In light of the coronavirus disease 2019 (COVID-19) pandemic, we are speaking with healthcare professionals from diverse backgrounds and specialties to learn more about their response to the current crisis. We recently interviewed Jack Turban, MD, a resident physician in psychiatry at The Massachusetts General Hospital in Boston, where he researches the mental health of transgender youth.

To share your own unique perspective on the pandemic and its effects on psychiatry, please get in touch with us via our submissions page. The following interview has been edited for length and clarity.

What effect has the COVID-19 pandemic had on your patients?

People’s reactions to COVID19 have been extremely diverse. A paper in Lancet recently showed that there is a long history of mental health suffering during viral pandemics.1 I’ve certainly seen many people’s mental health worsen as they lose social connections and have greater health anxieties. Dr Jessica Gold and I recently wrote about how a large number of our patients are having greater needs for as-needed anxiety medications. Calls to mental health crisis lines have also spiked.


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There are 2 important findings from that Lancet paper that are worth highlighting.1 The first is that social connection is protective against mental health problems during a pandemic. People should try to stay connected with a therapist (many are still working during the health crisis), schedule Zoom calls with friends, and set aside time for physically distant 1:1 conversations.

Paradoxically, some patients have noticed that their mental health improved during the pandemic. I’ve seen this in particular among minority patients, some of whom have highlighted that having less time out in public has provided a reprieve from the stigma they experience when they are out in the world and fears of harassment based on their minority status.

Are there specific mental health concerns for young people and/or LGBTQ+ patients during COVID-19?

Though we don’t have a good deal of data, it does seem that, on average, the mental health of LGBTQ+ folks is getting worse during the pandemic. The Trevor Project crisis line for LGBTQ+ youth has seen a surge in volume. There are many reasons for this surge, including that many LGBTQ+ young people come out of the closet when they go to college. For the first time, they build a support network that accepts their gender identity and sexual orientation. Many establish a connection with mental health services for the first time.

Because campuses closed during the pandemic, many lost these support systems. They may be back home with unsupportive families. They may be afraid to do telepsychiatry with their school therapist because they are worried that their families will hear them, and they’ll be outed (for some, this could have devastating consequences including physical violence or homelessness).

Luckily, there are resources like the Trevor Project crisis line, as well as online forums and text support, where people can still find support and affirmation that may help with their mental health. Some are scheduling regular phone calls with people from school who are supportive (sometimes they take these calls on long walks away from their families).

Discussions about the pandemic and mental health have been ubiquitous in the media, perhaps more so than ever before in a pandemic. Have you been impressed with the way mental health has been elevated during this time?

The media initially was very focused on physical health, but I was impressed to see that people recognized the mental health consequences of the pandemic relatively quickly – both for the general population and for healthcare providers. I hope this attention to mental health keeps up moving forward, as it is a topic that is too often neglected. 

It was unfortunate to see some try to politicize mental health, arguing that we need to reopen more quickly as the only way to alleviate people’s distress. This claim isn’t true, and there are a range of ways to support people’s mental health while also preventing the spread of the virus: improving access to digital mental health services, fostering social connection, advertising online substance use treatment programs, etc.

What are your concerns in the aftermath of the removal of antidiscrimination protections from the Affordable Care Act for transgender and nonbinary patients? What can healthcare providers do to help their patients in this moment?

The Trump administration has attacked the LGBTQ community in nearly every way imaginable. Transgender people have been particularly impacted. In addition to the concrete ways in which this harms people, it also sends a harmful message to transgender and nonbinary people that they are not accepted by our government. It’s important for healthcare providers to remind their transgender and nonbinary patients that they accept them for who they are and will fight for their health, both in the clinic, and more broadly in policy discussions.

Last year, you published an article in JAMA Psychiatry linking conversion therapy to psychological distress and suicide in transgender adults.2 How prevalent is conversion therapy, and how large a role do licensed mental health professionals play in it? What are the barriers to preventing its use?

We published another study in The American Journal of Public Health last year in which 13.5% of transgender participants nationwide reported that they had been exposed to gender identity conversion efforts at some point in their lives.3 Unfortunately, this is a large scale problem with dramatic mental health consequences. Currently, conversion therapy for gender identity is illegal in 20 states, Washington DC, and Puerto Rico, which means it is still legal in the majority of US states. Unfortunately, in many of these states, people continue to see transgender identity as a pathology, which it is not. This is another place where mental health professionals can educate their representatives to create positive change.

You’re quite active on social media, a medium that doctors have adapted to fairly cautiously and slowly. Why do you think social media is an important space for healthcare workers to share their perspectives?

Dr Jessica Gold and I recently wrote about many of the misconceptions that keep doctors offline. But I think times are changing. I’m so happy to see more physicians and researchers bringing their voices to social media.

Many of these platforms are rampant with medical misinformation, and it’s important for people with expertise to be on there to fight this misinformation and spread accurate medical facts.  

I’m also of the opinion that all researchers should be on social media. Often, our research findings sit in academic journals and don’t make their way to public knowledge. Social media is a way to get important information out of the ivory tower and to the places it is needed most.

Why did you choose to specialize in psychiatry, and what do you like best about the field? What kind of impact do you want to have on the field through your career?

Intellectually, I’ve always been interested in the difficult dynamic analyses of people’s mental health. But I’m also drawn to the significant social implications of psychiatry. Historically, our profession has caused great harm to minority communities. I hope to dedicate my career to learning from those communities how psychiatry can support them and start to make amends for some of those historical wrongs.

References

1.     Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic [published online May 18, 2020]. Lancet Psychiatry.  doi.org/10.1016/S2215-0366(20)30203-0

2.     Turban JL, Beckwith N, Reisner SL, Keuroghlian AS. Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults [published online September 11, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.2285.

3.     Turban JL, King D, Reisner SL, Keuroghlian AS. Psychological attempts to change a person’s gender identity from transgender to cisgender: estimated prevalence across US states, 2015 [published online September 4, 2019]. Am J Public Health. doi.org/10.2105/AJPH.2019.305237.