Be aware of the impact of our previous experiences: Trans people, mental health, and wellbeing

Prior experiences with healthcare providers and/or struggles with mental health can create barriers to trans people accessing healthcare. However, it is important to know that while the experience of dysphoria does play a part in impacting trans people’s mental health, being trans is not in itself a mental health condition and poor mental health ought not to be an inevitable outcome for trans patients.

It’s important to recognise the impact that a trans person’s previous experiences with healthcare professionals can have on their approach to accessing healthcare or communicating with healthcare professionals.

Previous negative experiences can act to deter trans people from accessing medical care as and when they need it. These previous experiences might also lead them to be more anxious about any appointments they do attend or about the prospect of an inpatient stay.

Trans people wait a long time to access NHS-funded transition related care, and many will be extremely conscious that their access to this care is controlled by medical professionals. Many trans people worry that a medical condition or procedure may result in them no longer having access to some or all aspects of their transition-related care – for example, their GP no longer prescribing their hormone replacement therapy or them being refused transition related surgery due to their mental health.

Trans people are more likely to experience poor mental health than the wider population.

Stonewall’s LGBT in Britain: Health Report (2018) found that within the past year:

  • 70% of non-binary people had experienced depression
  • 71% of trans people (including 79% of non-binary people) had experienced anxiety
  • 19% of trans people (including 24% of non-binary people) had experienced an eating disorder
  • 46% of trans people (including 50% of non-binary people) had considered taking their own life
  • 35% of trans people (including 41% of non-binary people) had self-harmed

The study also found that rates of mental ill health are higher for LGBT people of colour, disabled LGBT people and for LGBT people who have experienced a hate crime.

Within mental health services, 29% of the respondents to Scottish Trans Alliance’s Trans Mental Health Study (2012) felt that their gender identity was not seen as genuine and was seen as an aspect of their mental ill health, 26% felt uncomfortable being asked about their sexual behaviours and 17% were told that their mental health issues were because they were trans.

The Trans Mental Health Study found factors relating to discrimination, familial rejection, societal inequality and ongoing dysphoria can all have an impact on a trans person’s mental health. For disabled trans people, Black trans people and trans People of Colour, these issues are likely to be further exacerbated by other aspects of minority stress.

All of the factors outlined in this section may impact whether or not a trans patient presents at hospital at all, but also in the way they interact during appointments and inpatient stays. It’s important to be understanding of this in your interactions with trans patients and to take the extra time to listen to any of their concerns and offer reassurance. Taking a trauma informed approach to care is good practice, not just for trans patients but for all patients.

Read TransActual’s Trans Lives Survey 2021 and Transition Access Survey 2022 for more information on trans people’s experiences of discrimination and on the impact of waiting for transition-related care on trans people’s mental health.

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