Embedding integrated psychiatric care within a gender affirming surgical program: A process evaluation of the first year of implementation

Introduction While gender-affirming surgery is associated with improved long-term mental health, individuals may experience mental health challenges perioperatively. Integrating psychiatric care within gender-affirming surgical programs could support patients. This evaluation described the implementation of an integrated psychiatric care model within a gender-affirming surgery program.Methods In the integrated care model, a psychiatrist (0.5 days/month) was added to an academic hospital’s gender-affirming surgical program to provide direct care and indirect care (e.g., case conferences). A process evaluation was conducted. Program activities were tracked quantitatively and analyzed descriptively. Qualitative interviews with surgical team members (n = 5) and patient experience advisors (n = 3) were conducted to understand program context, implementation, and recommendations, and analyzed thematically.Results Over one year, direct care and indirect care were implemented (median 4.5 patient visits/month, IQR 2.75–6.25; 1 case conference/month, IQR 1-1). Qualitative contextual findings highlighted challenges in accessing mental health care, the many factors that impact on perioperative mental health, and the impact of mental health on surgical outcomes. Model feedback highlighted benefits of interdisciplinary collaboration, and future recommendations included expanding services, enhancing patient resources, and educating other health professionals.Discussion Integrated psychiatrist care was feasibly implemented. As the program and evaluation were small in scale, further research is needed.