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Transgender For Mental Health Professionals

Rates of mental illness, self harm, and suicide are significantly higher among trans people than non-trans people. This is due to ‘minority stress’ which describes the social and emotional impact that comes from being marginalised or discriminated against. 

Access to mental health services is part of the solution. Unfortunately, issues of gender diversity have historically been criminalised and pathologised, and psychiatry has left a long legacy of unhelpful diagnoses and mistreatment within the health profession. It is important to understand the depth of issues and barriers to accessing mental health care that trans people face.

There is often a heavy focus on gender dysphoria at the core of mental illnesses experienced by trans people. However, more recent studies show that discrimination and intolerance are far more likely to be the source of mental health issues for trans people. Contributing factors can include hostility in the workplace or at school, rejection from friends or family, or even a negative social climate (such as that experienced during the Marriage Equality Postal Survey).

That being said, many trans people have no issue with their gender and seek mental health services for unrelated reasons just like anybody else. The reason they present might have nothing to do with their trans identity, and therefore it is important that assumptions are not made, and that their trans status is addressed only if the client raises it. Many trans people report not telling their therapist they are trans for fear of having all future issues pinned on their trans identity. While there can be many complicated feelings around transition, it is important not to focus solely on this aspect of their life, but to work within a holistic and contextual framework that acknowledges the impact of external factors.

A refusal to acknowledge issues, other than those related to gender dysphoria and transition, can be a significant barrier to seeking out treatment and can often lead to frustration that other issues are not being taken seriously. It is vitally important to ensure that any kind of intake process is mindful of a person’s identity. If there is a need to collect data on someone’s legal identity, it is  important to ensure there is room for a preferred name and pronoun to be recorded, and even more importantly, this is always used to address the person. It is always good practice to start by asking how someone would like to be addressed. It is also useful for professionals to introduce themselves by telling the client their name and their pronoun, even if this appears obvious. This gives permission for clients to state theirs.

Due to difficulties finding employment, experiencing discrimination at work, as well as the expense of transition, the trans community experiences higher rates of poverty than the broader population. Thus it is important to be mindful of the financial barriers that a trans client might be facing. Being upfront about fees and options around access can take the strain out of approaching mental health services for the first time. It is also important to refer clients onto free services, such as crisis hotlines, or social support programs such as those offered at AGA.

Word of mouth is a very powerful way the trans and gender diverse community communicate.  Creating a trans friendly and respectful practice will enable positive word of mouth and strong engagement from the trans community.

Key Points

  • Transgender people experience very high rates of mental illness, self harm and suicide. Studies show this is often in response to experiences of discrimination and hostility rather than gender dysphoria.
  • Be aware of the legacy that psychiatry has left in the trans community: a history of being pathologised, and attempts at ‘conversion’ or ‘cure’ (which still persist) mean that many people are wary of mental health professionals. As such, a trans-affirmative approach is essential.
  • Ensuring practices are mindful of the needs of trans people can help remove the barriers that stop vulnerable individuals from reaching out to mental health services.
  • Understanding that mental health services can often be financially or geographically inaccessible, it is important if professionals are not able to assist, that they refer trans people to other appropriate supports.