Mapping Interventions to Reduce Mental Health Services Disparities among Transgender and Nonbinary Adults

PROJECT SUMMARY/ABSTRACT.
Despite strides in social and political protections for transgender and nonbinary (i.e., transgender) people,
transgender populations continue to face crisis-level rates of mental health concerns. Recent national surveys
show that transgender people face also continue to face a burden of unmet need within healthcare systems,
reporting elevated rates of mental healthcare avoidance of and exclusion from often life-saving services. This
is often a result of discrimination from healthcare providers.
Many hospital systems are unequipped to support transgender people seeking mental healthcare. As such,
efforts to engage transgender individuals have not made significant dents in improving access to care and
reducing psychological stress. One particular site of risk and opportunity for intervention is the Bronx, NY, a
New York City borough containing the nation’s poorest congressional district and an epicenter of the ongoing
health concerns for TNB people. The current project aims to data from a large group of patients at Montefiore
Medical Center, a hospital system with over 3 million visits per year, to measure and address mental
healthcare disparities. This study targets mental healthcare disparities using patients’ medical charts as well as
interview data with transgender advocates and stakeholders.
For Aim 1 (Year 1), we will analyze the extent to which transgender people receive fewer and/or worse
quality mental health services at a large hospital site. We will do so by measuring differences between a large
sample of 9,968 transgender adults with an even larger sample of 49,840 non-transgender adults.
For Aim 2 (Year 2), we will meet with three groups of 36 stakeholders to contextualize why service
disparities exist and strategies to address them. The first group will be composed of transgender people
connected to mental health services. The second will be transgender people who are not connected to mental
health services. The third will be hospital staff and administrators who specialize in transgender-affirming care.
For Aim 3 (Years 3-4), we will integrate both types of data ( together and create a map to shift the ways
mental health services are provided to improve transgender-affirming care. This award was developed with the
goal of identifying barriers to and enablers of comprehensive TNB care, in order to measure and reduce mental
healthcare disparities for diverse, resilient adult transgender populations.

Grant Number: 5K23MH128582-04
NIH Institute/Center: NIH
Principal Investigator: Aaron Breslow