How do I get assigned to the right facility?

Whether you are entering a facility for the first time or have already been in a facility for some period of time, you can request a transfer to a gender-affirming facility. The process is a little different if you request it from the start.

 At the time you first enter the facility, an officer will complete an “Internal Housing Risk Factor Assessment”, which you can find at the end of this document. That form has places to fill out issues about potential risks to your safety at a facility. That is a good time to tell the intake officer that you would like to be placed in a gender-affirming facility. Once you tell them, then they have to follow instructions from this policy, and also described below.

In order to get the right assignment, you either need to self-identify as having “Gender Dysphoria”, or request a referral for “Gender Dysphoria”. After you make your request, then you should meet with a person called the Primary Care Clinician, or PCC, who works at your facility. That PCC should complete an evaluation to determine if you have “Gender Dysphoria” as well as make decisions about how to proceed with your case.

The evaluation should consider things like safe housing, work opportunities, education, program assignments, and your individual safety. These are done on a case-by-case basis. They also consider your security level, your prior history, medical records, and vulnerability. You should also be asked about your own views on your safety and what you think would be best. In some cases, the evaluation will also include if surgery should be a part of the potential treatment plan.

What is “Gender Dysphoria”?

Massachusetts uses a definition for “Gender Dysphoria” from a book, written by doctors at the American Psychiatric Association, called the Diagnostic and Statistics Manual of Mental Disorders [Fifth Edition], or the “DSM-5”. The definition is:

A difference between a person’s experienced and expressed gender and their assigned gender that has taken place for at least six months. It must include two of the following: 

  1. A marked incongruence between one’s experiences/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics);
  2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics);
  3. A strong desire for the primary and/or secondary sex characteristics of the other gender;
  4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender);
  5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender);
  6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender). 

When a PCC is deciding if a person has “Gender Dysphoria”, they try to determine if a person is experiencing distress or difficulties in socializing, working, or other important areas of life. They will do a face-to-face evaluation and review things like mental health history, medical history, and any medical documents you may have. If you have already been given a diagnosis of “Gender Dysphoria” in the past, then you don’t need to get another referral. 

If the PCC does not agree that you have “Gender Dysphoria” and should get the transfer, it doesn’t mean your case is over. Your case should be referred to two people: the Psychiatric Medical Director, and the Director of Clinical Programs. Then, you should get another face-to-face evaluation within thirty days of the referral. 

If I get a diagnosis from the PCC, what should happen? 

If the PCC decides that you qualify for services under “Gender Dysphoria”, then they should ask you if you will allow a “Release of Information.” They are asking for the Release of Information so that they can see what kinds of medical care you may have been getting in the past and try to continue it. 

The PCC works together with other people, including the Mental Health Director and other providers at the facility. You may meet with someone from your facility known as the on-site psychiatric provider. That person might be different from your Psychiatric Medical Director, or any of the other people you have met with so far. The PCC should then complete a form for you called the Gender Dysphoria Mental Health Referral Form in order to make sure that the facility is aware of your request to transfer. You can find that form at the end of this document.

The Psychiatric Medical Director or another officer should confirm the PCC’s Referral Form. They will consider a number of documents in this decision, including your Referral Form, a review of your medical records, and another consultation with the Psychiatric Medical Director or other officer. If there are any concerns about your diagnosis, then a person with the role Gender Dysphoria Consultant will review the case within 30 days. 

Once my diagnosis is confirmed, what kind of care should I receive? 

After you receive a confirmed diagnosis, you should be given an individualized plan that includes the diagnosis and any other medical concerns you may have. The PCC will make your individualized plan with assistance from a number of other medical providers at the facility. The individualized plan will be sent for final approval to a group called the Gender Dysphoria Treatment Committee. That Committee should look at your plan and make sure it is a good fit for your needs.

Some types of care that they can add to your plan include hormone therapy and meetings with an endocrinologist. Endocrinologists specialize in hormones and how they control metabolism, blood pressure, cholesterol, hunger, thirst, body temperature and more. Hormone therapy may be recommended if the facility’s Primary Care Provider believes that there would not be negative physical effects. 

Sometimes, the plan also includes housing recommendations. Final decisions about your housing are the responsibility of the Department of Corrections. Every six months, you should get something called an Internal Housing Risk Factor Assessment. You can find that at the end of this document. This Assessment is to make sure that your placement is correct for your case and includes a review of any safety risks you may be exposed to. 

If you are going to be transferred, then the facility has to follow a special Transportation plan called “103 DOC 530, Inmate Transportation”. This is not available to the public, but you can ask someone for a copy of it and they might provide one. 

Also, once you have been identified as Gender Non-Conforming, you have a right to shower separately from other people in your facility. This rule is part of a document called 103 DOC 750, number 11, which you can find here. Whether you have a “Gender Dysphoria” diagnosis or not, you should be allowed to shower, perform bodily functions, and change your clothing without non-medical staff of another gender viewing your body, except if there is an emergency. 

What if the Gender Dysphoria Treatment Committee doesn’t approve my plan?

If the Treatment Committee doesn’t approve your plan, they need to provide specific and justifiable reasons in writing. Their reasons need to explain why they are denying the recommended treatment. They have to base their decision off of proof that your treatment plan presents an overwhelming security, safety, and/or operational concern.

What are my rights once I have a treatment plan? 

Your treatment plan should contain at least three parts. You should be able to participate in at least monthly individual appointments with the facility’s mental health provider. Your treatment plan should also have personalized recommendations about clothing and canteen items that are approved for your use. If you are a woman seeking to be reassigned to a female facility, then you should be able to purchase clothing items and articles available to male individuals as well as female individuals with the same security clearance as you. You can find a full list of the types of items you are allowed to purchase and keep here

If there are parts of your Treatment Plan that you do not want to participate in, then the facility should write those down and make potential modifications to the plan if medically necessary. 

If you already took hormones before entering your facility, then you should tell the PCC that as soon as possible. They will want to review your Release of Information and prior medical records so that they can continue your care. If you don’t want to give them a Release of Information, then you don’t have to, but that may mean that your care plan changes and you can’t access hormones or other medical care you want. 

Is there any way for my treatment plan to be taken away?

There could be a time that the facility decides that your treatment plan presents an “overwhelming security, safety or operational” difficulty. If they want to make that claim, then the Director of Behavior Health has to refer the treatment recommendation to two people: the Deputy Commissioner of the Prison Division, and the Deputy Commission of Re-entry. They will complete a “security review”, which takes into account your personal history, how long you have been at that facility or other facilities, and your current situation.

If those two people agree that your plan presents a security, safety, or operational problem, then they have to forward your plan to the Commission for a final review. If the Commissioner agrees and wants to reject your treatment plan, then that security review needs to include specific and justifiable reasons for denying it. The review also needs to be in writing. It has to be completed within 60 days. 

What is the Prison Rape Elimination Act? 

The Prison Rape Elimination Act (PREA) is a federal law passed in 2003. Under PREA, rather than automatically assigning people to a facility, transgender and intersex people are assessed for potential safety threats and housed “on a case-by-case basis” according to gender identity. Correctional staff have to consider housing and program assignments at least twice a year to review any threats to safety experienced by transgender and intersex people living in prison. 

According to the law, they also have to take into account your own view of your safety. They are not allowed to separate you for housing or other program placements based solely on your LGBT status. 

PREA also protects “involuntary segregation”, or the removal of a person to a different housing assignment against their will. You cannot continue to be kept in a different part of the prison against your will unless prison officials have determined that there is no other way to keep you safe. They have to make that determination within the first 24 hours if they do place you in separate housing against your will. People cannot be segregated against their will for more than thirty days, and they must be given access to all of the same work, educational, and programming opportunities as any other person.