On the very day that the Supreme Court issued the Obergefell decision making marriage equality the constitutional law of the land, I spent part of my day in a doctor’s office just across the river in Arlington, Va. As my colleagues celebrated the major victory for LGBTQ rights in front of the Supreme Court that hot and humid Washington day, I was looking for a new psychiatrist. I had moved to the D.C. area six months before for a new job, and had been looking for someone who could simply continue and maintain the work of her three predecessors (across multiple states) in regard to my ongoing treatment for bipolar disorder. The process is straightforward and generally results in the continuation of treatment and medication.
However, that’s not what happened on that muggy summer day. Instead, my prospective therapist became fixated on the fact that I was transgender, and ultimately said that the diagnoses and medication regimens that had been working for me for the past several years were wrong and that I merely had "unresolved issues" from my transition of around 10 years ago. She also refused to write a refill for my current medications, which require uninterrupted access in order to manage my bipolar disorder. Interruption in access to psychiatric medications, like any other medication, can lead to a sudden worsening of symptoms and sometimes-lethal medication withdrawal.
While I eventually found a culturally competent mental health provider in D.C., my experience is far from unique in the transgender community. According to the National Transgender Discrimination Survey, 28 percent of transgender people have experienced some form of harassment in a health care setting due to their being transgender, and 19 percent have been outright denied medical care due to their being transgender. Health care discrimination for the transgender community is too often a fact of life, manifested in ways such as deliberate misgendering, denial of care, ridicule, or refusal to continue hormonal care.
While we know from this survey that 41 percent of transgender people have attempted suicide at some point in their lives (and are by extension much more likely to have contact with mental health care systems), we have not surveyed the transgender people on their experiences with psychiatry and mental health care. Therefore, we don’t know to what extent transgender folks are being discriminated against or mistreated in mental health care settings. Even in the best-case scenarios, transgender people are often misgendered and dead-named after providing the names and pronouns with which they identify.
There are many types of mental illnesses (depression, bipolar disorder, attention deficit hyperactivity disorder, post-traumatic stress disorder, schizophrenia, etc.), and they are as complex as the people who live with them. With the noteworthy exception of trauma-based mental health conditions, these are, like physical illnesses, by and large biological in origin and unrelated to a transgender person’s gender identity. However, this does not necessarily mean that — as evidenced by my experiences and those of so many of my friends — providers will be sensitive about transgender issues and will not try to conflate a patient’s gender identity with their mental illness, or to blame their mental illness for their gender identity. In fact, 50 percent of transgender people have reported having to educate their health care providers about transgender issues — this is all the more urgent in psychiatry, where patients are often not given the chance to educate their providers or have their input be heard in the first place.
It is clear that additional funding must be allotted to ensure that transgender people have access to affordable and culturally competent mental health providers. Unfortunately, lawmakers are pushing for mental health legislation that could be very harmful to transgender people. The so-called Helping Families in Mental Health Reform Act of 2015, introduced by Rep. Tim Murphy, a Pennsylvania Republican, with support from 187 members of Congress, touts itself as a solution to the need for mental health reform. Instead, what the bill would do, among other things, would be to gut the protection and advocacy programs that safeguard the rights of people with mental illness in institutional settings, and most alarming to the transgender community, would gut confidentiality provisions around mental health, granting family members and other individuals access to mental health records and treatment information.
When 57 percent of trans people have experienced significant family rejection, and one in five have experienced domestic violence, these attempts at mental health “reform,” which automatically assume people with mental illness as incompetent will be cared for by “loved ones” who may not be so loving, only place trans lives in even greater danger.
As we gear up for Pride celebrations all across the nation and draw Mental Health Awareness Month to a close, we must use this time as a call to action. To ignore the needs of transgender people with mental illness would be to leave an unacceptable gap in our advocacy for access to healthcare for all trans people and to ignore a fundamental intersectional issue. It is necessary for transgender community advocates to understand that mental health is a transgender issue, and to partner with the disability advocacy community, in order to ensure that mental health policies empower people with mental illness to be in charge of their own lives. One of the great mottoes of disability advocates is “nothing about us without us.” We must join that fray with that fundamental principle in mind. That is the way forward for a transgender community that is inclusive of mental illness.