Ellen Murray
@ellenfromnowon
Healthcare & Education Worker, SAIL NI
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These slides are available online:
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For personal use and reference. All rights reserved.
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genderjam.lgbt/pride
Access information
• Discussion around the following topics
throughout
– Mental illness, self-harm and suicide
– Drug and alcohol use and addiction
– Family rejection and homelessness
– Violent crime, including sexual crime
– Medical transphobia, homophobia and biphobia
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Major community problems
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Healthcare
Access to education
Employment
Legal recognition
The criminal justice system
Social discrimination
Support services
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What the problems cause
• Mental health emergencies
– Depression & anxiety
– PTSD
– Suicide
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Physical health problems
Poverty
Social isolation
Ongoing risk behaviours
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Mental health
• Comorbidity of mental illness common
• Mostly due to social factors
• Largely helped by acceptance &
accommodation
• Suicide
– 41% attempt rate (all ages)1
– 48% attempt rate (25 and under)2
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– Speaking From The Margins, Transgender Equality Network Ireland, 2013
– RaRE Study, PACE, 2014
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Trans healthcare
• We’ve largely the same healthcare needs as
the general population
• Specialist gender identity services
– Psychiatric/psychosexual setting
– Mental health support
– Referrals for endocrinology, surgery & other
interventions
– Holistic care
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Specific healthcare needs
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Mental health support
Endocrine interventions
Speech & language therapy
Fertility therapy (gamete storage)
Surgical interventions
On-going monitoring
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Healthcare services available
Info online: transgenderni.com/healthcare
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Problems in healthcare
• Informed by significant work with over 170
service users from August 2014 to April
2016 in Northern Ireland
– Lead to exclusion from health services
– Knock-on effect to health of individuals
– Wider impact socially on individuals
– Lead to mental health emergencies & suicide
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Mental illness & healthcare
• Generally poor experiences of mental health
care:
– Invalidation of trans identity due to comorbid
mental illness
– Denial or delay of endocrine & surgical care due
to comorbid mental illness
– Perceived inability to seek mental health care
when in specialist gender identity services
– Stigmatisation and misunderstanding generally
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Refusal of treatment
• Inaccessibility or denial of treatment
relatively common in general & specialist
practice:
– GPs unwilling to prescribe or monitor hormone
replacement therapy off-licence
– Patients perceived as “not trans enough”
– Specialists feel unqualified to support a trans
person
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Inappropriate referrals & delays
• “The trans cold”
– Referring trans people with unconnected
healthcare needs to gender identity services
• “Ruling out mental illness / delusion”
– Facilitating a referral to gender identity services
on the condition of attending psychiatric service
prior to referral
– Recommendations of “reparative therapy” or not
coming out / transitioning
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Sexual & reproductive health services
• Inaccessibility (real & perceived)
– Gender/sex segregation
– Inability to facilitate trans people with “atypical”
genital configuration
– Post-surgical sexual health care
– Lack of understanding of common trans
endocrine care & its impact on sexual health
• Abortion access
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Gender Identity Services
• Perceived stigmatisation of trans identities
– Mandatory mental health assessments
– “Real Life Experience” requirements
– Scrutiny over sex lives of trans people
• Clinical threshold of “being trans”
– Propagation of narratives of typical trans
experiences
– Difficulties for non-binary people and gender
non-conforming men & women
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Records & confidentiality
• Recording of correct names & gender
markers
• Access to preventative healthcare
– Prostate screening for trans women & other
people assigned male at birth
– Cervical smears and breast cancer screening for
trans men & other people assigned female at
birth
• Inappropriate disclosure of trans status
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Clinical transphobia
• Common throughout healthcare services
– Humiliation and invalidation on basis of trans
status
– Refusal to treat, or inappropriate treatment on
basis of trans status
– Harassment and bullying
– Inappropriate treatment of partners & families
of trans people
– “Reparative/conversion therapy”
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Clinical homophobia & biphobia
• Invalidation of gender on the basis of sexual
orientation
– Heterosexuality expected
– Typical homophobia & biphobia propagated
– Invalidation on grounds of asexuality, especially
after transition
• Erasure of LGBTQ culture and expression
– RLE requirements of masculinity / femininity
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Issues for non-binary people
• Invalidation
• Lack of clinical leadership
– Misinterpretation of guidelines & governance
• Records problems, misgendering, erasure
• Specific refusal of treatment
• Real Life Experience requirements
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Issues for young people
• Access to healthcare
– Very long assessment times in specialist services
– High age requirements for endocrine interventions
– Invalidation of identity; written off to teenage
confusion
– Particular difficulties for non-binary young people
– Requirement of parental consent, including when
over 16
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Issues for ill & disabled people
• Similar issues as cisgender disabled people
• Comorbidity & access problems
• Invalidation of trans identity due to illness or
disability
• Delays in care due to changes in disability/illness
• Lack of care for people with learning disabilities
• Extended assessment times for Autistic people &
others with developmental disabilities
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What you can expect
• >120% year on year increase in trans & nonbinary people accessing support
– Healthcare service waiting lists
– Support services being overwhelmed
• Slow improvement in social understanding
• Language changing
• Your friends are trans
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Supporting trans patients
• Using correct names, honorific titles,
pronouns & gender markers
• Respecting confidentiality & sensitivity
• Respecting agency & capacity
• Not pathologising their identity or experience
• Making accommodations where possible
• Making appropriate referrals
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How you can help
• Make sure your work is inclusive (it’s
probably not)
• Challenge your own prejudices and
misconceptions
• Consider getting involved with advocacy
• Listen to and amplify trans community
voices
• Never accept transphobia
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Support & guidance
TransgenderNI.com
Hub of information & support for trans
people and carers/professionals in NI
RCGP NI guidance
bit.ly/GPtransNI
RCPsych GIS guidance
bit.ly/CR181
GMC guidance
bit.ly/GMCtrans
GIRES
gires.org.uk
GenderJam Sexual Health Guide
genderjam.org.uk/sexualhealth
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Questions
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Thank you
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[email protected]
@SAIL_NI / @ellenfromnowon
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Healthcare info:
transgenderni.com/healthcare
General resources: transgenderni.com
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