If guidelines are released, but no one knows about them, do they really exist? It’s a good question, and in many regards, the answer is probably “no!” That said, we’re pleased to share that the Massachusetts Department of Mental Health (DMH) did finally release an LGBTQ Non-Discrimination policy over a year ago in August, 2021. While we didn’t know about it then, we’re happy to know about it now, and share them with you.
The policy is just about 9 pages long (though the last two pages are a glossary). It applies to both DMH staff, and people receiving DMH services. It contains a lot of positive guidance including (but not limited to):
¨ An individual’s sexual orientation and gender identity shall be exclusively determined by that individual; not by their legal guardian, a clinician, or anyone else. (Page 1)
¨ Staff are encouraged to share which pronouns are preferred as part of a “signature.” (Page 2)
¨ Throughout the intake and screening process, staff should avoid making assumptions about an individual’s gender based on anything other than their own gender description… Staff should not assume gender based on a person’s voice, clothing, appearance, or documentation, or ID. (Page 2)
¨ Absent a clinical review of necessity, transgender individuals shall not be placed in a single room against their wishes if the program has the capacity to provide multiple occupancy rooms… A transgender woman (MTF) should be placed in rooms, programs and/or housing for women, and a transgender man (FTM) should be placed in rooms, programs and/or housing for men, unless the individual indicates that they wish to be placed elsewhere. (Page 3)
¨ Transgender and gender non-conforming individuals seeking transition-related health care, including hormone therapy or gender confirming surgery, should have access to knowledgeable and experienced care that follows the current standards of care and is not contingent on rewards or prescribed behavior. (Page 4)
¨ Transgender and gender non-conforming individuals who are currently undergoing hormone therapy should have readily available access to these medications, just as any other individual has the right to obtain medications that have been prescribed to them. (Page 4)
¨ The definition of harassment includes: Deliberately not using the person’s self-identified/chosen name and/or pronouns.; Asking a person’s former name for unnecessary reasons.; Deliberately disclosing someone’s sexual orientation, gender identity, or intersex condition without their consent.; Telling someone that they cannot use a specific bathroom. (Page 6)
Overall, the guidance includes many points that—if genuinely followed—would have fundamentally changed the experiences of many gender diverse individuals receiving services in the past, and will inevitably positively impact many people moving forward. That said, there are at least a few spots in the policy that demonstrate that DMH still has more work to do.
For example, on page 2, the policy reads, “Staff are encouraged to share which pronouns are preferred as part of a “signature.”.” While well intended (and appreciated given that some employers have given employees a hard time about this), it’s important to note that statements about “preferred pronouns” imply that the gender identity of trans folks is a choice. Also on page 2, it states, “Employees who wish to change their name and/or gender may do so following Human Resources procedures,” with “change their… gender” implying that their actual gender is changing rather than simply their gender expression, and/or outward recognition of their gender (though one could reasonably assume they just mean change how it’s listed on paperwork). Someone’s gender may always have been the same, even if they make changes at a particular point to inform people of that fact and express that gender in new and different ways, and anything that suggests that someone just up and decided to change their gender has the potential to be harmful. And, like many of our systems, there still exists no mechanism within DMH to have one’s chosen name (often different than their legal name given the difficult, intimidating, and hoops-laden process for changing it with the government) recognized in medical charts, even though that is likely to increase the number of times they are misnamed, mispronouned, or treated in a discriminatory fashion. (Amusingly, DMH also demonstrates its inability to properly use its own objectifying and cumbersome ‘person served’ terminology when, on page 5, the document states “It is appropriate to support a person’s served goals.”)
Perhaps the biggest oversight is a clear description of what happens when someone acts in a way that is in conflict with the policy. Regardless, this represents a huge step forward, and we hope that people will get familiar with the policy and start looking to everyone to follow it.
You can read the full policy here: tinyurl.com/DMHLGBTQ