Gender Dysphoria Treatment Services

Gender Dysphoria Treatment Services

1. Basic Structure and functioning of the Specialized Clinic for clients with gender dysphoria at the

National Institute of Mental Health a. The clinic is held at the Navodaya day centre at the National Institute of Mental Health, Angoda every Friday at 8 AM-12 Noon under the supervision of Lead Consultant Psychiatrist from NIMH. b. Three new and followed up clients will be assessed per day. c. Care will be provided by a multidisciplinary specialty team. d. Initial assessment will be done by a registrar and a senior registrar according to the guideline. e. Clients will be assessed by the Consultant at least once during the first six visits. f. Hormonal therapy will be started by a senior registrar or the consultant psychiatrist. g. Referrals for surgeries will be done by the consultant psychiatrist. h. Psychiatric social worker will address the social issues and involves in issuing gender identification certificate 2. Assessment

Initial assessment will be done by a registrar and a senior registrar using comprehensive history, mental state examinations, physical examination and investigations during to the first

3. Management

Management will be guided by a senior registrar and the consultant psychiatrist.

4.1 Management Options

a. Changes in gender expression and role (real life experience which may involve living part time or full time in another gender role, consistent with one‘s gender identity) b. Hormone therapy to feminize or masculinize the body c. Surgery to change primary and/or secondary sex characteristics (e.g., breasts/chest, external and/or internal genitalia, facial features, body contouring) d. Psychotherapy (individual, couple, family, or group) for purposes such as exploring gender identity, role, and expression; addressing the negative impact of gender dysphoria and stigma on mental health; enhancing social and peer support; improving body image; or promoting resilience.

4.2 Legal Aspects

Gender Recognition Certificate (H1257) - General Circular 01-34/2016 DGHS, Ministry of Health

a. Clients should be stable in the preferred gender role. b. Should be followed up in the clinic continuously for 6 months with or without hormonal therapy. c. The consultant psychiatrist should recommend for the GRC at the end of first 6 months d. The process will be coordinated by the psychiatric social worker. e. After obtaining the GRC the client can apply to change name and gender marker on identity documents.(birth certificate, identity card, passport)

If necessary the consultant psychiatrist/ senior registrar can issue a letter mentioning the client‘s condition temporarily till he/she is eligible for the GRC.

4.3 Psycho-Social Support

Provide information and referral for peer support

For these clients an experience in peer support groups may be more instructive regarding options for gender expression than anything individual psychotherapy could offer. They should be encouraged to participate in community activities, if possible. Resources for peer support and information should be made available.

Eg; Heart to heart

4.4 Follow-up care

Clients will be assessed monthly in the clinic with necessary history, mental state, physical examination and investigations.(mentioned above)

5. Management of children and adolescents

Management of children and adolescents with gender dysphoria will be done liaising with a child and adolescent psychiatrist.

References

Standard of care; WPATH 2011; DSM 5; DGHS Circular on issuing of GRC