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.’
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.”