After spending four days in UNC Hospitals’ emergency room, Callum Bradford was eager to receive an answer to his pressing question.

The teenager who identifies as transgender and lives in Chapel Hill required psychiatric treatment following an overdose of prescribed medication. Due to a shortage of available beds, he was on the verge of being relocated to a different hospital within the UNC system.

Nervously, he inquired, “Will I be assigned to a unit for girls?”

Yes, he would.

He had a severe anxiety attack after hearing the response. Crying on the phone at the hospital, he told his parents, who spent days trying to overturn the decision they believed would only worsen their son’s already fragile state.

Despite their efforts to prevent it, the family was left with limited choices when Callum was taken back to UNC’s emergency room due to a second overdose a few months after the initial incident. According to hospital records provided by the family to The Associated Press, the 17-year-old expressed to doctors that he was struggling to control his desire to self-harm after learning he would be placed in a treatment unit that did not align with his gender identity.

Callum expressed deep regret for going to the hospital, knowing that he wouldn’t receive the necessary treatment. He wished that he hadn’t experienced that moment of crisis, shock, and fear because he believed it caused a setback in his mental health.

As the discussion surrounding healthcare for transgender minors has become more heated in the United States, those in positions of power and supporters of withholding gender-affirming medical procedures for minors have frequently argued that parents are not considering their children’s best interests when they pursue such treatment.

Prominent medical organizations state that these therapies are secure and caution against severe psychological repercussions for minors who are not able to obtain drugs that delay puberty, hormones, and, in certain instances, surgical procedures until they reach adulthood.

According to the Centers for Disease Control and Prevention, individuals aged 10-24 make up approximately 15% of all suicide cases, and studies have revealed that high school students who identify as LGBTQ+ have a higher likelihood of attempting suicide compared to their heterosexual peers.

Several transgender teenagers express that the harmful language promoted by numerous Republican politicians in recent times has become unbearable. In North Carolina, lawmakers implemented new restrictions on gender-affirming treatments for transgender youth this year, without addressing issues within the mental health care system. This state is among 22 others that have approved laws that limit or prohibit gender-affirming medical care for minors who are transgender. Many of these laws are currently facing legal challenges.

North Carolina lacks uniform treatment standards across hospitals and runs low on money and staff with proper training to treat transgender kids in crisis. That means the last-resort measures to support patients like Callum often fail to help them, and sometimes make things worse.

According to Dr. Jack Turban, who directs the gender psychiatry program at the University of California, San Francisco, and conducts research on barriers to quality care for transgender youth in inpatient facilities, it should never be considered acceptable to place a transgender child in a unit that does not correspond with their gender identity, regardless of any limitations a hospital may face.

According to Turban, if you do not acknowledge a person’s trans identity from the beginning, their mental well-being may deteriorate. This could potentially lead to a higher risk of suicide compared to when they first arrived.

Earlier this year, North Carolina legislators approved $835 million to improve mental health resources. However, none of this funding was specifically designated for addressing the treatment needs of transgender individuals. While the overall funding may have positive impacts, the lack of targeted efforts has left transgender youth vulnerable to a system that is not adequately equipped to support them in times of need.

A report by the American Psychiatric Association revealed that the shortage of pediatric psychiatric beds across the country was worsened by the COVID-19 pandemic. The number of individuals seeking emergency mental health services during this time was higher than ever before. However, the demand has not yet gone back to its pre-pandemic levels.

Dr. Samantha Meltzer-Brody, the head of the UNC Department of Psychiatry, stated that due to a severe deficit of at least 400 beds for inpatient psychiatric care for youth in North Carolina, UNC has been forced to transfer patients to other facilities, even if they are unable to meet their specific needs.

Hospitals do not have the capacity to accommodate and treat patients with mental health issues. This leads to a situation where patients are forced to wait in the emergency room for extended periods of time until a suitable bed becomes available, according to Meltzer-Brody.

UNC’s inpatient program allocates individual rooms to children on co-ed floors, but for overflow patients, they may be sent to hospitals without this option.

Meltzer-Brody explained that at the University of North Carolina hospital, they are forced to direct individuals to the next available bed. This means that those seeking trans care within the LGBTQ+ community may be referred to a facility that does not provide the most ideal level of care.

According to his records, Callum had a severe reaction upon learning that he would be placed in a unit for girls. He became extremely upset and began shouting and crying until he was put in an isolation room. Later, doctors discovered him in a trance-like state, repeatedly banging his head against the wall.

He remembered, “It felt like my mind shut down from the shock. I had never consciously engaged in such extreme self-harm before.”

The University of North Carolina chose not to provide a statement regarding Callum’s situation, even though the family was willing to waive their privacy rights. However, Meltzer-Brody did discuss the obstacles faced by all psychiatric patients in accessing gender-affirming treatment.

The policy of the public hospital system regarding gender-specific facilities suggests that patients should be assigned to inpatient units based on their self-identified gender whenever possible. However, due to the increase in patients in the emergency room in recent years, Meltzer-Brody stated that it is difficult to meet this goal.

The problem goes beyond just transgender youth and also impacts individuals with autism, addiction, and acute psychiatric disorders. These patients are often sent to facilities that are not equipped to provide the specialized care they need.

She mentioned that the lack of a national standard for accommodating transgender patients in psychiatric hospitals is not beneficial.

Lambda Legal, an organization advocating for LGBTQ+ civil rights, has provided guidelines for hospitals following the Affordable Care Act when treating transgender individuals. According to the organization, refusing to assign a gender-affirming room to a patient is a form of discrimination based on their identity, as stated by their understanding of the law.

However, these situations are not often brought to court due to the responsibility falling on families to advocate for their rights and support a child experiencing a crisis. This was expressed by Casey Pick, the director of law and policy at The Trevor Project, a nonprofit organization dedicated to preventing LGBTQ+ suicide.

“These are circumstances that are themselves often inherently traumatic, and adding a layer of trauma on top of that in the form of discrimination based on an individual’s gender identity just compounds the issue,” Pick said. “The last thing we should have to do is then add the additional trauma of going to court.”

Parents, such as Dan Bradford who is Callum’s father, express a sense of powerlessness when their children are undergoing psychiatric treatment against their will, which is a common occurrence after a suicide attempt. As a result of Callum’s designation for involuntary commitment, his parents also had limited authority to make medical choices for their son.

As a psychiatrist, Dan Bradford has consistently endorsed his son’s decision to undergo medical transition. This process began with the use of puberty-blocking drugs and a small amount of testosterone, which he continues to take. Eventually, Callum also underwent top surgery to remove his breasts. These permanent procedures are typically not performed on minors unless deemed necessary by medical professionals.

Callum’s father shared that his gender dysphoria was severe enough that delaying gender-affirming medical treatments could potentially be life-threatening. He tearfully expressed that any potential risks associated with the treatments seemed insignificant compared to the fear of losing their child.

The state of North Carolina prohibits medical professionals from administering hormones, puberty blockers, and gender-transition surgeries to individuals under 18 years old. However, there are exceptions for certain children like Callum, who had already started treatment before an August deadline and can continue if their doctors determine it is medically necessary.

Callum explained that despite still having access to hormones, it has been difficult for him to witness the General Assembly preventing his transgender friends from receiving the treatments that he believes have saved their lives.

Turban, the researcher at UC San Francisco, stated that when public policies are deliberated or implemented, it conveys a powerful message to these children about whether their government, society, and community acknowledge and embrace them or not.

The results of his studies show that numerous healthcare professionals are still not knowledgeable about LGBTQ+ identities and frequently make errors, such as using the incorrect gender marker on a hospital wristband or isolating a transgender patient in a private room while others have roommates.

Dan Bradford was worried about the potential psychological harm that could be caused by placing his son in a girls’ ward. To avoid this, he arranged for his son, Callum, to be admitted to a residential treatment center in Georgia. He also convinced the hospital in North Carolina, which was supposed to take Callum, to reject the transfer and allow him to be released early.

The adolescent went through a 17-week personalized rehabilitation program in Atlanta, addressing the issues that led him to the emergency room and the additional trauma he experienced there. He has now come back home and is focusing on his mental well-being by playing the keyboard and rowing with his co-ed team on the peaceful Jordan Lake. Callum shared that he is now considering his future for the first time in years.

There are promising advancements in store for young people in North Carolina who are dealing with mental health emergencies.

In October, the approval of additional state funding for mental health services has allowed UNC Hospitals to establish a 54-bed facility for youth behavioral health in Butner, located 28 miles (45 kilometers) north of Raleigh. Secretary Kody Kinsley of the State Department of Health and Human Services believes this facility will help to overcome obstacles in providing personalized care, particularly for transgender individuals. Additionally, UNC has disclosed their intention to open a separate children’s hospital in the next ten years.

The Butner facility’s leaders, who started its gradual opening this month, have committed to implementing a comprehensive approach that includes families so that parents are not excluded from their child’s treatment plan. Almost all patients will be housed in a separate room on a floor for both genders.

Meltzer-Brody stated that with the addition of a new facility and increased funding, more patients at UNC will be able to have their own room. However, patients who cannot be accommodated may still be directed to other facilities. The hospital has not made any changes to their policies regarding referrals for transgender patients, and there is still a lack of consistent standards for their treatment at other facilities in the state.

Callum expressed that his past experiences have diminished his confidence in the state’s inpatient care system. However, he remains hopeful that with policy adjustments, the addition of new resources could provide a more positive and gender-affirming treatment experience for others.

He expressed, “I am still present and content to remain here. That is my main desire for all of my transgender friends.”

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