Canada: Trans people´s challenges to access health and mental health services

Hunter Cubitt-cooke

Hunter Cubitt-Cooke I am a 32 year old, white, non-binary trans person who uses they/them pronouns. I come from a low class background and was raised in Canada’s conservative redneck capital, Alberta. I have been an activist and an anarchist, deeply feminist, anti-capitalist, anti-colonial and pro-queer and trans. I gave birth to my beautiful 4-year-old daughter and am now a parent. I work as an herbalist in an anti-capitalist worker collective now. I suffer from mental health and chronic pain and migraines. My primary focus now is healing. Healing myself and my family and trying to spread that healing into the world.

By Fernanda Sánchez Jaramillo.

Pictures: courtesy of Hunter.

FSJ: Is health one of the current challenges that trans people face in Canada?

HC: Health is a major challenge for trans people in Canada. Accessing competent and respectful health care can be close to impossible, at times traumatizing and often demeaning. There are also many social factors that contribute to the poor health outcomes of trans people like social isolation. We are often harassed and bullied out of training and schools; also cut off from our families and any supports. It’s difficult to find housing, employment and to access services etc.

FSJ: When and why did you need to access health services?

HC: So I needed to access health services to get the hormones I need as well as the surgery.   Through out the years I’ve had many bad experiences with doctors and nurses when I’ve had to encounter them for injuries and illnesses as well.

The medical establishment is a gatekeeper for trans people in terms of accessing hormones and surgeries. In order to qualify for hormones you need to identify as heterosexual (when you’ve transitioned) so I needed to identify as a “man trapped in a woman’s body that was attracted to women”.

If I had told my physician that I was attracted to men as well I would not have gotten my hormone prescription. You also need spend a year being completely out to coworkers, family etc. and using the washroom in the gender you identify as. Using bathrooms of the gender you identify as but do not yet appear as to most people without hormones puts people in really dangerous positions.

You also can’t have any mental health problems or instability, which most trans people do have as a result of trans phobia and the painful experience of living in the gender you are not. You can’t be homeless which a lot of trans people are as they can’t get work and even if they did have the money often landlords will not rent to a trans person.

FSJ: How was your experience with health services? Did you have any trans doctors?

HC: I have never had a trans physician. I have had a range from horrible to great health care in Canada. As a teenager, I told my doctor I was trans and wanted hormones and surgery. She refused and told me no one would do that for me. Eventually I found a doctor who was willing to prescribe hormones to me but I had to jump through a lot of hoops.

At times I’ve needed a hormone refill prescription and not been in a major urban center and been refused. Once a doctor screamed at me “YOU HAVE A VAGINA!!” when I wanted him to refill my prescriptions for me. Once I was trying to access mental health services and was referred to a psychologist through something called the “transgender health referral program”. This was supposed to be one of the better psychologists for trans people. He could not comprehend what a trans man was, how I could have possibly gotten pregnant, etc.

Most doctors are very ignorant on the subject matter and even those who are caring just don’t know a lot. There is very little research that has been done on long-term effects of hormones etc.

FSJ: Did you experience any stigmatization during doctor’s appointments?

HC: Definitely yes. It’s very hard to get a doctor who will see a trans person especially one who is willing to prescribe hormones. Then when you have one, it’s near impossible to get to see that doctor about any other health concern because it is usually only a small number of doctors for all the trans people.

I’ve often been humiliated and disrespected in waiting rooms before changing my name I’ve had nurses discuss in front of me in a room full of people whether I’m a man or a woman. In order to gain access to hormones I had to get diagnosed with a “disease” called gender dysphoria, which is considered a mental disorder. It is not an illness, this is pathologizing and opressive.

Hunter remembers…

“Once during an osteopath appointment I was asked if I love and accept my vagina. People are constantly asking trans people about their genitals and its very dehumanizing because it feels like something that wouldn’t happen to any other human. I can’t imagine that osteopath would have felt comfortable asking any woman out of nowhere if she loves and accepts her vagina”.

FSJ: How these experiences with health services impact your life and what is your suggestion to other trans people to protect them?

HC: It has contributed to my overall sense of anxiety and fear and also the feeling that there is nowhere to turn for support. I often feel alienated from the healthcare I need.   To other trans people I suggest always bringing a friend or family with you to doctors appointments, get someone to advocate for you, ask around to find doctors who are willing to see you in a respectful manner.

FSJ: Does mental health services satisfied the needs of trans people?

HC: Definitely not. Trans people are more vulnerable within institutions and are rarely protected and supported as needed. Services are often gendered with trans people being barred from services or for services not being applicable.

For example in my desperate search for mental health support during my postpartum depression and psychosis I was referred to a postpartum support group but how could I have gone to a room full of women who would be staring at me as I enter the room expecting an explanation while I was having a mental breakdown? And who knows how the women would have reacted. Likely I would have gotten more traumatized and likely the facilitator in the group would not have had my back and would have been totally ignorant to trans issues”.

Hunter and daughter

“At one point I was trying to access counselling services and was referred to someone and I had said I needed someone who was comfortable talking with trans people. This person kept veering the conversation away from what I was talking about and asking me a bunch of inappropriate questions like did I still have a vagina, how did I get pregnant how do I have sex etc. I reported that person and it turns out she had never even spoke to a trans person before”.

A lot of Dr.’s will make trans people see a psychologist who will try to get them to accept the gender they were assigned at and only after that process if they still want to transition, they get the hormones. Most trans people have PTSD, depression, anxiety etc. and it is extremely difficult to access services that can help. You also need money to get most of these things which trans people have less access too.

FSJ: What needs to be changed in order to provide a better service?

HC: I think the entire system is patriarchal and fundamentally flawed and needs to be completely dismantled. The idea of a doctor, a specialist, an expert that knows everything and the patient knows nothing is oppressive, disempowering and paternalistic.

We need to return to traditional modes of healing that are holistic, look at and respect the whole person, and is supportive of people’s own healing journeys and values different types of bodies.

A big part of why trans people are experiencing poor health outcomes is because of the unhealthy dynamics between men and women because trans people face a lot of the brunt of the violence as they are on the fringes and bring up issues of gender. Trans people need patriarchy, misogyny, sexism and homophobia to end to live healthy lives.   In the mean time much more education and exposure would help. It would help to have trans people as receptionists, nurses, technicians, and doctors and for patients to inform the process more. Even changing the intake forms to include trans people can go a long way.

FSJ: Are there any alternative service providers for trans people?

HC: There is a small amount of doctors and counsellors who specialize in trans people but is often very hard to get appointments because there are only a small number in Canada.

 

How mental health language impacts stigma

On this interview, Rebecca Palpant Shimkets, associate director, The Rosalynn Carter Fellowships for Mental Health Journalism and The Carter Center Mental Health Program, explains how journalists could contribute to reduce stigma while reporting on mental health.

Some of the key recommendations are:

  • Do not describe an individual as mentally ill if it is not necessary.
  • Use specific conditions and disorders terms.
  • Do not use terms such as “insane,” “crazy,” “nuts” or “deranged”.
  • Do not link mental health to violence.
  • Be mindful of the way you describe a person living with behavioral health issues.
  • Avoid using mental health terms to describe non-health issues.
Click here:
  

How Mental Health Language Impacts Stigma