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Gender Diversity and Mental Wellbeing

The mental health of the lesbian, gay, bisexual, transgender, intersex, queer/questioning and asexual (LGBTIQA) students can be poorer than the cisgender, heterosexual majority. 1

Contributory factors to the higher trans and gender diverse (TGD) mental health burden

Reasons for the high mental health burden within the LGBTIQA community are varied, with TGD people more significantly at risk. Being TGD is not itself a mental illness, but the minority stress experienced by TGD people within an often-hostile society leads to an increase in levels of anxiety and depression and decreased access to mental health care.

The TGD community almost universally experiences fearing and or being victim/survivors of violence and sexual assault, experiencing rejection by family and friends, and the frequent denial of medical care, housing, employment and education due to discrimination, bigotry and ignorance. It should be noted that not all TGD students will have poor mental health. Differing stressors and resources create different likelihoods of poor mental health.

The TGD community encompasses many ethnicities, ages, levels of ability and education, and socioeconomic statuses, although access to employment and education is limited by exposure to discrimination. Stressors for TGD people may include those resulting from other minority groups they have membership of, and not from being TGD.  Culturally and linguistically diverse students may have ways of relating to their gender identities that differ from dominant Western TGD norms. This can include Aboriginal and Torres Strait Islander students. Deferring to the terms used by the individual for their gender, their relationships and their role in society is vital.

A high overlap between the TGD and autistic populations exists, and additionally TGD students may have disabilities unrelated to their mental health.

Tips for supporting (TGD) students to feel safer in your institutions.

Examine your own biases

  • Do not assume all student are heterosexual or cisgender
  • Respect students’ privacy

Name/pronouns

  • Introduce yourself with your pronouns: this avoids only asking obviously-TGD students for their pronouns.
  • Routinely ask all students for their name and pronouns and model the use of them to encourage students to do likewise: this signals that TGD students are welcome and safe in the classroom and allows them to avoid using a legal name which may cause distress.
  • Refer to students using non-gendered collective terms instead of ‘ladies and gentlemen’.
  • Avoid the use of ‘he/she’ in class materials and instead use the neutral ‘they’.
  • Don’t wait until you have a visibly-TGD student, it is impossible to know if someone is TGD unless they tell you.

Course content

  • Highlight course content which may be upsetting to TGD students, this allows them to manage their mental health needs without disclosing that they are TGD.
  • Point out cisgenderism in course content and readings, even when that cisgenderism manifests in the seemingly benign assumption of cisgender heterosexuality in case studies.
  • Include TGD people in examples, where being TGD is incidental and not the focal point or issue, to normalise the existence of TGD people.
  • Challenge students who object to the inclusion of marginalised groups to think about why that inclusion is inconvenient enough for them to remark upon.

Navigating student conflict

  • A TGD student may have already been exposed to their peers engaging in casual transphobia: setting an example uses your authority in the room to set the tone and doesn’t rely on the TGD student complaining before change is made.
  • Challenge cisgender students who ask for sensitive information such as a previous name or which bathroom is used: reliance on TGD students to argue for inclusion or to rebut cisgenderism is an unfair burden on them.

Where to refer students for support

It is important to have an awareness of some common barriers to accessing mental health supports, In order to help TGD students navigate the mental health systems.such as, students may lack identification that reflects their chosen name and presentation, exposing them to potential transphobia. Wherever possible, make reasonable allowances for students without insisting on identification,  proof of mental health concerns, the financial barriers, lack of understanding amongst general clinicians, and extended wait times to access specialist supports.

TGD-specific services such as public gender clinics, private psychiatrists and psychologists and LGBTIQA counsellors at major universities may have extended wait times for initial appointments, high financial costs, and tend to be located in major cities only. Mental health professionals may claim to work with the TGD and or LGBTIQA population as a specialty. However, this does not mean they are trans-affirming and they may instead be anti-LGBTIQA. TGD-specific services may not be appropriate due the risk of being outed to unsupportive family.  Telephone counselling may be preferable for some students and a barrier for others. State TGD peak bodies such as Transgender Victoria or The NSW Gender Centre keep lists of TGD affirming mental health support services, as does QLife.

TGD-specific supports include:

Cisgenderism

Cisgenderism is an ideology, a society-wide belief that views binary, assigned sex as synonymous with gender and as one of the most basic divisions between people. The validity of this division relies on it being viewed as inherent and natural and it is therefore vulnerable to potential deconstruction.

The existence of TGD people calls into question this fundamental social divide. Viewing TGD people as unnatural and sexually deviant results from this belief and is termed cisgenderism. It manifests at all levels of society: at a structural level, erasure and exclusion can be shown by a refusal to allow a way to accurately record the gender of a TGD person or a demand for sterilisation surgery before changing legal documentation to reflect the gender a person identifies with and presents as; on an individual level, microaggressions and violence can be expressed by refusing to use the correct name and pronouns, threatened or actual disclosure of the TGD person’s gender identity to others, invasive demands for justification of the TGD person’s gender, and the ridiculing of TGD peoples’ bodies.

For people who have identities and bodies that are socially contested, interactions with others have a significantly increased ability to cause harm, particularly when those people are teens or young adults. Addressing cisgenderism requires an understanding of this deeply held social norm and examining the implicit biases it creates, in addition to critically reflecting on your own beliefs around gender identity, expression and expectations of others.

With an awareness of cisgenderism and the location of yourself within that ideology, education staff are well-placed to directly and indirectly address barriers for TGD students, and in doing so support their mental health.

The following references may be useful in beginning your reflections on what gender means to you, and why.

The impacts of marriage equality and marriage denial on the health of lesbian, gay and bisexual people (.pdf) ACON. (2016)

Australian Professional Association for Trans Health (AusPATH). Australian Professional Association for Trans Health (AusPATH) (2019)

Bending gender, ending gender: Theoretical foundations for social work practice with the transgender community. Burdge, B. J. (2007)

Gender trouble: Feminism and the subversion of identity. Butler, J. (1990)

Protocols for the initiation of hormone therapy for trans and gender diverse patients. (.pdf) Cundill, P., & Wiggins, J. (2017)

Transgender and gender diverse health and wellbeing background paper. Department of Health and Human Services (DHHS). (2014)

Smoothing the rough road of gender transition. Durham, P. (2019)

Unlearning cisnormativity in the clinic: Enacting transgender reproductive rights in everyday patient encounters. Erbenius, T., & Payne, J. G. (2018)

Transgender-competent health care. Fitz, M. (2019)

Introducing queer theory into the undergraduate classroom: Abstractions and practical applications (.pdf). Greene, F. L. (1996)

Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., T’Sjoen, G. G. (2017)

Snapshot of mental health and suicide prevention statistics for LGBTI people (.pdf) National LGBTI Health Alliance (2016)

From Blues to Rainbows: The mental health and well-being of gender diverse and transgender young people in Australia

Published: March 2020