Psychiatrist Shares Their Journey to Providing LGBTQ-Affirming Mental Health Care
MMHLA’s Executive Director, Adrienne Griffen, was in conversation with Surya Sabhapathy MD, MPH (they/them) about their journey to psychiatry, public health, and providing LGBTQ-affirming mental health care with an emphasis on transgender, nonbinary, and other gender-expansive people.
Dr. Sabhapathy is on the faculty at the University of Illinois in Chicago, and they direct the Department of Psychiatry’s Gender and Sexuality Clinic. Dr. Sabhapathy also attends the inpatient psychiatry unit at UIH, supervises psychiatry residents in the women’s mental health program, and provides consultative services for primary care providers.
Their clinical interests include complex trauma and expanding access to comprehensive mental health care for underserved populations, particularly gender minorities, and BIPOC.
Adrienne: What prompted your interest in mental health?
Surya: I was always interested in mental health even before medical school, but for most of medical school, I thought about doing primary care. Then I started to realize that I found it the most fulfilling to support patients struggling with mental health concerns, and the folks who were thinking actively about their social context and their personal histories.
Psychiatry emphasizes bio-psycho-social factors, and I found this multi-disciplinary approach to be the most rewarding. And doing my psychiatry rotation as a student—well, I just loved it, and I thought that I could easily enjoy any of the subspecialties.
We had a clinic that was focused mostly on adolescent care, with primary care and psychiatry working together. We met once a week to talk about cases, sharing concerns that the primary care doctor had, and what the psychiatrists were thinking, and I really enjoyed that integrated approach.
So it wasn’t a single “aha” moment, but rather it was a gradual feeling during the course of my medical school training.
Adrienne: How did you become interested in the mental health of women and LGBTQ+ individuals?
Surya: In terms of LGBTQ+ mental health, I am queer and non-binary, and I came out to myself and others during residency. It is really important to me to work with my community, especially with individuals who are gender diverse. There is not a lot of understanding about the most important issues, or even about what it even means to be trans or gender expansive. So a lot of folks have had significant traumatic experiences in medical or mental health care settings. So many times, when I introduce myself to a trans patient, I notice a palpable shift in their body language. There’s a visible relaxation. I think realizing that they’re working with a nonbinary provider helps create a sense of safety and releases some tension almost instantly.
As for perinatal mental health, planning for pregnancy or thinking about parenting is a time when people need a lot of support, and it feels important to do some prevention work to get parents stable, so we are not replicating patterns of inter-generational trauma.
A lot of patients we see, especially inpatient, are people with severe mental illness. Many have experienced a lot of chaos from a young age, including living with parents who had severe mental illness themselves. It is hard for a young person to learn how to self-regulate and manage their own mental illness, or even get connected to care early on if they haven’t had the support to do so.
It is great to see patients getting better, even if it takes a really long time. I’m currently caring for a patient who has been admitted to our hospital for several months. She was pregnant when she first came in, and she delivered the baby while she was inpatient. It took a long time to find the right medication because she was so sick and went unmedicated for so long. It is amazing to see the change in her now: she is reading, and going to group, and really wants to be a parent. And I can see her working her way to achieving that when even two months ago I worried it wouldn’t be possible.
I did a year between the third and fourth years of medical school and got a master’s in public health, which shifted my thinking to addressing systems of care and to doing primary prevention. What better time to start than preconception, before people even become pregnant?
Adrienne: How do you spend your time at work?
Surya: I spend about half the time as an attending psychiatrist in our inpatient unit, which has about 35 beds. We have four provider teams, and my team provides care mostly for pregnant people and women with psychosis, PMDD, or PTSD.
In addition, I run an outpatient clinic, which is almost exclusively gender-expansive people. We see patients who are trans or nonbinary and need ongoing mental health care or folks who need a one-time evaluation before gender-affirming surgery.
For some people, starting or changing hormone treatment can present a risk of worsening their other mental health conditions, so we sometimes get referrals from other doctors to confirm diagnoses and provide recommendations on the next steps in care.
I also work with a federally qualified health center associated with our hospital system, doing case supervision with nurse practitioners and physician assistants. It has been gratifying to see how we can extend care to the community, especially to people who really need extra support. I also do some teaching for psychiatry residents, mostly around social and cultural issues in psychiatry.
Adrienne: Was it difficult to get support from your supervisors to start your clinic?
Surya: No, but I had to do a lot of the legwork myself, and it is a balancing act between staffing the inpatient unit and my clinic. As the need for gender-affirming psychiatrists is increasing, I’m glad to be able to shift more of my time to the clinic for this coming year.
There are so many LGBTQ+ people who are relocating to Illinois from other states because of the wave of anti-trans sentiment and legislation across the country. They are seeking out safety because the current political climate is impacting not only their medical care but also their day-to-day survival. Many LGBTQ+ people feel much safer working with someone who shares their identities and can better understand their immediate needs.
During the pandemic, I was mainly running my clinic through telehealth, and I was doing a lot from home. We’ve shifted back to in-office work, but I still do quite a bit of telehealth. I have a few patients who live a distance away, and it has nice to be able to keep them on as patients.
Many of my patients have chronic health conditions, which make it difficult for them to navigate long trips on public transit or may increase their risk of COVID in crowded spaces, so it is wonderful to have the option to support them over telehealth.
Adrienne: What do you do in your time away from work?
Surya: Transitioning from being a resident to being an attending physician has made me think more intentionally about how I want to spend my free time. I started doing embroidery during the pandemic, and I also do collage. I have a fairly extensive container garden on my deck. I have recently started weightlifting—my gym is small and queer/trans-focused. The environment is incredibly affirming, and it’s really comfortable to be there and be able to move my body more, and also build a sense of community.
I’m lucky to have some amazing friends, both here in Chicago and across the country. Some of us travel together every year or two. I’ve been doing weekly online trivia with some friends since early in the pandemic, and it was a wonderful way to stay connected even when we couldn’t see each other in person.
Adrienne: You were part of MMHLA’s Board of Advisors, which provided us with guidance on inclusive language and helped create a racial equity framework to guide our work. Can you share some thoughts about that experience?
Surya: I really appreciate that MMHLA had the Board of Advisors. It was forward-thinking to involve people from a wide variety of backgrounds and have that community focus on what people need. I was grateful that MMHLA was so intentional about recruiting people representing specific communities, such as me representing the LGBTQ+ community. It seems that MMHLA has had a big focus on doing the right thing with advocacy, such as ensuring language is inclusive.
(Note: Learn about MMHLA’s Racial Equity Framework).
About Surya Sabhapathy MD, MPH (they/them)
Dr. Sabhapathy is on the faculty at the University of Illinois in Chicago, and they direct the Department of Psychiatry’s Gender and Sexuality Clinic. Dr. Sabhapathy also attends the inpatient psychiatry unit at UIH, supervises psychiatry residents in the women’s mental health program, and provides consultative services for primary care providers. Their clinical interests include complex trauma and expanding access to comprehensive mental health care for underserved populations, particularly gender minorities, and BIPOC.
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