Hospitals occasionally make the pain worse for trans youth in crisis.

With knots in his stomach, the transgender teen asked: “Will I be placed in a girls’ unit?”

The answer provoked one of the worst anxiety attacks Callum had ever experienced. Sobbing into the hospital phone, he informed his parents, who fought to reverse the decision they warned would cause their son greater harm.

Although they succeeded in blocking the transfer, the family had few options when a second overdose landed Callum back in UNC’s emergency room a few months later. When the 17-year-old learned he was again scheduled to be sent to a girls’ inpatient ward, he told doctors the urge to hurt himself was becoming uncontrollable. The exchange is documented in hospital records given by the family to The Associated Press.

“I had an immense amount of regret that I had even come to that hospital, because I knew that I wasn’t going to get the treatment that I needed,” Callum said.

As the political debate over health care for transgender youth has intensified across the U.S., elected officials and advocates who oppose gender-affirming medical procedures for minors have often said parents are not acting in their children’s best interest when they seek such treatment.

Major medical associations say the treatments are safe and warn of grave mental health consequences for children forced to wait to access puberty-blocking drugs, hormones and, in rare cases, surgeries.

Youth and young adults ages 10–24 account for about 15% of all suicides, and research shows LGBTQ+ high school students have higher rates of attempted suicide than their peers, according to the Centers for Disease Control and Prevention.

North Carolina lacks uniform hospital treatment standards and runs low on money and staff with proper training to treat transgender kids.

Sending a transgender child to a unit that does not align with their gender identity should be out of the question, said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, and a researcher of quality care barriers for trans youth in inpatient facilities.

“If you don’t validate the trans identity from day one, their mental health’s going to get worse,” Turban said.

When North Carolina lawmakers allocated $835 million to shore up mental health infrastructure earlier this year, none of the money was allocated to meet the specific needs of trans patients.

A nationwide dearth of pediatric psychiatric beds has been compounded by the COVID-19 pandemic as an unprecedented number of people sought emergency mental health services, according to the American Psychiatric Association. Demand has yet to fall back to pre-pandemic levels.

North Carolina is short about 400 youth psychiatric beds, leaving UNC with no choice but to send patients to other facilities, even those that cannot accommodate specific needs, said Dr. Samantha Meltzer-Brody, chair of the UNC Department of Psychiatry.

“We have no choice but to refer people to the next available bed,” she said.

UNC declined to comment on Callum’s case, despite the family’s willingness to waive its privacy rights. But Meltzer-Brody broadly addressed barriers to gender-affirming treatment for all psychiatric patients.

The public hospital system’s policy recommends inpatient assignments based on a patient’s “self-identified gender when feasible.” But with the ER overrun in recent years, Meltzer-Brody said meeting that goal is a challenge.

The LGBTQ+ civil rights organization Lambda Legal says denying someone access to a gender-affirming room assignment is identity-based discrimination.

Parents including Callum’s father, Dan Bradford, describe feeling helpless while their children are receiving psychiatric care involuntarily, which isn’t uncommon after attempted suicide.

A psychiatrist himself, Dan Bradford has always supported his son’s medical transition, which began with puberty-blocking drugs, followed by a low dose of testosterone that he still takes. Eventually, Callum underwent top surgery to remove his breasts. Irreversible procedures like surgery are rarely performed on minors, and even then only when doctors determine it’s necessary.

“In Callum’s case, the gender dysphoria was so strong that not pursuing gender-affirming medical treatments, like pretty quickly, was going to be life-threatening,” his father said.

North Carolina law bars medical professionals from providing hormones, puberty blockers and gender-transition surgeries to anyone under 18. Callum was able to continue treatment because he began it before an August cut-off date.

“When these public policies are discussed or passed, that sends a really strong message to these kids that their government, their society and their community either accepts them and validates them or doesn’t,” said Turban, the psychiatry researcher at UC San Francisco.

Fearing the plan to place his son in a girls’ ward would be deeply traumatizing, Dan Bradford secured a spot at a residential treatment center in Georgia. He has since returned home and for the first time in years, he’s thinking about his future.

Although he said his experiences eroded his trust in the state’s inpatient care network, he is optimistic that new resources could give others a more gender-affirming experience, if they’re paired with policy changes.

“I’m still here, and I’m happy to be here,” he said. “That’s all I want for all my trans friends.”