they identify as another gender. This can have a significant impact on their recovery, Shallcross said.

Allies and support

In addition to supporting patients, the GECOS team is also committed to providing resources and training to other staff members.

When the team launched in April, OSH employees were invited to participate in the team's work as allies – or people who actively support the rights of a marginalized group without necessarily being a member of it. The response was positive, said Jennifer Snyder, OSH psychologist and GECOS team member leading the allyship connections.

“That's how you change culture," she said. “We're a small team. We're not going to be everywhere all the time. It's important that we have a lot of people who stress the importance of gender-affirming care and can talk about why this is important and why we're doing it. A lot of research shows when you provide gender-affirming care people's mental health improves. We want our patients to do better and be successful and leave the hospital and have good lives."

Part of creating that culture is helping OSH employees expand their knowledge of gender and identity. The team has shared information with employees on pronoun usage and the importance of using the chosen names and pronouns of not only patients, but also their coworkers.

“We could greatly improve the mental health and feelings of validation for people in the hospital just by changing a pronoun and honoring their identity," Shallcross said.

Allies will learn ways to address conscious and unconscious biases and the misgendering of an individual, either in the moment or at a later time, depending on the situation. It takes practice, Snyder said.

“I think we've all had the experience of being someone who wants to stand up against racism or transphobia and you get in the situation, and you freeze," Snyder said. “Part of it may be shock and thinking, 'did that person just say that?' You can have good intentions, but you need practice."

Next steps

Walker said the goal is for OSH to become a center of excellence for gender-affirming care. Shallcross noted that in their consultations with other transgender care hospitals in the West and Pacific Northwest, that there weren't any known state psychiatric hospitals doing this work.

“We're excited to start this process and lead the way for people in public psychiatric facilities to have an opportunity for gender-affirming services," Shallcross said. “Rather than have patients think that they don't have a choice and that because they have a mental illness that they will never be believed about their gender identity, we are providing services that are absolutely saving lives."