Providing Counseling for Transgendered Inmates: A Survey of Correctional Services

Along with the rise of the multicultural movement, growing interest in transgender treatment has spread through the mental health and criminal justice community. Over the past 20 years, research has focused on the etiological aspect of transgenderism. Yet, almost no attention has been directed toward practice and policy standards for this population in correctional facilities. While thousands of individuals experience distress or dysphoria concerning their gender identity each year, little progress has been made in achieving standards of care, effective treatment models and programs for training correctional administrators and providers. Individuals with transgender needs (assessment, housing, and treatment) have been largely ignored despite that they remain a key minority population at risk to experience suicide, depression, and hate crimes (Lev, 2004). Many of these individuals are marginalized into areas with high rates of crime, poverty, and drug dealing and abuse. Consequently, transgenders have an increased risk of getting involved in the criminal justice system and committed to correctional facilities (Blight, 2000). Although there is no reliable estimate of the percentage of prison inmates currently requiring transgender or transsexual treatment, there is a significant correlation with criminal behavior (Peterson, Stephens, Dickey, & Lewis, 1996; Walinder, Lundstrom, & Thuwe, 1978), specifically among those experiencing gender dysphoria (Peterson et al.). Other researchers suggest this correlation is a "consequence" due to social intolerance in conjunction with comorbid pathological symptoms (Shaylor, 2009, Peterson et al, 1978). As such, an estimated 40 percent of transsexual individuals have been involved with prostitution (Hoenig, Kenna, & Youd, 1970; Blight, 2000). Criminal justice administrators and mental health providers are faced with the challenges that arise when dealing with individuals with transgender concerns. Although the literature addressing assessment, housing and treatment needs of transgendered inmates is limited, administrators and providers must be systematic in their responses. There is a realistic expectation on the criminal justice system to ensure effective services for transgendered inmates while in correctional facilities. This creates a burden on the corrections system as these administrators and providers are hampered by non-systematic approaches and practices for managing and treating this population (Richard, 2000). Despite literature which correlates criminal behavior and gender identity disorders (transsexual, transgender) with disproportionately high prevalence rates of transsexuals within the correctional system, few studies have been conducted to suggest appropriate models of treatment for transgendered inmates. Numerous studies report transgendered inmates suffer considerably more problems than general population inmates. These include rape (Banbury, 2004), blackmail (Banbury, 2004; Knowles, 1999), contraction of HIV or other sexually transmitted diseases (Stephens, Cozza, & Braithwaite, 1999), relapse or increase of psychological symptoms (Banbury; Knowles; Peterson et al., 1996), lack of social support, limited or inadequate mental health treatment, denial of hormonal therapy (HRT) (Peterson et al, 1996), and death due to hate crime (Knowles, 1999). Yet the population remains virtually ignored by current researchers. Corrections play a significant role in coordinating treatment services for transsexual and transgender inmates. When inmates with transgender issues are committed to correctional facilities, these institutions should be required to provide effective, adequate, and compassionate care. Sufficient care requires the application of empirically supported interventions; however there are few empirical studies which demonstrate best practices for the clinical management of transgendered persons confined in correctional facilities. …