First manual for transgender residents with mental health issues

Thursday, March 14, 2013

The Hennepin County Attorney’s Office has amended its Adult Services manual for cases involving transgender residents with mental health issues, the first such program in Minnesota.

Bill Neiman, senior supervising attorney for the Hennepin County Attorney’s Adult Services Division, decided that specialization was needed after working on a recent case. This person tried denying a female identity by engaging in stereotypically masculine pursuits, first as a high school athlete then as a U. S. Marine and finally as a truck driver, Neiman said.

Finally, this individual decided to be seen as a woman and began that transition. However, in order to receive transgender medications and surgery, any person must be psychiatrically stable. The psychiatrist who did the examination concluded the patient had some underlying mental illness. That, in turn, prevented the individual from getting the help he most needed, Neiman said.

“I have never seen an individual in as much pain,” said Neiman, who has handled nearly every type of case in his 34 years as a prosecutor. “When I first met him, I thought he was a woman. But he was caught in this trap,” and wanted to slice off his male genitalia because his mental illness would prevent participation in a program such as the University of Minnesota’s Center for Sexual Health, Neiman said.

Neiman turned to Assistant Hennepin County Attorneys Pat Olson and Andrea Martin and asked them to put together a new section for the division’s manual. Martin and Olson had written manuals for helping other populations that required specialized treatment, such as juveniles with mental health issues, people with eating disorders and pregnant women with chemical dependency issues or mental illness.

The transgender community is a growing population, but still are small enough that most attorneys and care providers don’t see enough of them to be well-versed in their needs, Nieman said.

With the help of an intern, Jallison Hubbard, the attorneys worked for about three months compiling the manual. Martin said other organizations encouraged the work. Phil Duran of OutFront Minnesota and Ellen Krug of Call for Justice spent nearly two hours working with Martin and Olson.

Hubbard, at Krug’s suggestion, also developed a survey sent to psychiatrists, non-profits and treatment facilities asking for recommendations on where transgender individuals could receive good treatment and put those responses into a spreadsheet for the office’s use.

Martin said the survey was a logical step because often in the commitments the Adult Services Section handles there needs to be a psychiatric exam or chemical or alcohol treatment. Sometimes the transgender respondent would tell the social worker or lawyer that he or she feared poor treatment at the recommended treatment facility due to being transgender, Martin said.

“I am very proud that this office stepped forward and provided a valuable service to all of us,” Hennepin County Attorney Mike Freeman said. “It is only right to treat all people with respect and sometimes we just need a little education so we can do that."

The manual discusses:

  • a glossary of transgender terminology including use of pronouns;
  • the Minnesota Human Rights Act and how it covers transgender people; and
  • state and federal cases involving transgender persons.

“I’m thrilled they are doing a glossary,” Krug said. “It’s important. It’s important to educate the psychiatrists, the social service community that they are in crisis. We want healthy people running around and for transgender folks, they need to change genders.”

The manual also discusses the recognized standards of care for changing genders and the need for two mental health professionals to examine a person before surgery for their transition can be performed.

Those examinations often wind up at the county attorney’s office when it becomes necessary to have those individuals committed by the court to a hospital or chemical treatment facility. But it appears to the transgender individual as a Catch-22, Martin said.

“They say, ‘I don’t need your help, I don’t need a psychiatric hospital, I need someone to help me with my gender identity,’ ” Martin said. “Certainly, the people we see are in a unique situation that most others don’t see.”

Krug shared her story of changing from a man to a woman during a continuing legal education session at the Hennepin County Attorney’s Office in October. Krug said she applauded Freeman for inviting her to speak and was pleased with the manual and hoped it would be replicated by police departments, paramedics and emergency room doctors and nurses.