Another barrier for transgender and non-binary minorities: getting mental-health help

Transgender and non-binary racial and ethnic minorities experience “significant discrimination” in mental-health care access, suggests a new report distributed by the National Bureau of Economic Research.

African-American and Hispanic people who are transgender or non-binary — especially non-binary African Americans and Hispanic transgender women — encounter discrimination when they try to access mental-health care appointments, according to results from the first wave of a still-ongoing study by researchers at Tulane, Texas A&M, American and Georgia State Universities.

“Regardless of the cause of any underlying discrimination, if [mental-health care providers] are less responsive to and less helpful towards racial and gender minorities, this behavior will decrease access and reduce the probability that these individuals receive timely and necessary medical care,” the authors wrote. 

“Discrimination, including based on gender identity, also violates the American Counseling Association, the American Psychological Association, and the American Medical Association’s ethics codes,” they added.

The researchers conducted an experimental field study in which they requested appointments with mental-health providers through “a popular online website,” with randomly assigned names to indicate a particular gender and race, a randomly assigned common mental-health concern, and disclosure of the fictitious patient’s gender identity. 

They then recorded whether providers responded to their inquiries with an appointment, a call or offer of consultation, an offer of waitlist placement, a referral to another provider, a rejection or a nonresponse. 

For transgender and non-binary people and cisgender racial minorities contending with psychological stressors, ‘counseling and therapy are effective and common strategies for helping with numerous mental health concerns, such as stress, anxiety, depression, and substance misuse.’

— a new report distributed by NBER

Preliminary data from the first wave of the researchers’ experiment included 1,000 observations and provided a nationally representative sample, they said. The authors acknowledged that while their study discussed transgender and non-binary people as a group (referred to throughout the paper as TNB), they are separate gender identities.

Transgender refers to someone whose gender isn’t exclusively the gender they were assigned at birth, according to the Trans Journalists Association; non-binary is an umbrella term for genders aside from man and woman, as well as a term for a specific gender. Cisgender refers to someone whose gender is exclusively the gender they were assigned at birth.

In general, comparing transgender and non-binary prospective patients to cisgender ones didn’t reveal differences in providers’ positive response rates — a lack of difference that the researchers chalked up to positive response rates potentially being higher for white transgender individuals. But this is offset by “significantly more frequent” discrimination that transgender and non-binary African-American and Hispanic people face, they added.

And while prospective patients who are African American and Hispanic do, on average, face discrimination, the discrimination against specific intersectional groups appears to fuel that overall difference, the authors found. The biggest differences in positive response rates came from comparing transgender and non-binary African American (50%) and Hispanic people (53%) to cisgender white people (62%), the authors found.

“Thus, it appears that the discrimination against [transgender and non-binary] prospective patients is largely discrimination against [transgender and non-binary] African-Americans and Hispanics,” they wrote.

As the authors note, transgender and non-binary people already struggle with discrimination and stigma in many other aspects of their lives, and are more likely than cisgender individuals to live in poverty, be unemployed and face obstacles in the health-care system. They also experience mental-health conditions like depression, anxiety and suicidality at higher rates than people who aren’t transgender or non-binary.

Transgender women of color are at particularly high risk for violence. At least 40 transgender or gender non-conforming individuals have been killed by violent means in 2020, according to the Human Rights Campaign, “the majority of [whom] were Black and Latinx transgender women.”

For transgender and non-binary people and cisgender minorities contending with psychological stressors, “counseling and therapy are effective and common strategies for helping with numerous mental health concerns, such as stress, anxiety, depression, and substance misuse,” the present study’s authors said.

“However, suppose providers of these mental health services discriminate against TNB individuals and racial minorities by restricting access to these services,” they added. “In that case, this discrimination may partially cause and likely exacerbate underlying race and gender identity-related mental health disparities.”

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Racialized trans and non-binary people in Canada face higher levels of discrimination, fear of police: report

New insights from a national survey of transgender and non-binary people in Canada suggest that trans people of colour face more harassment, with almost three quarters reporting they fear harassment or scrutiny from police forces simply because of who they are.

Forty-five per cent reported having been harassed at some point at work or at school.

In 2019, Trans PULSE Canada conducted a survey of 2,873 trans and non-binary people across Canada. The report released this week represents the second analysis of the data collected in that survey, focusing on racialized trans and non-binary people.

The report specifies that they used the term “racialized” to include “people and communities that experience racism.”

“Racialization can be conceptualized as ‘the process by which societies construct races as real, different and unequal in ways that matter to economic, political and social life,’” the paper stated, quoting the Ontario Human Rights Commission. The report clarified that their count of racialized trans and non-binary people includes those who identified as a person of colour as well as those who indicated on the survey that they were perceived as a person of colour.

Out of the 2,873 respondents who took the survey in 2019, 14 per cent identified as racialized — a little over 400 people. The authors pointed out that barriers to accessing the survey or the possibility that many did not know about its existence mean that this cannot be taken as a true reflection of what percentage of trans and non-binary people are racialized.

Trans PULSE Canada’s first analysis of this data, released in March, focused on how survey respondents reported having healthcare needs unmet.

While racialized and non-racialized respondents reported similar levels of mental health and issues getting health care, there were some marked differences.

One in four trans and non-binary people of colour said they were disabled or living with a disability, compared to 18 per cent of non-racialized trans and non-binary people.

When it came to being the target of violence or harassment, racialized trans and non-binary people were more likely to receive all forms of violence and harassment, reporting at least four per cent more than non-racialized respondents.

That gap widened depending on what type of violence or harassment the survey specified.

Half of racialized respondents had been the target of sexual harassment, compared to 42 per cent of non-racialized respondents.

And a third of trans and non-binary people of colour reported having been sexually assaulted within the last five years, compared to a quarter of non-racialized trans people.

Trans people of colour were also eight per cent more likely to avoid religious institutions out of fear of harassment or being outed than non-racialized trans people.

One of the most significant differences between racialized and non-racialized respondents came when respondents were asked if they experienced worries about being stopped or harassed by police or security.

Although it was high across the board — half of non-racialized trans or non-binary people said they did worry about police harassment — 73 per cent of racialized respondents answered that they feared police harassment.

On top of that, only 19 per cent of racialized respondents anticipated getting fair treatment from the police if they reported a physical assault, while a third of non-racialized respondents felt that they’d be treated fairly. The trust level dropped if respondents were asked about reporting a sexual assault, with only one in 10 of racialized respondents anticipating fair treatment.

Feeling unable to trust the police can have direct ramifications for wellbeing and health. A quarter of trans people of colour said they had specifically avoided calling 911 for emergency medical services within the last five years.

Researchers said this was the first quantitative, all-ages data that has been compiled on racialized trans and non-binary people within Canada, and that the results highlight how racialized members of the trans community face high levels of discrimination, violence and “anticipated and actual negative experiences with police and the legal system.”

As with racialized people in the general Canadian population, racialized trans and non-binary people experienced profound levels of discrimination compared to their non-racialized peers,” the study stated.

One racialized participant of the survey, who was not identified in the paper, was quoted as saying they are “hoping this [study] will shape change to uphold the full humanities of trans femmes and trans women … I see white, trans femmes experience life with so many more options for their survival than those of us who are racialized.” 

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