While some may be seeking specific assistance for gender-related themes, others are seeking assistance with depression, anxiety, or other clinical concerns unrelated to their gender identity.Primary care should be trauma-informed in its delivery, with an understanding that many patients present with complex trauma histories with interpersonal, social and medical systems-based trauma experiences. Trauma-informed care and training for all staff and providers can enhance care engagement and health outcomes.In a recent publication, Machtinger and colleagues describe a theoretical framework for providing trauma-informed primary care. The model is based on the needs of women who have a history of trauma.Primary care providers should be equipped to handle basic mental health needs of transgender patients (e.g., depression and anxiety) just as any other patient.Any primary mental health concerns beyond the scope of the provider's routine practice should be referred to transgender-affirming mental health providers.In some cases patients will have a carve-out of mental health services from their medical plan.
Mental health concerns endorsed by a patient should not be automatically assumed to be related their gender identity. Transgender people may be seeking mental health care for a number reasons; in addition to mental health issues relating to or resulting from one's gender identity, transgender people do experience the background rates of mood disorders and other psychiatric conditions seen in the general population.The model proposes the need to address the primary care environment, patient screening, provider response to the patient's needs, and a foundation of organizational values that support trauma informed care across all levels of the organization.