WARNING: This story contains a discussion of suicide.
Elisha Dacey’s 15-year-old daughter is caught in a care gap: too old to be accepted into one Winnipeg gender transition clinic, too young to check into another.
“They were right in that sweet spot of not getting or qualifying for any kind of public health, so it was frustrating and demoralizing,” Dacey said. “Since then we have been waiting.”
The Gender Diversity Affirmation and Action Clinic for Youth (GDAY) helps children and adolescents in the transition.
It used to help patients as young as 15, but has reduced the referral criteria by age by one year to 14.
This was in response to the lawsuit being outgrown “due to the fact that we don’t have any funding,” read a letter from a GDAAY doctor to Dacey’s son’s pediatrician in April this year.
Trans Health Klinic, the only other program in town, helps people ages 16 and older make the transition. Dacey was recently informed that her son is now on that waiting list.
They join the roughly 600 other youth and adults who remain in waiting list limbo amid a shortage of care providers outside of the two clinics trained in gender-affirming care.
“That’s a huge barrier in itself, just the lack of professionals to specifically deal with this,” Dacey said.
Years Waitlist Challenge
The clinics offer a variety of services, from mental health counseling and care to hormone replacement therapy and gender-affirming surgeries.
Admission is a multi-tiered process, and the entire process can take years.
Many patients come from family doctor referrals and each clinic has struggled to keep up with the demand.
The annual number of consultations has tripled in GDAAY. Nearly two dozen young people sought consultations the year GDAAY launched in 2011, and that number has grown to about 75 per year, according to a statement from Shared Health, the entity that oversees health care delivery in Manitoba.
Shared Health attributes this to increased awareness of transgender issues, an increase in gay-straight alliances, and a focus on reducing bullying.
Currently, there are almost 300 youth on the GDAAY waiting list and it is an average wait of two years. That’s a similar number of patients on the Trans Health Klinic waiting list, which averages a year-and-a-half wait.
Dr. Brandy Wicklow, GDAAY Medical Director, co-authored a scientific article in 2018 based on work with child patients in GDAAY which suggested trans youth seeking services faced distress “over long waiting times”.
Spring Funding Aid for Programs
In May, the province committed $1.2 million over two years to help the two clinics improve access to care for transitioning youth, including hormone replacement therapy medication, psychological support and surgeries.
Staff at each program were encouraged to listen to the news.
“It’s been a challenge working in this system knowing the waiting list is so long,” said Dr. Megan Cooney, a Shared Health pediatrician and adolescent medicine specialist who has worked with GDAAY for five years.
“What we are most looking forward to with the expansion of the program is being able to provide more support to families on the waiting list.”
The Progressive Conservative government provided $490,000 to the Klinic Community Health Centre, which Trans Health Klinic runs, and $700,000 to expand access to GDAAY, according to a press release that was quickly removed from the government website.
Until this spring, the pediatricians, endocrinologists, mental health experts and others who have worked at GDAAY have done so through an “in-kind” arrangement with their employer: essentially doing work from their desks while handling other general tasks. because the program has never been formally funded.
The funding enables GDAAY to hire dedicated staff for the first time, including an administrative assistant, program coordinator, part-time social worker, and full-time child psychologist.
Cooney said the gap between 14 and 16 is something GDAAY “hopes to be able to fill again” once it’s staffed.
The clinic tries to connect children and their families with a social worker while they wait, though Cooney acknowledged the stakes are high for children who can’t get the help they need.
“Specifically, gender-affirming hormonal medications, when indicated, improve health and well-being and decrease suicidality,” said Dr. Cooney.
SEE | GDAAY doctor discusses the importance of supporting gender diverse youth:
Haran Vijayanathan, director of community health and wellness at Trans Health Klinic, said trans and gender diverse youth face increased risks of mental health problems and suicide, particularly when they don’t have supportive people in their lives.
Long waiting lists add another layer.
“That’s often a big challenge for people, especially when they’ve come out and are comfortable with who they are,” he said. “They are experiencing a lot of psychological and emotional trauma because that process hasn’t started.”
Vijayanathan said the two-year funding commitment has helped the clinic increase staffing with four more peer support workers and the first social worker at the Klinic dedicated to trans care. But what is needed to keep the momentum going is “sustained” funding year after year, Vijayanathan said.
Dacey agrees. “I want the funding to become permanent… I would like to see it basically removed from the ideological lines. It’s health care,” Dacey said.
Meanwhile, Parker Morran hopes to make an impact as a dedicated new social worker at Trans Health Klinic.
They are one of the first points of contact for many who pass by.
“My job is kind of a dream job; I get to date trans people every day,” said Morran, who is also trans and gender fluid. “I can relate to the people I meet on that level because I have.”
They said they waited eight months about a year and a half ago to come into Trans Health Klinic for their own transitional care. Morran is now on hormone replacement therapy, specifically testosterone, and is in the middle of another public health list for top surgery. She has an estimated wait of two years, they said.
They said that getting on the charts carries the thrill of knowing the wheels are in motion. This contrasts with the “limbo” of waiting.
“It’s really not fair to have to ask people to wait. It would be nice to just be able to call, sign up and make an appointment in a few months or less,” they said.
Morran wishes to make gender-affirming healthcare more of a priority in the healthcare system.
“But I’m happy with the progress that has been made of late.”
SEE | Vijayanathan on the hard-fought rights of 2SLGBTQIA:
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