Too often, individuals with mental health disabilities face discrimination, whether it's at school, at work, or in other public spaces. That discrimination, in turn, can exacerbate mental health struggles, including by reinforcing feelings of inferiority and exclusion. Robust enforcement of anti-discrimination laws can help stop this vicious cycle. That is one reason why it is so important that a federal appellate court has issued a landmark decision that should help protect individuals with one particular mental health disability—gender dysphoria—from discrimination.
The lawsuit, Williams v. Kincaid, concerned Ms. Kesha Williams, a transgender woman who, while incarcerated in Virginia, was forced to reside in men's housing even though she identified as female. While incarcerated, Ms. Williams not only faced harassment by (male) inmates and prison deputies but also suffered delays in getting treatment for her gender dysphoria. According to the American Psychiatric Association, gender dysphoria "refers to psychological distress that results from an incongruence between one's sex assigned at birth and one's gender identity." Many, but not all, transgender individuals experience gender dysphoria.
After she was released from prison, Ms. Williams filed a lawsuit, alleging a violation of the Americans with Disabilities Act (ADA). The ADA prohibits discrimination against a person on the basis of that person's disability, including discrimination by "public entities" like prisons, schools, state-run hospitals, and state governments. Although the ADA defines "disability" broadly to include both physical and mental health disabilities, the statute also excludes from the definition of "disability"—and therefore from the statute's protections—"gender identity disorders not resulting from physical impairments." Although the statute does not define "gender identity disorders" (and does not mention gender dysphoria), the trial court had held that the exclusion applied to Ms. Williams' gender dysphoria and barred her ADA claim.
The Fourth Circuit rejected the trial court's analysis and affirmed that gender dysphoria is indeed covered by Title II of the ADA, meaning that schools, prisons, and other "public entities" generally cannot discriminate against a person on the basis of that person's gender dysphoria (or other mental health disability).
The Fourth Circuit explained that, at the time the ADA was adopted in 1990, "gender identity disorders"—which were expressly excluded from the statute's protections—did not include "gender dysphoria." Back in 1990, under the then-current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), "the gender identity disorder diagnosis marked being transgender as a mental illness," the Fourth Circuit explained. That is no longer true, thanks to advances in medical understanding. The current DSM has removed the term "gender identity disorders" and added the diagnosis of "gender dysphoria," which did not exist as a diagnosis in 1990 and which has a completely different meaning. While "gender identity disorder" focused only on an individual's gender identity, gender dysphoria concerns not the mere fact of being a transgender person but rather the distress and other disabling symptoms that characterize that particular mental health condition. The ADA protects individuals with gender dysphoria (and other mental health disabilities), because "a transgender person's medical needs are just as deserving of treatment and protection as anyone else's," the Fourth Circuit affirmed.
The Court's mid-August decision is one step towards better protections for transgender individuals experiencing mental health disabilities, which remains a significant problem in Maryland and across the country. About 1.4 million adults identify as transgender, including 24,000 adults in Maryland alone. According to the American Medical Association, transgender individuals are three times more likely than the general population to report or be diagnosed with mental health disorders. The increased prevalence of these mental health diagnoses among transgender individuals likely reflects "the chronic stress from coping with societal stigma and discrimination because of one's gender identity and expression," the AMA has concluded—and discrimination in public places "contributes to these existing mental health disparities." Left untreated, mental health conditions like gender dysphoria can lead to depression, substance abuse, and even suicide.
A new paper published in the journal Health Affairs this month provides further support for the American Medical Association's conclusions. That paper affirms that transgender adults suffer poorer health outcomes than their cisgender counterparts, due at least in part to the discrimination and stigma transgender individuals face. That paper also finds that transgender adults are more likely to report having a disability than their cisgender counterparts.
The Americans with Disabilities Act is one legal tool to help protect the rights of transgender individuals with disabilities, but it is not the only one. As the Fourth Circuit previously explained in a case called Grimm v. Gloucester County School Board, Title IX of the Education Amendments of 1972 prohibits discrimination against transgender individuals in education programs or activities that receive federal financial assistance. A third federal law, Title VII of the Civil Rights Act of 1964, protects transgender individuals in the workplace—as the Supreme Court explained in a 2020 case known as Bostock v. Clayton County. State laws can offer further protections. Maryland law, for instance, prohibits owners or employees of places of "public accommodation" (restaurants, hotels, etc.) and employers from discriminating against individuals on the basis of "gender identity" or "disability."
The attorneys at Brown, Goldstein & Levy have deep experience assisting transgender clients who have faced discrimination as part of our LGBTQ+ practice. We represent transgender individuals in all areas of the law, including employment, family, insurance coverage, and criminal defense. When doing so, we draw on decades of experience litigating civil rights cases, including cases in which we represent individuals with mental health disabilities as part of our nationally-recognized disability rights practice. We are also proud to partner with other organizations to advocate for LGBTQ+ equality in the law and to shape policy. We are dedicated to advancing the rights and full equality of the LGBTQ+ community.
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