Trans-Affirming Mental Health Care: Considerations for Clinicians
Access to affordable, quality mental health is vital for positive individual outcomes as well as healthy communities. There are nearly 20% of adults in the U.S. with a mental illness, according to Mental Health America’s State of Mental Health in America Report 2022. Even more, the prevalence of mental health conditions among marginalized populations, like the LGBTQIA+ community is even higher. The study found that 39% of folks who identify as LGBTQIA+ reported having a mental illness. This number increases even more when specifically looking at transgender folks, and increase more again among Black trans folks.
Studies have found that transgender individuals who experience gender incongruence — also known as dysphoria — are more likely to experience depression, anxiety, and suicidality. Even with all these facts well documented, finding gender-affirming clinicians is not always easy to find.
To boost your competence as a clinician in the mental health field, here are some things to consider expanding upon in your practice to better support transgender clients.
Continue educating yourself on transgender issues
Gender-affirming support is one of the top ways clinicians — and the rest of us — can help move towards a more inclusive world for trans folks. Beyond this, staying up-to-date on state and federal legislation impacting the trans community is key. As a clinician, already having an understanding of what’s going on when it comes to the fight for trans rights will help take off some of the pressure trans clients may feel about educating a non-trans clinician.
Beyond staying up to date on legislation, continued education on transgender healthcare is a necessary step all clinicians should take. Educational programs for health care professionals — whether it be medical schools or graduate programs for social work or mental health counseling — do not prepare students appropriately for a future of working with members of the LGBTQIA+ community. In fact, NPR reported in 2019 that many medical schools specifically did not offer classes on LGBTQIA+ health issues as part of required curricula. Instead, these issues were covered in elective classes, some of which were taught by students themselves. However, you can commit to continuing learning on your own. There are formal trainings hosted around the country, as well as books, articles, shows, organizations, and other online resources you can tap into to educate yourself on trans experiences. Here are some we’d recommend:
- The Transgender Training Institute
- The World Professional Association for Transgender Health
- A Clinician’s Guide to Gender-Affirming Care: Working with Transgender and Gender Nonconforming Clients
- Trans Bodies, Trans Selves
- Understanding Gender Through the Lens of Transgender Experience
- The Body One Is: The Best Form of Containment or The Crying Game Redux
- LGBTQIA+ Glossary of Terms for Health Care Teams
Have a list of community resources on hand
The transgender community faces unique barriers when it comes to accessing healthcare. In a study of over 6,000 transgender and gender non-conforming folks, it was found that experiences of discrimination where equal treatment was denied was reported by 24% of participants in doctor’s offices or hospitals, 13% in emergency rooms, 11% in mental health clinics, and 5% for ambulance or emergency services. Study participants also reported higher rates of harassment and disrespect for the same locations.
Because of this discrimination and lack of equitable treatment, many trans folks may not know where to turn for various services or be fearful of potentially hostile and harmful environments. As a clinician, having a list of trans-affirming community organizations and businesses can be extremely helpful to clients. Building a list like this can also be a great opportunity to connect with the LGBTQIA+ community in your area. This list could include things like additional therapists, doctors that specialize in trans healthcare, helplines, community support groups and non-profit organizations, resources for name changes, and even gender-affirming salons. All of these types of services can be great tools to promote the wellbeing of trans clients.
Consider offering sliding scale rates for care
Beyond the frustration and fear that can come from seeking out trans-affirming services, many trans folks also are at greater risk for unemployment and poverty, which means they have a more difficult time obtaining adequate health insurance coverage. Studies have found that transgender workers report unemployment at twice the rate of the population as a whole in the U.S. Even more, transgender workers in the U.S. are nearly four times more likely than the population as a whole to have a household income of under $10,000 (15% versus 4%).
These statistics are caused by many factors like hiring bias, on-the-job discrimination, wage inequities, lack of explicit legal protections, inablity to update identity documents, unequal access to insurance benefits, and denial of personal medical leave. So, as a clinician, you may consider offering sliding scale rates or taking on select pro-bono clients to make your services more accessible to trans folks who may not have insurance and/or the financial means to pay out-of-pocket rates.
Lastly, we wanted to provide some additional tips and suggestions for improving your services for transgender folks –
- If you’re not sure of a term your client uses, just ask. There’s a big difference between asking your client what a specific term means and expecting them to educate you on the entirety of the trans rights movement.
- Use gender-neutral and affirming language like they/them/theirs, people/foks/friends, child or sibling, and partner or spouse. And if you mess up, apologize.
- Remember gender identity is just one of many identities clients have. Affirm the experiences of your client within the intersection of all their identities.
- Be aware of microaggressions like backhanded compliments, presumptions about sexuality, or unnecessarily outing a client to another clinician.
- Foster a gender-inclusive environment at your practice including access to all gender restrooms, intake paperwork that allows for expression of gender identity, and gender-affirming online practices like adding pronouns to email signatures and Zoom names.
If you want to learn more services we provide for the LGBTQIA+ community here at Mind Body Co-op, go here!
Mind Body Co-op is Chicago’s only space for individuals to discover, explore, and heal what is occurring internally at the cognitive, emotional, and physical levels. This unique, holistic approach to treatment and wellness is born out of the belief that examining the cognitive, emotional, and physical pieces and how they intersect helps lead to uncovering your full potential by providing thoughtful, collaborative, and complete integrative mental health care. We offer a variety of clinical services, including individual psychotherapy, group psychotherapy, psychological/neuropsychological assessments, medication management, CPT (comprehensive transitional program), medical nutrition therapy, somatic mindfulness, somatic groups, DBT, adventure therapy, therapeutic yoga, and more. We provide culturally competent services in English, Mandarin, Spanish, French, Russian & Arabic.