CHAPEL HILL, N.C. (AP) 鈥 Four days of waiting under the flickering fluorescent lights of UNC Hospitals' emergency room left Callum Bradford desperate for an answer to one key question.
The teen from Chapel Hill needed mental health care after overdosing on prescription drugs. He was about to be transferred to another hospital because the UNC system was short on beds.
With knots in his stomach, he asked, 鈥淲ill I be placed in a girls' unit?鈥
Yes, he would.
The answer provoked one of the worst anxiety attacks he had ever experienced. Sobbing into the hospital phone, he informed his parents, who fought for days to reverse the decision they warned would cause their already vulnerable son .
Although they initially succeeded in blocking the transfer, the family had few remaining options when a second overdose landed Callum back in UNC's emergency room a few months later. When the 17-year-old learned he was again scheduled to be sent to an inpatient ward inconsistent with his gender identity, he told doctors his urge to hurt himself was becoming uncontrollable, according to hospital records given by the family to The Associated Press.
鈥淚 had an immense amount of regret that I had even come to that hospital, because I knew that I wasn鈥檛 going to get the treatment that I needed,鈥 Callum said. 鈥淭hat moment of crisis and shock and fear, I would wish anything that that hadn鈥檛 happened, because I truly think that I took a step backwards from where I was before in terms of my mental health.鈥
As the political debate over health care for transgender youth has intensified across the U.S., elected officials and advocates who favor withholding have often said parents are not acting in their children鈥檚 best interest when they seek such treatment.
say the treatments are safe and warn of grave mental health consequences for children forced to wait until adulthood to access puberty-blocking drugs, hormones and, in rare cases, surgeries.
Youth and young adults ages 10鈥24 account for about 15% of all , and research shows have higher rates of attempted suicide than their peers, according to the Centers for Disease Control and Prevention.
Some transgender teens say the negative rhetoric popularized by many Republican politicians in recent years has become too much to bear. In North Carolina, legislators enacted for trans youth this year while barely discussing flaws in the psychiatric care system. It's one of at least 22 states that have restricting or banning gender-affirming medical care for transgender minors. Most .
North Carolina lacks uniform treatment standards across hospitals and runs low on money and staff with proper training to treat transgender kids in crisis. That means the last-resort measures to support patients like Callum often fail to help them, and sometimes make things worse.
Sending a transgender child to a unit that does not align with their gender identity should be out of the question, no matter a hospital's constraints, said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, and a researcher of quality care barriers for trans youth in inpatient facilities.
鈥淚f you don鈥檛 validate the trans identity from day one, their mental health鈥檚 going to get worse,鈥 Turban said. 鈥淧otentially, you鈥檙e sending them out at a higher suicide risk than they came in.鈥
When North Carolina lawmakers allocated $835 million to shore up mental health infrastructure earlier this year, none of the money was specifically allocated to the treatment needs of trans patients. Though the funding may benefit everyone, a lack of direct action has left trans youth at the mercy of a system ill-equipped to help them when they need it most.
A nationwide dearth of pediatric psychiatric beds was compounded by the COVID-19 pandemic, which saw an unprecedented number of people seeking emergency mental health services, according to a report by the American Psychiatric Association. Demand has yet to return to pre-pandemic levels.
A 鈥渄ire shortage鈥 of at least 400 inpatient psychiatric beds for North Carolina youth has left UNC with no choice but to send patients to other facilities, even those that cannot accommodate specific needs, said Dr. Samantha Meltzer-Brody, chair of the UNC Department of Psychiatry.
Emergency rooms are not designed for boarding, nor can they provide comprehensive mental health treatment. That creates an immediate need to place patients left waiting in the ER for days or even weeks before a bed opens up, Meltzer-Brody said.
While UNC鈥檚 own inpatient program assigns all children to individual rooms on co-ed floors, it sends overflow patients to some hospitals that don't make such accommodations.
鈥淲e have no choice but to refer people to the next available bed,鈥 Meltzer-Brody said of the University of North Carolina-affiliated hospital. 鈥淚f you鈥檙e talking about the LGBTQ+ community and seeking trans care, you may be sent to a place that is not providing care in a way that is going to be most optimal.鈥
Callum exploded when he was told about plans to place him in a unit for girls, his records note. He shouted and cried hysterically until he ended up in an isolation room. Doctors later found him banging his head against the wall in a trance-like state.
鈥淚t was almost as if sort of my brain had turned off because of such a shock," he recalled. "I had never acted on such severe self-harm without even realizing that I was doing it.鈥
UNC declined to comment on Callum's case, despite the family's willingness to waive its privacy rights. But Meltzer-Brody did broadly address barriers to gender-affirming treatment for all psychiatric patients.
The public hospital system's policy on gender-designated facilities recommends inpatient assignments based on a patient's 鈥渟elf-identified gender when feasible.鈥 But with the ER overrun in recent years, Meltzer-Brody said meeting that goal is a challenge.
The issue extends beyond transgender youth, affecting patients with autism, addiction and acute psychiatric disorders who are sometimes sent to facilities unfit to provide specialized care.
It doesn鈥檛 help, she said, that there is no national standard for how psychiatric hospitals must cater to transgender patients.
The LGBTQ+ civil rights organization Lambda Legal has outlined treating transgender patients under the Affordable Care Act. The organization says denying someone access to a gender-affirming room assignment is identity-based discrimination, based on its interpretation of the law.
But such cases rarely end up in court, because the burden falls on families to advocate for their rights while supporting a child in crisis, said Casey Pick, law and policy director at The Trevor Project, a nonprofit focused on LGBTQ+ suicide prevention.
鈥淭hese are circumstances that are themselves often inherently traumatic, and adding a layer of trauma on top of that in the form of discrimination based on an individual鈥檚 gender identity just compounds the issue," Pick said. 鈥淭he last thing we should have to do is then add the additional trauma of going to court.鈥
Parents including Callum's father, Dan Bradford, describe feeling helpless while their children are receiving psychiatric care involuntarily, which isn鈥檛 uncommon after attempted suicide. Callum's involuntary commitment designation also temporarily stripped his mother and father of many parental rights to make medical decisions for their son.
A psychiatrist himself, Dan Bradford always has supported his son's medical transition, which began with puberty-blocking drugs, followed by a low dose of testosterone that he still takes. Eventually, Callum underwent top surgery to remove his breasts. Irreversible procedures like are rarely performed on minors, and only when doctors determine it's necessary.
鈥淚n Callum鈥檚 case, the gender dysphoria was so strong that not pursuing gender-affirming medical treatments, like pretty quickly, was going to be life-threatening,鈥 his father said, wiping tears from his eyes. 鈥淎ny risk that might be associated with the treatments seemed trivial, quite frankly, because we were afraid we鈥檙e going to lose our kid if we didn鈥檛.鈥
North Carolina law bars medical professionals from providing hormones, puberty blockers and gender-transition surgeries to anyone under 18. But some kids like Callum, who began treatment before an August cut-off date, can continue if their doctors deem it medically necessary.
Although he retained access to hormones, Callum said it has been brutal seeing the General Assembly block his transgender friends from receiving the treatments he credits as life-saving.
鈥淲hen these public policies are discussed or passed, that sends a really strong message to these kids that their government, their society and their community either accepts them and validates them or doesn鈥檛," said Turban, the researcher at UC San Francisco.
His research has found that many medical providers still lack training about LGBTQ+ identities and make common mistakes, such as printing the wrong gender designation on a hospital wristband or placing a transgender patient in a single-occupancy room when everyone else has a roommate.
Fearing the plan to place his son in a girls' ward would be deeply traumatizing, Dan Bradford secured a spot at a residential treatment center in Georgia. He pleaded with UNC to release Callum early and convinced the North Carolina hospital that was supposed to take him to reject the transfer.
The teen then spent 17 weeks in an individualized treatment program in Atlanta, recovering from the circumstances that landed him in the ER and the added trauma he endured there. He has since returned home and is taking care of his mental health by playing keyboard and rowing with his co-ed team on the calm waters of Jordan Lake. For the first time in years, Callum said he's thinking about his future.
There are some positive developments on the horizon for North Carolina youth facing mental health crises.
The new state funding for mental health services approved in October has enabled UNC Hospitals to open a 54-bed youth behavioral health facility in Butner, 28 miles (45 kilometers) north of Raleigh. State Department of Health and Human Services Secretary Kody Kinsley said the facility should alleviate some barriers to individualized care, including for transgender patients. And UNC has announced plans to open a freestanding children's hospital within the next decade.
Leaders of the Butner facility, which began its phased opening this month, have promised to take a whole-family approach so parents are not shut out of their child's treatment plan. Nearly every patient will be placed in an individual room on a co-ed floor.
The new facility and funding will allow more patients to stay in single-occupancy rooms at UNC, but overflow patients may still be sent elsewhere, Meltzer-Brody said. The hospital system has not changed its policies on transgender patient referrals, and other facilities across the state that receive those patients still lack uniform standards for treating them.
Although Callum said his experiences eroded his trust in the state's inpatient care network, he is optimistic that the new resources could give others a more gender-affirming treatment experience, if they are paired with policy changes.
鈥淚鈥檓 still here, and I鈥檓 happy to be here,鈥 he said. 鈥淭hat鈥檚 all I want for all my trans friends.鈥
___
The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
