The AAMFT Blog

Why We Need Gender-Affirming Care Now More Than Ever

 

Gender-affirming care, especially for minors, has sadly become a political battleground over the past few years. You might have read, or heard, terms like “gender ideology”, “rapid onset gender dysphoria”, or “social contagion”, especially when discussing young people. If you’re feeling somewhat confused, it’s understandable. There is so much misinformation out there that it has become increasingly challenging for people outside of the field to even understand what gender-affirming care is, and why it matters. Fortunately, all major, reputable professional associations now have some information available to their members, as well as the public, to counter such misinformation. I was privileged to be part of the task force that worked on AAMFT’s Gender-Affirming Care Position Statement, as well as being one of the editors, and contributors, working on the draft AAMFT Gender-Affirming Care Guidelines. Many other organizations also have position statements and/or guidelines for their members, and I have included a few at the bottom of this blog post. For now, let’s take a moment to clarify what gender-affirming care is and why it matters now, maybe more than ever.

 

Defining gender-affirming care

In its simplest definition, gender-affirming care (from hereon referred to as GAC) is any type of medical care, whether psychological or physiological, that supports and affirms someone’s gender identity and/or expression. Interventions in GAC can be social, psychological, legal, and medical. Usually GAC involves a multidisciplinary team of providers, including Marriage and Family Therapists (MFTs), and most of the public attention has been focused on medical interventions, especially surgical ones. Even though GAC has mostly been discussed in reference to transgender people, people of any gender might access GAC. In fact, according to a study of medical data published in the Journal of American Medical Association, cisgender boys received 97% of the breast reduction operations performed on minors in the United States. Other results from the study highlighted that, in 2019, the rates of receiving a gender-affirming surgical procedure with a gender dysphoria diagnosis were “5.3 per 100 000 total adults compared with 2.1 per 100 000 minors aged 15 to 17 years, 0.1 per 100 000 minors aged 13 to 14 years, and 0 procedures among minors aged 12 years or younger”. The majority of the procedures were chest-related ones, at a rate of 59.7% for adults and 96.4% for minors. Out of the total of 636 breast reductions procedures carried out on adults, 80% were performed on cisgender men, while out of the 151 breast reduction procedures 97% were carried out on cisgender boys, as stated earlier. No procedures were carried out among minors aged 12 years old or younger, and most of the procedures conducted on minors were on young people aged between 15 and 17 years old. Given that, despite these facts, the attention remains on the care of trans people, especially youth, let’s turn our attention to why GAC is needed and it’s, in fact, considered a form of life-saving care by both trans people and gender specialists.

 

The need for culturally-attuned gender-affirming care for trans, nonbinary and/or gender expansive people.

GAC is often referred to as “life-saving care” by many trans, nonbinary and/or gender expansive (TNBGE) people. With the rates of suicidality being ten times as high for TNBGE people when compared to cisgender people, it seems to make sense that care that enables people to live more at peace with themselves (and also be more accepted and acceptable to mainstream society) would be considered essential. Let me break some numbers down to make sure we understand just how essential this type of care is. In 2023, a new study by the Williams Institute at UCLA School of Law found that 81% of transgender adults had thought about suicide, with 42% having attempted and 56% having engaged in non-suicidal self-injury. Just like we see in other marginalized and oppressed populations, the study also found higher rates of problematic alcohol and substance use and of psychological distress, such as depression and anxiety. The numbers for TNBGE youth are equally concerning, with the Trevor’s Project 2023 U.S. National Survey on the Mental Health of LGBTQ Young People indicating that about half of TNBGE youth surveyed had seriously contemplated attempting suicide, with 1 in 5 having actually attempted. Rates for Black, Brown, Latinx and Indigenous TNBGE youth were higher than for their white counterparts. Around three quarters of TNBGE respondents experienced depression and anxiety.

If this is starting to sound discouraging, it’s because it is. Sadly these numbers seem to be on the rise given the current political climate with the Trevor’s Project finding “an overall volume increase of nearly 700% [for calls to their helpline] on Nov 6, compared to the weeks prior” and NPR reporting that suicide attempts amongst TNBGE youth had increased up to 72% in states that had passed anti-trans laws. It’s important to state that those numbers are not due to people’s gender identity, but rather to the stigma, rejection, bullying, harassment and violence that TNBGE youth and adults experience in our cisgenderist world, including in family therapy. In fact, multiple studies have shown that there are protective factors, especially for youth, with family acceptance, correct pronoun use and various forms of GAC reducing, or even downright eliminating, those health disparities between TNBGE and cisgender youth. In addition to these protective factors, regret rates for GAC medical interventions are lower than for most surgical interventions, ranging from around 1% to 13% depending on which study is considered. We also need to remember that rates of surgical interventions in minors are so low as to be negligible, as shown in the study mentioned earlier in this article, making the issue of potential regret somewhat moot.

When we take all the facts from reputable sources into consideration, it seems pretty straightforward to state that GAC saves lives, and that it’s our ethical duty, as both MFTs and healthcare providers, to not only provide it, but also to do so in a way that is culturally attuned and effective. In fact, given the role that family acceptance plays as a protective factor for those who are most vulnerable, that is young people, and especially young people of the global majority, MFTs have a key role as part of the multidisciplinary teams involved in the care of youth and their families. At a time when bold rhetoric with little substance, if any, behind it, is loud and ubiquitous, it’s important to remember what our priorities as healthcare providers are. I hope that you will agree with me that those priorities are to do the least harm possible, and to provide forms of care that have been proven, over and over, to have more benefits than downsides, as it’s the case for gender-affirming care.

 

 

Alex Iantaffi, PhD, SEP, CST, CST-S, LMFT. 
AAMFT Approved Supervisor
Past President MAMFT
Former Chair QTAN
WPATH Certified Gender Specialist and Mentor (SoC8)

 

 

References and further reading

Ansara, Y. G., & Berger, I. (2016). Cisgenderism. The Wiley Blackwell encyclopedia of gender and sexuality studies, 1-3.

 

Blumer, M. L., Ansara, Y.G., & Watson, C. M. (2013). Cisgenderism in family therapy: How everyday clinical practices can delegitimize people's gender self-designations. Journal of Family Psychotherapy, 24(4), 267-285.

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L., Deutsch, M. B., ... & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International journal of transgender health, 23(sup1), S1-S259. Can be accessed in various languages at https://wpath.org/publications/soc8/

Coolhart, D., & Shipman, D. L. (2017). Working Toward Family Attunement: Family Therapy with Transgender and Gender-Nonconforming Children and Adolescents. The psychiatric clinics of North America, 40(1), 113-125.

Cox, L. C., Benson, K. E., & Iantaffi, A. (2021). Therapists' Accountability and Engagement with Transgender and Nonbinary Couples. In Harvey, Rebecca, Megan J. Murphy, Jerry J. Bigner, and Joseph L. Wetchler, eds. Handbook of LGBTQ-affirmative couple and family therapy. (pp. 105-120). Routledge.

Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of gender-affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814-e2418814.

Edwards, L., Goodwin, A., & Neumann, M. (2019). An ecological framework for transgender inclusive family therapy. Contemporary Family Therapy, 41, 258-274.

Giammattei, S. V. (2015). Beyond the binary: Trans‐negotiations in couple and family therapy. Family process, 54(3), 418-434.

Iantaffi, A. (2015). Gender and sexual legitimacy. Current Sexual Health Reports, 7, 103-107.

Iantaffi, A. (2020). Gender trauma: Healing cultural, social, and historical gendered trauma. Jessica Kingsley Publishers.

Iantaffi, A. (2020). Increasing gender awareness to reduce harm in health care. Creative Nursing, 26(2), 83-87.

Keeley, S. (2022). Integrative Family Therapy with Transgender, Gender Diverse, and Non‐binary (TGDNB) Young People. Australian and New Zealand Journal of Family Therapy, 43(1), 151-162.

Kidd, J. D., Tettamanti, N. A., Kaczmarkiewicz, R., Corbeil, T. E., Dworkin, J. D., Jackman, K. B., ... & Meyer, I. H. (2023). Prevalence of substance use and mental health problems among transgender and cisgender US adults: Results from a national probability sample. Psychiatry research, 326, 115339.

McGeorge, C. R., Coburn, K. O., & Walsdorf, A. A. (2021). Deconstructing cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients. Journal of Marital and Family Therapy, 47(3), 785-802.

Nath, R., Matthews, D. D., DeChants, J. P., Hobaica, S., Clark, C. M., Taylor, A. B., & Muñoz, G. (2024). US national survey on the mental health of LGBTQ+ young people. West Hollywood, California: The Trevor Project.

Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of adolescent Health, 63(4), 503-505.

Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network open, 5(2), e220978-e220978.

Statements by other professional associations

APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science

https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care

American Academy of Child & Adolescent Psychiatry Policy Statement on Access to Gender-Affirming Healthcare

https://www.aacap.org/AACAP/Policy_Statements/2024/Access_Gender-Affirming_Healthcare.aspx

NASW Article on Gender-Affirming Care as Lifesaving

https://www.socialworkers.org/News/News-Releases/ID/2642/Gender-Affirming-Health-Care-Saves-Lives

AASECT Position Statement on the Dignity and Rights of Transgender and Gender-Expansive Individuals

https://www.aasect.org/transgender-position-statement#:~:text=AASECT%20affirms%20the%20dignity%20and%20rights%20of%20transgender,TGE%20people%20can%20feel%20affirmed%2C%20empowered%2C%20and%20respected.

Statement on ROGD by the Coalition for the Advancement &

Application of Psychological Science

https://www.caaps.co/rogd-statement

Endocrine Society Gender Dysphoria/Gender Incongruence Guideline Resources

https://www.endocrine.org/clinical-practice-guidelines/transgender-medicine-and-research

American Medical Association Clarification of Evidence-Based Gender-Affirming Care H-185.927

https://policysearch.ama-assn.org/policyfinder/detail/Gender?uri=%2FAMADoc%2FHOD-185.927.xml

February is Black History Month

Black History Month, celebrated in February, is a time to recognize and celebrate the significant contributions and achievements of African Americans throughout U.S. history, highlighting their impact on culture, society, and progress, with a focus on stories often overlooked in traditional narratives. Carter G. Woodson is credited with starting Black History Month, originally establishing it as "Negro History Week" in 1926 to promote the study and celebration of African American history and culture; he is often referred to as the "father of Black History Month." The month of February was eventually chosen to coincide with the birthdays of Abraham Lincoln and Frederick Douglass.

A vitally important aspect of Black history is linked to our nation’s Historically Black Colleges and Universities (HBCUs). HBCUs are institutions of higher education established primarily to serve the African American community, particularly during times when legal and social discrimination prevented African Americans from attending predominantly white institutions, such as after the Civil War and the abolition of slavery. These colleges and universities have played a crucial role in the advancement of Black education, culture, and leadership in the United States. There are currently 107 HBCUs in the United States.

These institutions not only provided academic instruction but fostered a sense of community, activism, and empowerment. HBCUs became centers for political and civil rights activism during the Civil Rights Movement, producing leaders like W.E.B. DuBois, Ida B. Wells, Thurgood Marshall, Martin Luther King, Jr., Rosa Parks, Andrew Young, Maya Angelou, and Stokely Carmichael.

Some of the most well-known HBCUs include: Howard University (1867), Spelman College (1881), Morehouse College (1867), Jackson State University (1877), Tuskegee University (1881), Florida A & M University (1887), Clark Atlanta University (1865), North Carolina A & T State University (1891), Langston University (1897), and Bethune-Cookman University (1904).

HBCUs have produced African American professionals in fields like law, medicine, science, business, politics, and education. HBCUs have been central in shaping the African American cultural, intellectual, and political landscape. They often emphasize not just academic rigor but cultural pride, social justice, and community service. Many of these schools were active in the Civil Rights Movement, with their campuses serving as organizing grounds for protests, sit-ins, and political rallies. Students and faculty at HBCUs were among the first to push for social change before the 1960s and beyond. Furthermore, HBCUs have contributed significantly to the U.S. economy by producing graduates who go on to have successful careers, particularly in areas such as education, government, business, and health. Many also offer scholarships and support for students from underserved and marginalized communities.

Despite their profound impact, HBCUs have faced significant challenges, including underfunding, lack of resources, and the threat of closure due to competition with larger, predominantly white institutions. Historically, these schools have not received the same level of federal and state funding as non-HBCUs, despite their critical role in educating African American students. However, in recent years, HBCUs have experienced a resurgence in interest and enrollment, partially due to their emphasis on fostering a supportive, inclusive environment for students. Many HBCUs have also benefited from philanthropic contributions and increased federal funding. 

HBCUs are places where undergraduate and graduate students can thrive academically, socially, and professionally. While their student bodies today are still primarily composed of African Americans, many schools are racially and ethnically diverse. HBCUs continue to promote an environment of excellence, with robust academic programs, research opportunities, and a strong focus on leadership development and social justice.

With this proud history in mind, AAMFT will be forging a path to bring awareness of the marriage and family therapy field at Historically Black Colleges and Universities. In 2024, AAMFT was pleased to announce the official launch of the AAMFT MFT @ HBCU CEO Workgroup, chaired by Dr. Debbie Manigat.

This initiative aligns with AAMFT’s core values and seeks to expand access to systemic mental health education and services. The workgroup will engage with faculty and administrators at targeted HBCUs to advocate for the development of MFT programs, participate in outreach efforts, and help develop future systemic leaders and scholars. Building relationships with HBCUs is an opportunity to continue to fulfill the AAMFT mission of recognizing that relationships are fundamental to the health and well-being of diverse individuals, couples, families, and communities. Be on the lookout for further information and announcements about this exciting new workgroup and their efforts!

 

Happy Black History Month from the MFT @ HBCUs CEO Workgroup:

Dr. Debbie Manigat

Dr. Leslie Anderson

Dr. Dara Mcdowell

Dr. DeAnna Harris-McKoy

Dr. Camille Lafleur

Dr. Symphonie Smith

Dr. Christine Beliard

Dr. Kevana Nixon

Wilson Manigat, MBA

Katrina Edmonds, MS

The Ultimate Guide to Pricing Your Therapy Services

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

We live in a time of growing awareness about the importance of mental health care. However, stigma remains pervasive—and much of it has been internalized by us as therapists. This internalized stigma impacts not only our clients but also how we run our practices and care for ourselves.

Minimizing the value of our work often shows up in the ways we neglect our business needs. This might include haphazard decision-making, a lack of planning, or not setting clear boundaries for sustainable practices. It’s common to find therapists charging inconsistent fees, taking on clients they know they should refer out, or even avoiding their own mental health support. These patterns don’t just harm us—they ultimately affect the quality of care we provide.

This guide is meant to support you in pricing your therapy services while also honoring your needs as you seek to create a private practice that supports your life.

Reflecting on the Power of Your Work

Take a moment to reflect on the powerful work you do. Think of a recent session where you witnessed a breakthrough with a client, or recall how your efforts have changed lives, broken cycles of abuse, or fostered deep healing. The work you do impacts not just individuals but entire generations. Sit with the awe of what you provide—not just for your clients but also for their families and communities. Your work changes lives, and that transformation changes you too.

I want to encourage you to pause here and reflect, maybe even write down some of the changes you have seen in your clients through your work with them.

And when you come back, I want to ask you, what is that worth? If you ask me, it’s priceless. This work cannot be valued in dollars, because its true value extends far beyond an exchange in a session.

So how do you price something that is priceless?

The Cost of Therapy and The Cost of Living

Because your work is priceless you can’t price it based on worth, but you can price your services based on the cost. There is a cost to running your business and a cost to living your life. Those costs are going to be unique to you! The cost of living and running a business in Los Angeles is far different than Mobile, Alabama. Your private practice is here to not only get great clinical outcomes for your clients but to also sustain a good life for you.

Honoring Your Needs as a Therapist

If your purpose and passion are to help others, how will you ensure you’re able to continue doing this work? Sustainable therapy requires attending to your physical, emotional, and spiritual well-being. It means investing in continued learning, securing support through supervision, and creating financial and scheduling boundaries that allow you to thrive. Without these supports in place, it’s impossible to show up fully for your clients.

Take a moment and look at your life, your circumstances, your privileges, and your struggles. No one has a life like yours and what you need to do is different from your colleagues. You may be a caregiver, a sole provider, or have a chronic illness that limits the size of the caseload you can manage, all of which can impact what you need your fee to be to take care of you so you can do this work well. Accepting ourselves opens the doors to setting a fee that sustains our work without burnout.

The Preventing Burnout

Burnout isn’t just harmful to you—it impacts your clients as well. Overworking leads to reduced focus, diminished energy, and less effective care. It’s not uncommon to hear of therapists taking on 10 clients a day or working without breaks, leading to exhaustion and forgetfulness. This isn’t why you became a therapist. Every client deserves your full presence and expertise, which can only happen when you respect your own limits.

Imagine leaving your last session of the week with enough energy to enjoy dinner with loved ones or take a peaceful evening walk. This vision is possible when you set boundaries and honor your capacity so that you can also give clients the highest and best care possible. Your fee needs to allow for this.

Understanding the Importance of Your Fee

Your fee isn’t just a number—it’s a reflection of your unique circumstances and the value of your work. Yet too often, therapists base their rates on what others charge, without considering their own needs or the cost of running a sustainable business. Your financial realities are shaped by factors such as student loans, family responsibilities, location, and the cost of living. These need to be factored into your decisions.

1. Determine how many clients you can realistically see in a week while maintaining your best work. You might be tempted to look to your colleagues and figure out what “full” means when it comes to a caseload. You want to look inward, knowing yourself and what feels good to you physically, energetically, and emotionally. This can also be impacted by the type of work you do. Longer sessions with couples might take more out of your energy than seeing an individual for brief sessions. Suspend judgment and really look at how many weekly clients can work for you.

1. Calculate the number of weeks you’ll work in a year, accounting for vacation, holidays, and sick time. Again, your circumstances may mean that you need more time off. If you plan for it in your fee, you will have less stress when these circumstances arise.

1. Identify your gross income you need to make to cover the cost of running your business and the cost of being in your life. From business expenses to taxes to personal expenses, you want to look at the whole package of what money you need to bring in to pay for your business to run and for your life to be lived well. Going back to what you need to sustain a good life, look at what it costs to live and to plan for retirement, savings, and other financial needs. Your fee is also determined by the amount of money you need to have in your life.

The Private Practice Fee Formula

To create a fee that takes into consideration what you need to have a good life, to show up in the therapeutic relationship with full presence and attunement, you want to take the above elements and put them into the following formula:

Gross Income Goal / Weeks Worked Per Year = Gross Income Per Week Needed

Gross Income Per Week Needed/ Number of Sessions Per Week = Session Fee

 Now oftentimes when people do the math, they have an 'aha' moment and decide - wait, I want more time off than that or I want to see fewer clients. That’s fine, play with the numbers but you can see their impact overall and what it means for your weekly schedule and your time off. We would say about 90% of people going through our business school who apply this formula, change their fee. And another 20 - 30% ultimately begin developing other streams of income when they discover that 1:1 is not enough to provide the income they desire but not until AFTER they manage their clinical practice’s needs.

Challenging the Profession’s Money Stories

Now that you have played with the fee, you may notice emotions or narratives arising. Many therapists shy away from charging sustainable fees because they fear being perceived as “money-hungry.” This fear often stems from early money stories shaped by culture, family, and societal influences. Reflect on your own history with money. What were your first experiences earning, saving, and spending? How do these lessons show up in your practice today? Understanding these roots can help you rewrite your narrative around money and value.

The therapy profession has its own collective story, particularly in the United States. Many of us began our careers overworked and underpaid, with unpaid internships, low-paying placements, and heavy workloads. This “paying your dues” mentality sets a dangerous precedent that devalues our work and perpetuates burnout. It’s time to break this cycle.

Building a Sustainable Practice

A sustainable practice benefits both you and your clients. When you set fees that reflect your needs, create space for professional growth, and prioritize your well-being, you model the very self-respect and boundaries you encourage in your clients. This also creates space for high-quality care, as you’re able to focus fully on your work without the distraction of financial stress.

Your practice should align with your values and support your vision for the future. This means considering not just your fee but also your schedule, the number of clients you see, and the resources you need to provide excellent care.

Ready to achieve great clinical outcomes while building a practice that works for you? Click here for our FREE How to Set Fees training and take the first step toward a sustainable, thriving practice.

National Human Trafficking Prevention Month

January is National Human Trafficking Prevention Month. Every year since 2010, the President has dedicated the month to raise awareness about human trafficking and to educate the public about how to identify and prevent this crime.

During this month, we recognize the efforts of foreign governments, international organizations, anti-trafficking entities, law enforcement officials, survivor advocates, communities of faith, businesses, and private citizens all around the world to raise awareness about human trafficking.

More than 20 years ago, the Trafficking Victims Protection Act of 2000 (TVPA) enshrined the United States’ commitment to combating human trafficking domestically and internationally. In 2010, by presidential proclamation, President Obama declared January “National Slavery and Human Trafficking Prevention Month” and every year since, each president has followed this tradition.

Presidential proclamations not only raise the profile of the issue, but are also snapshots of global trends, challenges, and significant U.S. anti-trafficking policy achievements. Some highlights include:

• In 2012, the issuance of the Executive Order ‘Strengthening Protections Against Trafficking in Persons in Federal Contracts’
• In 2016, the first convening of the U.S. Advisory Council on Human Trafficking
• In 2017, the State Department’s launch of its largest anti-trafficking program, the Program to End Modern Slavery
• In 2021, the release of the updated National Action Plan to Combat Human Trafficking

Human trafficking includes both forced labor and sex trafficking. It not only represents a threat to international peace and security but also undermines the rule of law, robs millions of their dignity and freedom, enriches transnational criminals and terrorists, and threatens public safety and national security everywhere.

There are estimated to be more than 27.6 million people — adults and children — subjected to human trafficking around the world, including in the US. Traffickers often take advantage of instability caused by natural disasters, conflict, or a pandemic to exploit others.

Like the US, many countries around the world have worked to implement the “3P” paradigm of preventing the crime, protecting victims, and prosecuting traffickers, through the passage and implementation of national anti-trafficking laws. Today, there are 178 parties to the UN Protocol to Prevent, Suppress and Punish Trafficking in Persons. Only 10 of the 188 countries and territories assessed in the Department of State’s 2024 Trafficking in Persons Report have yet to adhere to this international standard to ensure their laws criminalize all forms of human trafficking and take concerted steps to prevent human trafficking, protect all victims, and cooperate internationally to combat this global crime.

Despite the nearly worldwide adoption of international and domestic norms to address and prevent human trafficking, we continue to witness traffickers exploit people in the US and around the world. But everyone has the power to help make a difference. Every Presidential proclamation for January ends with a call to action for all Americans to recognize the vital role everyone can play in combating all forms of human trafficking.

Resources

• Understanding Human Trafficking
• 20 Ways You Can Help Fight Human Trafficking
• The U.S. Government’s Response to Combating Human Trafficking 
• Human Trafficking Hotlines
• U.S. Advisory Council on Human Trafficking Annual Report

Warning signs for professionals and the public

Since human trafficking is often a crime that is hidden in plain sight, it is important to be aware of its warning signs. Some indications that a person may be a victim of human trafficking include (especially in the case of women and children):

• Appearing malnourished
• Showing signs of physical injuries and abuse
• Avoiding eye contact, social interaction, and authority figures/law enforcement
• Seeming to adhere to scripted or rehearsed responses in social interaction
• Lacking official identification documents
• Appearing destitute/lacking personal possessions
• Working excessively long hours
• Living at their place of employment
• Checking into hotels/motels with older males, and referring to those males as boyfriend or “daddy,” which is often street slang for pimp
• Poor physical or dental health 
• Tattoos/ branding on the neck and/or lower back
• Untreated sexually transmitted diseases
• Small children serving in a family restaurant
• Security measures that appear to keep people inside an establishment - barbed wire inside of a fence, bars covering the insides of windows
• Not allowing people to go into public alone or speak for themselves

January 20 is Martin Luther King, Jr. Day

“Everybody can be great, because everybody can serve.” —MLK

The observance of the Dr. Martin Luther King, Jr. holiday in January is a time for us to reflect on the life and achievements of an extraordinary leader in American history. Dr. King devoted his life to advancing equality, social justice, and economic opportunity through service to others. He also linked the quest for equality to healthcare and talked about the importance of being first in moral excellence and generosity. He taught us that everyone has a role to play.

Martin Luther King Jr. faced significant mental health challenges, particularly related to the immense stress and emotional toll of his leadership in the Civil Rights Movement. He experienced episodes of depression, anxiety, and deep personal doubts, often stemming from the constant threats on his life, the pressure of being a public figure, and the heavy responsibility he bore for the movement’s success. King’s close associates and family members noted his periods of fatigue, insomnia, and a sense of isolation. Despite these challenges, he remained dedicated to his cause, seeking solace through his faith, family, and close circle of friends. While King was not publicly open about his mental health struggles, it’s clear that the emotional strain of his work, combined with the personal risks he faced, had a significant impact on his well-being. King was concerned that people opposed to the Civil Rights Movement would use his depression to discredit him, as the stigma against people with mental illness was more pronounced in the 1950s and 1960s.

On this special day of remembrance, we can all hold ourselves accountable to acknowledging the work that remains to fulfill his dream. Many will mark the King holiday by volunteering in their neighborhoods—service is a powerful tool for strengthening our communities. Beyond volunteer service, there is much that can be done to improve the conditions in which all Americans are born, grow, work, live, and age.

Overall, we have made considerable progress improving health and healthcare for racial and ethnic minorities and disadvantaged populations. The life expectancy gap between Blacks and whites is at its narrowest point over the last three decades; cancer disparities are improving for all minority groups, including Asian Americans and Pacific Islanders, and teen birth rates have dropped for all races and Hispanic groups.

However, persistent and pervasive health disparities remain and addressing them will require not just a federal response, but also state and local organizations dedicated to achieving health equity. Issues like serious mental illness, the opioid epidemic, and childhood obesity are just some of the pervasive problems that continue to challenge us. Every day, 115 Americans die from drug overdoses due to opioids. One in five children in the United States is overweight or obese, and the rates are higher among African American and Latino children. And about 10 million American adults experience serious mental illness conditions each year.

Throughout the country, many communities will participate in the MLK Day of Service on January 20. The holiday remains the only federal holiday observed as a National Day of Service—a “day on, not a day off.”

Wherever you live, we hope you will join the hundreds of thousands of Americans who will spend the MLK Day of Service volunteering for a good cause or community activity. Some ideas are below.

Volunteer at an organization: 

• Volunteer at a local animal shelter or food bank
• Volunteer at a local, state, or national park
• Mentor a young person
• Participate in a social justice or anti-racism workshop

Help a neighbor

• Reach out to a neighbor in need
• Collect and donate non-perishable food items 
• Donate old linens like bath towels, blankets, and sheets to an animal shelter 
• Read letters, newspapers, or magazines to residents in a nursing home 
  
  

Beautify a community space 

• Clean up a public space
• Plant trees, grass, and flowers to create community green spaces
• Reclaim an abandoned space or park for community use
• Organize a classroom

You can find more information about Martin Luther King Jr. and MLK Day of Service activities here.