Department of Psychiatry Joins Forces with Alberta Health and AHS to Launch Prairies' First Gender Program

Dr. Michael Marshall, a psychiatrist with a special interest in transgender mental health, is dedicated to serving the needs of Alberta's stigmatized and often isolated transgendered population.

01 February 2018

Dr. Michael Marshall, a psychiatrist with a special interest in transgender mental health, is dedicated to serving the needs of Alberta's stigmatized and often isolated transgendered population.
At his clinic in Red Deer, a city of just over 100,000 people midway between Edmonton and Calgary, Marshall assessed, counselled and diagnosed 700 transgendered patients on a regular basis, while up to 14 new referrals landed on his desk every week.
Many had waited months - or even years - to begin the long journey toward finally beginning to lead more authentic lives.
"The demand is huge, and the waiting lists are long," says Marshall. "It should come as no surprise that transgendered individuals who are waiting for interventions have some of the highest rates of suicide, low mood, anxiety and other stress-related issues of any population group. Without proper supports, transgendered people are at risk."
Marshall is one of just seven Alberta psychiatrists who specialize in serving transgendered individuals. Edmonton's recently retired Dr. Lorne Warneke is another. But as health professionals they have had few external resources. It was a gap the University of Alberta's Department of Psychiatry also identified, and was determined to address.
"It was actually quite fortuitous," says Marshall. "I was looking to have a more fully supported program than what I could offer in Red Deer, and the Department of Psychiatry was looking to meet the needs of the population here in Edmonton. So we happened by accident - rather than by design - to arrive in the same place, looking for the same thing."
The result? The Department of Psychiatry, in partnership with Alberta Health and Alberta Health Services (AHS), is set to launch the first Gender Health Program in Canada's prairie provinces. Effective Feb. 13th, Marshall will assume his new role as Program Lead, The Gender Program, in the U of A's Department of Psychiatry.
"I'm hugely excited about the potential for this program. I think we are building something that could be world-class, and I'm keen to see where it goes," says Marshall.
"The Department of Psychiatry has been the biggest cheerleader I've had. They're a forward-thinking department that has worked collaboratively to get this program off the ground. Our goal is to lay the foundations for a world-class Gender Health Program, with core components in the clinical, educational and research areas. We want to become the leading center for transgender health in Canada."
At present, Toronto's Centre for Addiction and Mental Health (CAMH), which operates the Adult Gender Identity Clinic, offers the only fully integrated transgender health program in Canada, with nurses, social workers and psychologists working alongside a staff psychiatrist. However, a clinic in Montreal remains the only site in Canada where final stage gender reassignment surgeries are performed.
Marshall's vision to create a similarly robust, multi-disciplinary program in the Department of Psychiatry will take time and significant funding to build, he says. But with the support of AHS, he has begun mapping out a five-year plan to turn it into reality.
"Essentially, the program will be comprised of three arms: a clinical arm - which we will launch immediately - as well as a research arm and a teaching arm," he says.
"The aim of the teaching arm is to have doctors, medical students and other health care professionals who are involved in health care delivery, rotate through the Gender Health Program to get the necessary training to allow them to be competent in providing care," he explains.
"In addition, there should be a role for lecturing, teaching and curriculum development on issues around gender dysphoria, in whatever agency or school wants it, but in particular at the University of Alberta."
Marshall expects the program will eventually include a new Fellowship in Transgender Health Studies.
"In addition to the teaching arm there will be a research arm, and we hope to sponsor a research chair that will help us investigate all matters related to transgenderism. There is very little research on transgenderism right now, so this will be a key part of developing good evidence-based care that can be applied in the clinic," he says.
In the short term, however, Marshall's focus is on launching the clinic itself. It will be housed in the Department of Psychiatry for now until a more permanent home is found.
"We'll have a clinical secretary who will receive the referrals from a physician, psychologist, social worker or some other health care professional," says Marshall. "As the program gets set up the first point of contact for patients will be the nurse. Patients will make an appointment with the nurse, generally for an initial hour-long assessment. From there we'll gather the information I'll require to form a view about triage, and I'll see the patient in time."
Since he has also inherited Dr. Warneke's case load, Marshall now has about 1,300 transgendered patients under his care.
"That's obviously a large case load for a solitary psychiatrist, but we hope to create a hub for transgendered individuals that provides good clinical care in a multi-disciplinary way. After all, patients are whole people, and they will have social, psychological, physical health and other health care needs that we hope to be able to meet in one place," he says.
"So while this multi-disciplinary hub will have at its core one or more psychiatrists, there will be also be a nurse, perhaps some practicum students, and in time, a clinical social worker and psychology professionals with whom we will collaborate. So they will always be in reach and will provide input from these agencies to us, and from us back to them."