Case Study 14.1: Inpatient Psychiatric Admission

Victoria (pronouns she/her/hers), 17 years old, was admitted to an inpatient psychiatric unit after an overdose. After a recent sexual assault and beating, Victoria moved in with her grandmother and lived there for 3 months prior to admission. Her grandmother is tolerant of her desire to transition, but does not approve of her “lifestyle choice,” praying that “Jesus will forgive her.” Victoria began gender-affirming hormone therapy 6 months ago, but after her mother lost her job due to the COVID-19 pandemic, she also lost her health insurance. With no insurance, she was no longer able to afford gender-affirming therapy and overdosed on amitriptyline (prescribed for anxiety and depression), but survived. When admitted, Victoria surrendered her estradiol supply, per facility policy, and later asked the charge nurse for her daily dose. First, the staff ignored her. Then, when they responded, they used her dead name, Derek, and refused to call the physician to obtain an order for the medication. The physician, who met with Victoria the following day, told her that the therapy was not safe for adolescents and encouraged her to follow up with her primary care provider after discharge.
1) What could you do immediately to advocate for Victoria?
2) What intervention would you recommend for the health professional staff to increase awareness and reduce personal biases?
3) What organizational policies would help to prevent or reduce future discrimination or inequitable treatment of transgender patients admitted to the unit?
4) What health-related concerns are essential to consider for Victoria as a transgender adolescent?
5) Script a statement to advocate for Victoria’s ongoing gender-affirming therapy based on clinical practice guidelines (Deutsch, 2016).

Sample Answer

Sample Answer



Advocating for Transgender Adolescent Patients in Inpatient Psychiatric Units


In the case study of Victoria, a 17-year-old transgender patient admitted to an inpatient psychiatric unit after an overdose, we are faced with a critical scenario that highlights the challenges and discrimination often experienced by transgender individuals in healthcare settings. This essay aims to address immediate advocacy steps for Victoria, recommend interventions for health professional staff to reduce biases, suggest organizational policies to prevent discrimination, identify health-related concerns for transgender adolescents like Victoria, and script a statement advocating for her gender-affirming therapy based on clinical practice guidelines.

Thesis Statement

It is imperative to advocate for transgender adolescent patients like Victoria in inpatient psychiatric units through immediate action, interventions to reduce biases among health professional staff, implementation of organizational policies to prevent discrimination, consideration of specific health-related concerns, and adherence to clinical practice guidelines for gender-affirming therapy.

Immediate Advocacy Steps for Victoria:

1. Ensure Immediate Access to Gender-Affirming Medication: Advocate for Victoria’s right to access her prescribed medication by contacting the physician or senior staff members to obtain the necessary order promptly.
2. Use Correct Name and Pronouns: Educate the staff on the importance of using Victoria’s preferred name and pronouns to affirm her gender identity and foster a respectful environment.
3. Provide Emotional Support: Offer counseling and emotional support services tailored to address the trauma and mental health needs of transgender adolescents like Victoria.

Interventions for Health Professional Staff:

1. Training on LGBTQ+ Cultural Competency: Conduct mandatory training sessions to increase awareness and understanding of LGBTQ+ issues, terminology, and best practices for providing inclusive care.
2. Encourage Self-Reflection: Encourage staff members to reflect on their personal biases and assumptions towards transgender individuals and challenge discriminatory behaviors.

Organizational Policies to Prevent Discrimination:

1. Non-Discrimination Policies: Implement clear policies that prohibit discrimination based on gender identity or sexual orientation within the healthcare facility.
2. Inclusive Language Guidelines: Develop guidelines that mandate the use of respectful and inclusive language when interacting with transgender patients.

Health-Related Concerns for Transgender Adolescents:

1. Mental Health Support: Provide specialized mental health services that cater to the unique needs of transgender adolescents, including trauma-informed care and gender-affirming therapy.
2. Hormone Therapy Monitoring: Regularly monitor hormone therapy effects, side effects, and adherence to ensure the safety and well-being of transgender patients like Victoria.

Scripted Statement for Advocating Gender-Affirming Therapy:

“As per clinical practice guidelines outlined by Deutsch (2016) and in alignment with Victoria’s treatment plan, it is essential to advocate for the continuation of her gender-affirming hormone therapy. Research supports the positive impact of hormone therapy on the mental well-being and gender dysphoria of transgender individuals. As such, I recommend that Victoria’s healthcare team reassess her hormone therapy needs and ensure timely access to prescribed medications as part of her comprehensive care plan.”


In conclusion, advocating for transgender adolescent patients in inpatient psychiatric units requires a multi-faceted approach that includes immediate action, staff interventions, policy changes, consideration of health-related concerns, and adherence to clinical guidelines. By implementing these strategies, healthcare providers can create a more inclusive and supportive environment for individuals like Victoria, ensuring they receive the respectful and affirming care they deserve.



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