Experts say government must do more to get nonbinary people the health care they need

A new study has shed light on the mental health needs of nonbinary Americans, many of whom say they have attempted suicide, have a serious mental illness, or were put through a harmful practice known as “conversion therapy” to change their gender or sexual orientation at some point in their lives.

Policy experts say it’s up to officials at the federal, state, and local level to ensure they get have all the resources they need to confront those challenges and get whatever assistance they require.

The study was released on Tuesday by the Williams Institute, a public policy think tank based out of the University of California, Los Angeles, and estimated that of the LGBTQ population in the United States, 1.2 million people in the community are nonbinary, or do not identify as male or female.

It found that 82% of nonbinary adults between the ages of 18 and 60 had experienced emotional abuse during childhood. Forty percent of those adults had experienced physical abuse and 41% said they were sexually abused as a child.

Additionally, 11% of nonbinary people had undergone “conversion therapy” for either their sexual orientation or gender identity.

“Conversion therapy” is a dangerous practice that claims to be able to change someone’s gender or sexual orientation. This so-called treatment can include using pain to direct the patient to behave a certain way, or “talk therapy,” also known as psychotherapy, according to the Trevor Project, an organization focused on suicide prevention for LGBTQ people.

LGBTQ people who have undergone “conversion therapy” were more likely to have attempted suicide on one or more occasion than those who had not, a 2018 study showed.

The Williams Institute study also found that a large percentage of nonbinary people faced some kind of mental health struggle. Fifty-one percent of those surveyed said they had a serious mental illness and 39% had attempted suicide.

Caroline Medina, a policy analyst for the Center for American Progress’ LGBTQ research and communications project, said there’s plenty the government can do to assist nonbinary people who need equal access to quality mental health treatment, in order to confront those issues.

“The prevalence of these traumatic experiences among nonbinary people really highlights the need for a number of things. …They need to invest in programs that increase family acceptance, reduce risk, and promote the wellbeing of LGBTQI+ children and youth, including nonbinary children and youth,” they said.

Officials can also make it harder for them to be subjected to “conversion therapy.”

“The harms of conversion therapy on minors are well-documented and states should continue to ban this practice by licensed mental health professionals,” Medina added. “Additionally, [the Department of Health and Human Services] should act to ensure that federal funds are not used to reimburse providers engaging in conversion therapy.”

According to Born Perfect, an organization that seeks to end “conversion therapy,” 20 states have already banned the practice altogether.

Medina noted that Congress could also pass the Prohibition of Medicaid Funding for Conversion Therapy Act, which Rep. Sean Patrick Maloney (D-NY) reintroduced in the House in April. The bill would amend part of the Social Security Act to ban payments under Medicaid for this purpose.

And finally, Medina said, federal, state, and local governments “should be meaningfully investing in culturally competent mental and behavioral health care with services tailored to meet the needs of nonbinary people.”

That means the federal government could incorporate cultural and clinical competency standards and training into federally administered and funded programs, which would elevate the kind of health care nonbinary people receive.

The Department of Health and Human Services can also do more to fight discrimination in health care.

In May, the department announced that it would enforce an Affordable Care Act regulation, Section 1557, to include anti-LGBTQ discrimination. It explained that, following the landmark 2020 Supreme Court decision in Bostock v. Clayton County, which banned discrimination against LGBTQ workers, “The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation.”

In 2020, the Trump administration finalized a rule that gutted Obama-era protections for LGBTQ people in health care under the law. Later that year, two federal district courts halted parts of the rule from going into effect.

Still, other parts of the rule were allowed to take effect, including a provision eliminating a regulation that makes it easier for transgender and/or nonbinary people to get coverage for gender-affirming care.

It’s unclear whether the Biden administration plans to issue its own rule that would provide more clarity on LGBTQ nondiscrimination protections in health care. Valarie Blake, professor of law at West Virginia University, told NPR in May that she expected the administration would move ahead with a new rule that “gives a little more shape to what sex discrimination means.”

The administration could also push for Congress to pass the Equality Act.

The Equality Act provides clear nondiscrimination protections for LGBTQ people in health care, education, housing, public accommodations, and more, and would help improve nonbinary people’s health care experiences.

Further, it recognizes “conversion therapy” as a form of discrimination.

Medical experts have spoken out in support of the legislation.

“Research demonstrates that public policies aimed at reducing discrimination and extending legal protections to LGBT people are associated with reduced stigma, leading to better physical health and mental health outcomes,” the American Psychological Association states on its website, explaining its “longterm” approach to advocacy on the subject.

Still, the group warns, “Passing the Equality Act will not be easy in the current political climate. … Psychologists have an important role in this effort as constituents of members of Congress and as spokespeople for what the authority of psychological science can contribute to the discussion.”

The bill passed the House in February. It is currently awaiting a vote in the Senate, where it faces steep odds, with little Republican support.

Published with permission of The American Independent Foundation.