Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD

A first-of-its-kind document from the Association of American Medical Colleges lays out 30 core competencies that will be rolled into physician training. The goal: a culture change in how healthcare is provided to the LGBT community.

A landmark report from the Association of American Medical Colleges includes the first guidelines for training physicians to care for people who identify as lesbian, gay, bisexual, or transgender, who are gender nonconforming, or who are born with differences of sex development. The report, released this week, establishes 30 core competencies that AAMC says physicians should be required to master.

“This groundbreaking publication represents a major step forward in giving medical schools, teaching hospitals, and health systems a roadmap for improving the care of LGBT and other individuals with differences in gender identity, gender expression, and sex development,” AAMC President and CEO Darrell G. Kirch, M.D., said in a statement.

The guidelines will encourage family and healthcare professionals to move away from thinking of these patients differently from others, Kirch added.

“Physicians and medical school faculty members are committed to treating all patients equally, yet research shows that everyone has unconscious biases that can affect how we interact with people from different experiences and backgrounds,” he said. “This new resource will help train physicians to overcome these blind spots and deliver high-quality care to all patients.”

Discrimination in medical care remains a serious issue for the LGBT community. According to a 2010 Lambda Legal survey, 56 percent of lesbian, gay, or bisexual respondents and 70 percent of transgender and gender-nonconforming respondents experienced at least one or more forms of discrimination in healthcare, including being denied care they needed, healthcare professionals refusing to touch them or using excessive precautions prior to contact, and being blamed for their health status.

Altering the way healthcare practitioners are trained in these areas could ultimately result in a culture change within the profession, according to Alice Dreger, professor of medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine, who contributed to the AAMC report.

“We believe that once doctors start to recognize that the spectrums we are talking about are all around them in their own institutions, a deeper respect for the concerns for these patients will emerge,” Dreger wrote ina recent Slate article. “Given how radically the culture around medicine is changing, with these educational reforms inside medical schools, perhaps as soon as 10 years from now we will see a new world.”

AAMC said the competency-based model will enable medical educators to work the guidelines into existing training materials seamlessly. The association is currently developing a workshop that will focus on integrating the material into current curricula. That program will be piloted at the University of Louisville School of Medicine next year.

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Journal of Gay & Lesbian Mental Health Volume 18, Issue 4, October - December, 2014 is now available.

PLEASE NOTE: AGLP Members receive free subscription to the Journal and unlimited access to the online edition.

Log in to the AGLP Members Area to view this content for free, or visit Taylor and Francis to see about subscriptions at http://www.tandfonline.com.

Dee Mosbacher, MD, Ph.D., accepts the 2014 AGLP John Fryer Award

Caitlin Ryan

Dee Mosbacher, M.D., Ph.D., psychiatrist, filmmaker, and activist for women’s and gay rights, accepted the John E. Fryer Award from the American Psychiatric Association (APA) at their annual IPS meetings in October in San Francisco. The award is presented by the APA in association with the Association of Gay and Lesbian Psychiatrists and given in honor of Dr. John Fryer, a gay psychiatrist who played a crucial role in prompting the American Psychiatric Association to review the scientific data and to remove homosexuality from the APA’s diagnostic list of mental disorders in 1973.

Dr. Mosbacher founded Woman Vision, a nonprofit aimed at promoting tolerance and equal treatment of all people, in 1993.  Through Woman Vision, Mosbacher has produced nine documentary films dealing with women’s and LGBT rights.  Straight from the Heart (1994), directed and produced by Mosbacher, portrays parents’ love and acceptance of their gay children, and was nominated for an Academy Award.  All God’s Children (1996) deals with gays and lesbians in the black church, and the stigmatization of homosexuality in the African American community.  No Secret Anymore (2006) chronicles the life and love affair between gay activists Del Martin and Phyllis Lyon, and Training Rules (2009) explores the issue of homophobia in college sports. 

In 2012, Woman Vision launched a project called The Last Closet, a web-based campaign and video project to end anti-gay bias in men’s professional sports.

Dee Mosbacher's 1985 documentary, Closets are Health Hazards: Gay and Lesbian Physicians Come Out, was remarkable at the time, as many fewer physicians were able to be open in their lives and work, and the general public did not associate the words “gay” and “physician.”  She followed this up with the 1991 film Lesbian Physicians on Practice, Patients, and Power, largely filmed at a Women in Medicine conference.

Dee Mosbacher lives in San Francisco with her wife of many years, psychiatrist Nanette Gartrell.

Created by AGLP in 2006, The John E Fryer, MD Award honors an individual whose work has contributed to the mental health of sexual minorities. The award was endowed through a generous grant from the Gill Foundation, a bequest from the estate of psychiatrist Frank Rundle, and contributions from many AGLP members. Other past awardees include Barbara Gittings and Franklin Kameny; Past APA President Laurence Hartmann; Psychiatrist and Researcher Richard Pillard; San Francisco Mayor Gavin Newsome; LGBT activist Evan Wolfson; and Bishop Gene Robinson, and Caitlin Ryan.

 




 

APA Board of Trustees passes Position Statement on Issues Related to Homosexuality

A position paper on same sex attraction was passed by unanimous consent of the Board of Trustees of the American Psychiatric Association on December 7, 2013. The position is decisive, far reaching, comprehensive, and likely will be used frequently in legal, political, and social venues to advocate for the mental health and well-being of gay and lesbian peoples.  The position statement was initiated through the Association of Gay and Lesbian Psychiatrists’ representation in the legislative Assembly of the American Psychiatric Association, which is the largest psychiatric association in the world.  That effort is a mark of AGLP’s continuing advocacy for the LGB community and the APA’s continuing commitment to equality for lesbian and gay peoples.  
 
Title:  Position Statement on Issues Related to Homosexuality

APA Position:  While recognizing that the scientific understanding is incomplete and often distorted because of societal stigma, the American Psychiatric Association holds the following positions regarding same-sex attraction and associated issues.

It is the American Psychiatric Association’s position that same-sex attraction, whether expressed in action, fantasy, or identity, implies no impairment per se in judgment, stability, reliability, or general social or vocational capabilities.  The American Psychiatric Association believes that the causes of sexual orientation (whether homosexual or heterosexual) are not known at this time and likely are multifactorial including biological and behavioral roots which may vary between different individuals and may even vary over time. The American Psychiatric Association does not believe that same-sex orientation should or needs to be changed, and efforts to do so represent a significant risk of harm by subjecting individuals to forms of treatment which have not been scientifically validated and by undermining self-esteem when sexual orientation fails to change.  No credible evidence exists that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective does sexual orientation need to be changed.

The American Psychiatric Association opposes discrimination against individuals with same-sex attraction whether it be in education, employment, military service, immigration and naturalization status, housing, income, government services, retirement benefits, ability to inherit property, rights of survivorship, spousal rights, family status, and access to health services.  The American Psychiatric Association recognizes that such discriminations, as well as societal, religious, and family stigma, may adversely affect the mental health of individuals with same-sex attraction necessitating intervention by mental health professionals, for which, the American Psychiatric Association supports the provision of adequate mental health resources to provide that intervention.  The American Psychiatric Association supports same-sex marriage as being advantageous to the mental health of same-sex couples and supports legal recognition of the right for same-sex couples to marry, adopt and co-parent.

 

Matching Grant Fund Secured
for the John Fryer, MD, Award

The American Psychiatric Foundation (APF) Board of Directors, acting on the recommendation of the APF Legacy Fund Committee, has approved a matching grant fund of $10,000 to develop the endowment of the Association of Gay and Lesbian Psychiatrists’ John Fryer, M.D. Award.  The APF Board recognizes the importance of sustaining Dr. Fryer’s legacy through this prestigious award, by honoring the contributions of LGBT leaders in the field of psychiatry.

The Fryer Award educates psychiatrists on a wide range of significant LGBT issues.  Fryer lectures take place at the Annual Meeting of the American Psychiatric Association (APA) and are popular and well-attended. By publishing these lectures as papers in the Journal of Gay & Lesbian Mental Health, which has a wide circulation among psychiatrists and other mental health workers, the reach of these lectures is extended even further.  Past honorees have included prominent advocates for the LGBT community, such as Barbara Gittings, Frank Kameny, Evan Wolfson, and Bishop Gene Robinson, as well as experts in psychiatry and the mental health field, including Lawrence Hartmann, Richard Pillard, Marjorie Hill, and Caitlin Ryan.

The award is named for John Fryer, M.D., the Philadelphia-area psychiatrist, who appeared with Barbara Gittings and Frank Kameny as “Dr. H. Anonymous” at the 1972 APA Annual Meeting and helped move forward the process of removing the diagnosis of homosexuality from the DSM.  John Fryer, MD was born in Kentucky in 1938.  He attended medical school at Vanderbilt University and completed his psychiatry residency in Philadelphia and spent the rest of his career in Philadelphia.  His early years as a psychiatrist were difficult because of his sexual identity.  He was forced to leave the University of Pennsylvania’s Psychiatry Residency Program when it was discovered that he was gay, and later he completed his residency at Norristown State Hospital. Dr. Fryer was never apologetic about who he was or how he presented himself, and he went on to have a distinguished career as a professor of family and community psychiatry at Temple University.  

The Association of Gay and Lesbian Psychiatrists (AGLP) has instituted a fund raising campaign, in association with the American Psychiatric Foundation, which will launch with this $10,000 matching grant, to help endow this award in perpetuity.   For more information about how you can get involved, please contact Roy Harker, Executive Director of AGLP at rharker@aglp.org.   Tax-deductable contributions can be made through this secure link.  

 

 

Streamlined access to all articles of the Journal of Gay and Lesbian Mental Health to AGLP Members

The IT and production editors at Taylor & Francis have developed a new and streamlined way to access all of the content for articles published in the Journal of Gay and Lesbian Mental Health. AGLP members with valid and current memberships can now access the Journal directly through the AGLP website. Go to www.aglp.org, click on the Members Area link (upper right hand of the screen) and once you are logged in, a box will appear on the right side of the blue banner to access the content. The older system, using a separate username and password, is being eliminated.

Yous should find this new streamlined approach to access more user friendly. If you have any questions at all, or need to be reminded of your username and password, please contact the National Office at rharker@aglp.org.

Journal of Gay and Lesbian Mental Health 
2015 Outstanding Psychiatry Resident Paper Award

The Journal of Gay and Lesbian Mental Health (JGLMH) is a quarterly, peer-reviewed journal indexed by PsychInfo.  JGLMH is the official journal of the Association of Gay and Lesbian Psychiatrists (AGLP) (www.aglp.org ).  
 
We are seeking outstanding resident papers on LGBT mental health; these can be original research papers, case series and detailed case reports, or review articles.  The award includes $500, publication in JGLMH, and assistance with travel to the AGLP annual meeting (held concurrently with the APA) in Toronto in May to present the resident’s work.  The deadline to be considered for a 2015 award is March 1, 2015.  Co-authored papers are eligible as well, but the resident must be the first author.

Entries can be submitted to editors@aglp.org.
 

Dr. Saul Levin Speaks Out on Progress and Challenges in Providing Health Care for LGBT Community

New Rochelle, NY, March 18, 2014—In recognition of the 40th anniversary of the decision by the American Psychiatric Association (APA) to remove homosexuality from the list of disorders in the diagnostic manual known as DSM, Saul Levin, MD, MPA, the openly gay CEO and Medical Director of the APA, expresses how "incredibly proud" of the organization he is for taking that stand, in an interview in LGBT Health, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The interview is available free on the LGBT Health website.

In the interview conducted by LGBT Health Associate Editor, A. Evan Eyler, MD, MPH, University of Vermont College of Medicine, Burlington, Dr. Levin discusses how clinicians can help their patients receive the care they need and cope with the discrimination and stigma they may experience when they disclose their sexual orientation or gender identity. He emphasizes the importance of LBGT individuals coming out to their health care providers to receive optimal health care and allowing documentation of their LGBT status in electronic medical records to facilitate research into the health needs of their communities.

“In the 40 years since the declassification of homosexuality as a psychiatric disorder, American medicine, mental health care, and society have come a long way toward accepting homosexuality as a natural variant of human sexuality,” says Editor-in-Chief, William Byne, MD, PhD, Icahn School of Medicine at Mount Sinai, New York, NY. “We still have a long way to go, however, in decreasing the stigma, discrimination, and barriers to health care experienced by sexual orientation and gender identity minority persons. The interview insightfully addresses what has been accomplished, what remains to be done, and the work needed at multiple levels to accomplish it.”

About the Journal
Spanning a broad array of disciplines LGBT Health brings together the LGBT research, medical care and health care, and advocacy communities to address current challenges and improve the health, well-being, and clinical outcomes of LGBT populations. The Journal publishes original research, review articles, clinical reports, case studies, legal and policy perspectives, and much more. LGBT Health is published quarterly online with Open Access options and in print. Complete tables of content and a sample issue may be viewed on the LGBT Health website.

About the Publisher
Mary Ann Liebert Inc., publishers is a privately held, fully integrated media company known for establishing authoritative medical and biomedical peer-reviewed journals, including AIDS Patient Care and STDs, AIDS Research and Human Retroviruses, Journal of Women’s Health, and Population Health Management. Mary Ann Liebert, Inc., publishers pioneered the first journal on AIDS in 1983. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s more than 80 journals, newsmagazines, and books is available on the Mary Ann Liebert Inc., publishers website.
Interview with Saul Levin, MD, MPA, CEO/Medical Director of the American Psychiatric Association...
online.liebertpub.com
Dr. A. Evan Eyler:Hello, Saul. Thank you very much for taking the time for this interview today.