Barriers to care persist as Winnipeg gender transition clinics hope to chip away at backlogs

WARNING: This story contains discussion of suicide.

Elisha Dacey's 15-year-old is caught in a care gap: too old to be acceptedat one gender transition Winnipeg clinic,too young to get in at another.

"They were right in that sweet spot oftechnically not getting or qualifying for any kind of public health, so that was frustrating and demoralizing," said Dacey. "Since then we've still been just waiting."

The Gender Diversity Affirmation and Action for Youth clinic (GDAAY) helps children and youngteens transition.

It used to help patients up to the age of 15, but has reduced the age referralcriteria by one yearto 14.

That was inresponse to demand outpacing resources "owing to the fact that we are entirely unfunded," reads a GDAAY doctor's letter to Dacey's child's pediatrician in April of this year.

The Trans Health Klinic, the only other program in the city, helps people 16 and up transition. Dacey was recently informed their child is now on that waitlist.

They join the roughly 600 other youth and adults who remain in waitlist limbo amid a shortage of care providers outside the two clinics trained in gender-affirming care.

"That's a huge barrier unto itself is just the lack of professionals who are dealing specially in this," said Dacey.

Years-old waitlist challenge

The clinicsoffer a range of services,from counselling and mental health care to hormone replacement therapy and gender-affirming surgeries.

Intake is a multi-level process and the entire process can span years.

Manypatients come from referrals from family doctors and each clinic hasstruggled to keep pace with demand.

• Have you encountered barriers to transition services outside the clinic programs? Email bryce.hoye@cbc.ca

The annual number of consultations has tripledat GDAAY.Nearly two dozen youth sought consultations the year GDAAY opened in 2011, and that number hasincreased to about 75 per year, according to a statement from Shared Health, the entity overseeing the delivery of health care in Manitoba.

Shared Health attributesthatto increased awareness about transgender issues, a rise in gay-straight alliances and a focus on reduced bullying in schools.

WATCH |Gender transition clinics hope to chip away at backlogs as barriers persist:

Gender transition clinics optimistic as supports slowly expand for 100s stuck in waitlist 'limbo'

1 year ago

Duration 2:28

A pair of Manitoba clinics struggling to keep up with demand for gender transition care see a glimmer of hope as new supports take shape after short-term provincial funding announced this spring. That hope doesn't necessarily extend to all of the roughly 600 wait-listed patients and their families impacted by delays.

Currently, there are nearly 300 youth on the GDAAY waitlist and it's an average two-year wait. It's a similar number of patients on the Trans Health Klinic waitlist, which averages a 1-year wait.

Dr. Brandy Wicklow, the medical lead of GDAAY,co-authored a scientific paper in 2018 based on work with child patients at GDAAY that suggested trans youth seeking services faced distress "over long wait times."

Spring funding boon to programs

In May, the province committed $1.2 million over two years to help the two clinics improve access to care for transitioning youth, including hormone replacement therapy medication, psychological supports and surgeries.

Staff with each program were encouraged to hear the news.

"It's been challenging to work in this system knowing that the waitlist is as long as it is," saidDr. Megan Cooney, a pediatrician and adolescent medicine specialist with Shared Health who has worked with GDAAY for five years.

"What we're most looking forward to with the program expansion is actually being able to provide more support to families on the waitlist."

The Progressive Conservative government provided $490,000 toKlinic Community Health Centre, which runs the Trans Health Klinic, and $700,000 to expand access to GDAAY, according to a news release that was quicklyremoved from the government's website.

Up until this spring, the pediatricians, endocrinologists, mental health experts and others who have staffed GDAAY have done so through an "in kind" agreement with their employer essentially, doing the work offthe sides of their desks while managing other general duties because the program has never been formally funded.

The funding enablesGDAAY tohire dedicated stafffor the first time, includingan administrative assistant, a program co-ordinator, a part-time social worker and a full-time child psychologist.

Cooney said the gap between 14 and 16 is something GDAAY is "hoping to be able to fill again" once they have staff in place.

The clinic tries to pair up kids and their families with a social worker while they wait, though Cooney acknowledged the stakes are high for kids who can't get the help they need.

"Specifically gender-affirming hormone medications, when they're indicated, they improve health and wellness and they decrease suicidality," said Dr. Cooney.

WATCH | GDAAY doctor discusses importance of supporting gender diverse youth:

Access to transition care can improve the lives of many youth in our community: doctor

1 year ago

Duration 1:33

Dr. Megan Cooney, a pediatrician and adolescent medicine specialist with Shared Health who works at GDAAY, said gender-affirming care thats offered in a safe and effective way has the potential to improve the lives of many youth in our community."

Haran Vijayanathan, community health and wellness director with the Trans Health Program at Klinic Community Health, said trans and gender diverse youth face higher risks of mental health challenges andsuicide, particularly when they don't have supportive people in their lives.

Long waitlists add another layer.

"That's often a huge challenge for individuals, especially when they've come out to themselves and they're comfortable with who they are," he said."There's a lot of psychological and emotional trauma that they're experiencing because that process hasn't started."

Vijayanathan said the two-year funding commitmenthas helped the clinic boost staffing with four more peer support workers, add more nurses and nurse practitioners, and up patient time with psychologists and physicians. The firstsocial worker at Klinic dedicated to trans care was also hired. Butwhat's needed to keep the momentum going is "sustained" funding year over year, saidVijayanathan.

Dacey agrees. "I want to see that funding become permanent ... I'd like to see it basically removed from ideological lines. It'shealth care," Dacey said.

In the meantime, Parker Morranis hoping to have an impact as that newdedicated social worker at Trans Health Klinic.

They'reone ofthe first points of contact for many who come through.

"My job is kind of a dream job;I get to hang out with trans people every day," said Morran, who is also trans and genderfluid. "I can relate to the people I meet with on that level because I've done it."

They said they waited eight monthsabout a year and a half ago to get into Trans Health Klinicfor their own transition care. Morran is now onhormone replacement therapy testosterone specifically and midway through another public health listfor top surgery.It has anestimated two-year wait, they said.

They said getting on the lists comes with excitement in knowing the wheels are in motion. That's contrasted against the"limbo" of waiting.

"It's not fair to have to ask people to wait, really. It would be nice to be able to just call, register and make an appointment in a few months or less," they said.

Morran wishes gender-affirming health care was more of a priority inthe health system.

"But I am glad for the progress that has been made in the last little while."

WATCH | Vijayanathan on hard fought 2SLGBTQIA rights:

Long waits for gender-affirming care huge challenge

1 year ago

Duration 1:55

Haran Vijayanathan, community health and wellness director at the Trans Health Klinic, the lack of a support network can make the long waits for access to gender-affirming transition care even harder.

If you or someone you know is struggling, here's where to get help:

• Talk Suicide Canada: 1-833-456-4566 (phone) | 45645 (text between 4 p.m. and midnight ET).
• Kids Help Phone: 1-800-668-6868 (phone), live chat counselling onthe website.
• Canadian Association for Suicide Prevention:Find a 24-hour crisis centre.
• This guide from theCentre for Addiction and Mental Healthoutlines how to talk about suicide with someone you're worried about.