Pride and Prejudice: Celebrating Identity Among 2024’s Legislative Attacks

The author thanks Thara Nagarajan, M.D., for her assistance in preparing this article. Nagarajan is a second-year child and adolescent psychiatry fellow at the University of California, San Francisco and a former APA Diversity Leadership Fellow.

When I think of Pride Month, I have visions of people celebrating in colorful clothes and cheerfully sharing inspiring stories of social justice victories in our great nation—stories of people being able to live, love, and exist as their authentic selves.

When I thought about what to write for this article, those are the stories that I wanted to tell. However, with the record number of anti-trans bills in all parts of the country, I felt that there was another story I had to tell: one with disheartening statistics and a significant call to action to protect the rights of our patients to seek the much-needed and well-validated care that they deserve.

There are increasing numbers of pieces of legislation that either ban or severely restrict our transgender and gender-diverse patients from accessing health care resources. Some of this legislation also criminalizes physicians who provide this care. As of press time, Trans Legislation Tracker was tracking 552 bills in over 42 states and 45 bills at the federal level. This represents a dramatic increase in the last four years.

Population-level statistics show that these bills and laws have a growing negative impact on the mental health of LGBTQ+ youth. The 2023 Trevor Project National Survey on the Mental Health of LGBTQ+ Young People found that the mental health of trans and gender-diverse patients is highly affected; nearly 33% of LGBTQ+ youth stated their mental health was poor most of the time or always due to anti-LGBTQ+ policies and legislation and 41% said they had seriously considered attempting suicide in the past year.

We have seen this reaction to discrimination reflected in the clinical stories from our LGBTQ+ patients who wait several months to upward of years to access medically necessary gender-affirming care. Tragically, we have also seen the social impacts of not getting care. The death of Nex Benedict, a nonbinary teenager, shows the direct impact of how anti-trans rhetoric led to Nex being bullied and assaulted by their peers in a school bathroom, ultimately leading to Nex’s death from suicide (New York Times, March 15).

These figures can make many of us mental health clinicians feel despondent, overwhelmed, and fearful for our patients and our ability to care for LGBTQ+ individuals. Many psychiatrists have gone beyond clinical and research areas to confront this rising dilemma by becoming advocates to directly address the political atmosphere harming this community. To effect change, advocacy extends the Hippocratic Oath of doing no harm by supporting causes, ideas, and policies. Trainees and attendees can advocate for LGBTQ+ rights publicly and politically. Lobbying and campaigning can help psychiatrists safeguard LGBTQ+ patients as well as the ability of physicians to provide the highest standard of care for their patients.

State lobbying is a highly impactful place to start, especially because many state legislatures are introducing anti-trans measures. Psychiatrists can inform legislative officials about how these laws harm patients using evidence-based data. Statistically, only a small percentage of the hundreds of anti-trans laws introduced in state legislatures will become law. This is the time for physicians to advocate as mental health experts to legislators about the harm such legislation will cause to our LGBTQ+ community.

There are many ways you can get involved in advocacy. Several organizations, including APA, connect doctors to their representatives. They host “advocacy days” and other lobbying conferences to educate physicians on how to connect with their elected officials. Every year APA hosts a federal or state advocacy conference during which psychiatrists can learn more about how to establish coalitions with legislators. APA’s political action committee, APAPAC, represents the profession of psychiatry and mental health care to Congress through nonpartisan contributions to candidates who have demonstrated an understanding of and support for our profession and our patients. APA’s Congressional Advocacy Network is APA’s grassroots network, situating APA members as key contacts for their members of Congress. APA members who have questions about advocacy may contact the staff of APA’s Division of Advocacy, Policy, and Practice Advancement at [email protected]. Information on these and other resources is posted here.

Another method to effect change is to campaign. This can indirectly influence political leaders by changing public opinion. Speaking in public forums, social media campaigns, and public op-eds are all forms of campaigning. These techniques teach the public about these laws and inspire them to lobby their politicians for LGBTQ+ rights. In fact, psychiatrists in the 1970s joined campaigns to depathologize homosexuality at APA, leading to the eventual removal of homosexuality from DSM and resulting in the formation of AGLP: The Association of LGBTQ+ Psychiatrists, which is now the oldest professional LGBTQ+ organization in the United States.

As often is quoted during PRIDE month, “the first Pride was a riot.” Pride month honors LGBTQ+ persons and the ongoing fight for their rights. Our trans and gender-diverse patients need us more than ever, and as healers, we must protect and uphold LGBTQ+ human rights. ■

Audrey La Noce, D.O., is the founder and CEO of Total Mental Wellness, a private practice in Fort Lauderdale, Fla. She is a corresponding member of APA’s Council on Advocacy and Government Relations and supports her local district branch in Florida.