IHPME Alumni and Faculty Drive Collaborative Effort to Tackle Inequities in Transgender and Gender Diverse Mental Health Care

A recent study led by an IHPME alum has shed light on a critical gap in mental health care pathways for Transgender and Gender Diverse (TGD) individuals.

By: Marielle Boutin

Dr. June Lam, a graduate of the Clinical Epidemiology and Health Care Research (CEHCR) PhD program and Associate Scientist with the Institute for Mental Health Policy Research at CAMH, spearheaded the research in collaboration with IHPME faculty members Paul Kurdyak and Charles J. Victor, as well as Alex Abramovich and Juveria Zaheer from CAMH.

The study found that TGD individuals are less likely to seek regular follow-up care after a psychiatric hospital stay, but more likely to attend follow-up appointments after emergency room visits for mental health issues, compared to the general population. According to Dr. Lam, this is especially concerning, as it indicates that there are barriers for TGD individuals in seeking appropriate care following discharge, despite higher rates of follow-up after emergency room visits.

“The decreased follow-up after a psychiatric hospitalization suggests that the experience of the hospitalization itself may be affecting the likelihood that TGD individuals will follow up for care afterwards,” says Dr. Lam.

As part of the research, Dr. Lam’s team interviewed TGD patients who have experienced psychiatric hospitalization, and they described how difficult it was to access outpatient care even though there was a critical need for mental health support. Barriers included minority stress and discrimination, leading them to seek care through the emergency department.

“Unfortunately, many TGD participants described how the inpatient experience was transphobic and not set up to care for TGD people, such that the longer they spent in hospital, the less likely they were to return for outpatient care in the system after discharge,” says Dr. Lam.

The study highlights the need for better discharge reforms, improved training on TGD-affirming care, and integration of mental health supports tailored to TGD patients.

These changes can begin with something as simple as asking TGD individuals for their chosen name and pronouns during intake, according to Dr. Lam, ensuring this information is communicated clearly in the patient’s electronic medical record (EMR).

This dedication to improving care for 2SLGBTQIA+ and other marginalized communities is what drove Dr. Lam to pursue the ClinEpi program. Centred around preparing future clinician-scientists to conduct research and apply findings to improve patient care, he felt that the ClinEpi program would give him the tools to shed light on the health challenges faced by a disproportionate number of marginalized communities compared to the general population.

Dr. Lam benefited from collaborating and learning from the diverse perspectives of his classmates and faculty, providing him with a more holistic view of the world.

“I loved my time in the ClinEpi program! I had such rigorous methodological training, and I got to work with and learn from such a diverse group of brilliant and passionate researchers,” says Dr. Lam. “I have learned to view the health system in a fundamentally different way and learned how to leverage rigorous research to provide evidence to improve care and health equity.”

The program empowered him to make meaningful changes in their clinical practice and career – from contributing to improved care for TGD patients in the CAMH emergency department, where he works as a psychiatrist, to gaining the skills and confidence to work as an independent researcher and Associate Scientist.

Looking ahead, Dr. Lam hopes to publish a qualitative study exploring the lived experience of TGD patients who have been through psychiatric hospitalization, which offers many specific recommendations on how to create a more inclusive, patient-centred healthcare system.