Tackling health inequalities in the trans community

Recent research reported in the Guardian revealed that transgender people in the UK are much more likely to experience long-term mental health problems compared to their cisgender counterparts.

The research, led by the University of Manchester in collaboration with the Proud Trust and LGBT Foundation, is the first large-scale study of its kind and found that one-in-six transgender people are at risk of long-term mental health conditions, compared to one-in-10 cisgender men and women.

The study, based on pre-existing data of 1.5 million over 16-year-olds, including 8,000 transgender people, also found that those with a gender identity other than cisgender male or cisgender female were more likely to report unmet needs at their last GP consultation. 

Sadly, these figures are reflected in suicide rates within the transgender community, with statistics showing that around half of transgender youth attempt to take their own lives (Biggs, 2022).

And yet transgender people are increasingly reluctant to access healthcare, with one survey of British trans people finding that 57 per cent of respondents reported avoiding going to see a doctor when unwell (TransActual, 2021)

Why is this? A multitude of factors could be to blame including a lack of awareness or assumption of cisnormativity from healthcare professionals, discrimination from those outside of the LGBTQ+ community and residual frustration with services following long waiting lists associated with gender-affirming treatment (Wright et al., 2021).

Thus, while the mental health disparities and the transgender community's hesitation to engage with services can be explained, it fails to provide a solution to a multifaceted problem within the NHS.

How can we address the healthcare needs of the trans community in a world where there is no button to erase all stigma and preconceived notions of transgender individuals? Or a similar button to erase the negative experiences of transgender people in healthcare and society? One way to solve this problem is the same within healthcare as it is elsewhere: Representation.

Disclosure, a 2020 documentary about transgender representation on screen, identified that 80 per cent of individuals in the USA reported not knowing a transgender person. In both the UK and USA, it has been reported that 0.5 per cent of individuals do not align their gender with their sex registered at birth (UK census, 2021, Herman et al., 2022).

Therefore, the assumption can be drawn that, as in the USA, so in the UK, not many people know a transgender person or are aware that they do. This is important because most individuals' understanding of transgender people will be gathered exclusively from the media, where portrayals are often offensive, stigmatising and ultimately inaccurate.

This impacts public perception, which guides institutional legislation, maintaining harmful narratives.

This is where a workforce that includes members of the transgender community becomes invaluable. According to the NHS Staff Survey (2022) there are currently believed to be only 2,000 transgender staff in the NHS, 0.4 per cent of a 600,000+ workforce. Crucially, regional variations mean that while in some areas there may be representation, in others there may be little or no representation which may make transgender people reluctant to seek treatment.

Inclusion of transgender practitioners has multiple benefits across NHS services. For practitioners who would usually not be exposed to the transgender community, working in teams with transgender individuals toward a common goal allows for better awareness of trans identities, beyond what is observed in the media.

Working alongside colleagues from the community encourages empathy and understanding, which in turn can rewrite preconceived notions of trans people, improving practitioner cultural competence and allowing a more open approach to institutional change and individual learning.

Undeniably a more open, competent, and trans-inclusive workforce will have a ripple effect for the comfort, health and safety of transgender patients. Patients who, despite the media vitriol, have a right to the comprehensive healthcare delivered with respect and dignity mentioned in the NHS Constitution for England (2023).

For reasons mentioned before, transgender patients have received substandard care, including being subjected to ill-informed assumptions and degradation at already vulnerable times.

A trans-inclusive and informed workforce can provide better care for transgender patients. Aside from this, the presence alone of receiving care from a transgender practitioner, for a transgender patient has the potential to impact a patient's journey and perception of services.

In short, I believe that increased transgender representation within one of the largest healthcare workforces in the world can improve education and openness, contributing to an improvement in mental health outcomes, a better NHS, a more informed public, and a trans-inclusive future that is safer for all.

Views expressed in the article are those of the author, not the BPS.

About the author

Chaz Hill is a mental health wellbeing practitioner at Surrey and Borders Partnership NHS Foundation Trust.

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References

• Biggs M. (2022). Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom. Archives of sexual behavior, 51(2), 685–690. https://doi.org/10.1007/s10508-022-02287-7
• TransActual. Trans lives surgery 2021: enduring the UK's hostile environment. https://www.transactual.org.uk/trans-lives-21 (cited Feb 2024).
• Wright, T., Nicholls, E. J., Rodger, A. J., Burns, F. M., Weatherburn, P., Pebody, R., McCabe, L., Wolton, A., Gafos, M., & Witzel, T. C. (2021). Accessing and utilising gender-affirming healthcare in England and Wales: trans and non-binary people's accounts of navigating gender identity clinics. BMC health services research, 21(1), 609. https://doi.org/10.1186/s12913-021-06661-4
• Herman, J. L., Flores, A. R., & O'Neill, K. K. (2022). How many adults and youth identify as transgender in the United States?