APA's Division 18 (Psychologists in Public Service), Division 19 (Society for Military Psychology), and Division 44 (Society for the Psychology of Sexual Orientation and Gender Diversity) applaud the U.S. Department of Veterans Affairs’ (VA) January 12, 2022, decision to provide veterans with the option of identifying as non-binary on their VA medical records (VA Office of Public and Intergovernmental Affairs, 2022).
The VA has officially recognized the provision of healthcare services for transgender and intersex veterans since 2011. The current decision expands existing VA care to recognize non-binary veterans. There are several different identity labels and experiences that fall under the non-binary umbrella. For example, some people experience an absence of gender, others experience a presence of multiple genders, others fluctuate between different genders, or identify with third gender in-between or outside the gender binary.
As Denis McDonough, the secretary for veterans affairs, stated, “All veterans, all people, have a basic right to be identified as they define themselves. This is essential for their general well-being and overall health. Knowing the gender identity of transgender and gender diverse veterans helps us better serve them.”
While no official data on the experiences of non-binary people in the VA system exist, research with transgender veterans suggest that improvements to care for people with all marginalized gender identities are needed within the VA system. Health disparities for trans veterans exist, with transgender veterans reporting both greater utilization of medical care (Kauth et al., 2019) and greater prevalence of medical problems (Blosnich et al., 2013).
Stigma experiences and discrimination also lead transgender veterans to have a higher prevalence of mental health concerns (Blosnich et al., 2017; Brown & Jones, 2016; Helsen et al., 2021). Transgender veterans also report experiencing stigma within the VA healthcare system, including lack of trans-specific medical knowledge among healthcare providers (Lutwak et al., 2014; Rosentel et al., 2016), stigmatizing interactions with healthcare providers (Rosentel et al., 2016) and anticipation of stigmatizing interactions (Shipherd et al., 2012), although there have been some recent signs of improvement (Kauth et al., 2019). It is hoped that recognizing non-binary identities on medical records will both increase access to appropriate medical care for non-binary veterans, and lead to increased awareness of and reduced stigma towards non-binary veterans and those with other marginalized gender identities. We appreciate the VA taking this important step to improve equity and inclusion for both the veterans they serve as well as VA employees.
References
Blosnich, J. R., Brown, G. R., Shipherd, J. C., Kauth, M. R., Piegari, R. I., & Bossarte, R. M. (2013). Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing Veterans Health Administration Care. American Journal of Public Health, 103, e27-e32. https://doi.org/10.2105/AJPH.2013.301507
Blosnich, J. R., Marsiglio, M. C., Dichter, M. E., Gao, S., Gordon, A. J., Shipherd, J. C., Kauth, M. R., Brown, G. R., & Fine, M. J. (2017). Impact of social determinants of health on medical conditions among transgender veterans. American Journal of Preventive Medicine, 52, 491-498. https://doi.org/10.1016/j.amepre.2016.12.019
Brown, G. R., & Jones, J. T. (2016). Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the Veterans Health Administration: A case–control study. LGBT Health, 3, 122-131. http://doi.org/10.1089/lgbt.2015.0058
Helsen, V., Enzlin, P., & Gijs, L. (2021). Mental health in transgender adults: The role of proximal minority stress, community connectedness, and gender nonconformity. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000530
Kauth, M. R., Barrera, T. L., & Latini, D. M. (2019). Lesbian, gay, and transgender veterans’ experiences in the Veterans Health Administration: Positive signs and room for improvement. Psychological Services, 16(2), 346–351. https://doi.org/10.1037/ser0000232
Lutwak, N., Byne, W., Erickson-Schroth, L., Keig, Z., Shipherd, J. C., Mattocks, K. M., & Kauth, M. R. Transgender veterans are inadequately understood by health care providers. Military Medicine, 179, 483–485. doi.org/10.1089/trgh.2016.0006
Rosentel, K., Hill, B. J., Lu, C., & Barnett, J. T. (2016). Transgender veterans and the Veterans Health Administration: Exploring the experiences of transgender veterans in the Veterans Affairs Healthcare System. Transgender Health, 1, 108-116. http://doi.org/10.1089/trgh.2016.0006
Shipherd, J. C., Mizock, L., Maguen, S., & Green, K. E. (2012). Male-to-female transgender veterans and VA health care utilization. International Journal of Sexual Health, 24, 78-87. https://doi.org/10.1080/19317611.2011.639440
VA Office of Public and Intergovernmental Affairs. (2022). VA health records now display gender identity. Found online at: https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5753