Article: Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment

With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients’ psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.

Three years after the start of the COVID-19 pandemic, our health care system continues to face a mental health boarding crisis for pediatric patients that disparately impacts TGD youth. To address this crisis, a multilevel approach is needed, including increased primary mental health care, diversion of patients from Emergency Departments to bolstered outpatient services, and enhanced gender-affirming care for patients when they must board. Additional research should be done to better characterize the demographics of boarding patients and how factors, such as TGD identities, impact wait times and mental health outcomes.