Transgender Mental Illnesses and Discrimination in Healthcare
Should people be judged depending on who they are or what they are? In most societies, no one is concerned with who a person is, and the focus is on what an individual is. Stereotypical beliefs govern how an individual treats another, even without taking time to understand the person. The healthcare system has not been left behind, and discrimination against specific groups is becoming widespread. Transgender individuals are among the people experiencing widespread discrimination in healthcare. Transgender patients have been reporting a multitude of experiences in healthcare, which point to discrimination. They have reported being denied some treatments, such as fertility treatment, routine screening, and even counseling. Discrimination has become one of the factors that have been linked to delayed care and the development of comorbidity. Whenever an individual encounters a negative experience in healthcare, it becomes likely that the individual will postpone or not seek healthcare services in the future. Although systematic changes have been taking place to ensure that there is providing education, the knowledge gap has not yet been closed, and this group continues to face discrimination as a barrier to healthcare. The article, Protecting and Advancing Health Care for Transgender Adult Communities by Medina et al. (2021) talks about the challenges the transgender community face in healthcare. The authors indicate that transgender people are more likely to experience health-related problems compared to the general population. This is largely because they are more likely to experience health problems related to HIV/AIDS, mental illnesses, substance abuse, and sexual violence. This indicates that there is a need to understand this group better. Medina et al. (2021) argues effectively that the disparity in healthcare for transgender people arises from social determinants, and they significantly contribute to the high cases of mental health problems in this population.
The audience of the article, Protecting and Advancing Health Care for Transgender Adult Communities by Medina et al. (2021) is the federal government and policymaker. They make this very clear as they reference the government being the only entity having enough funding and power to provide real change to the treatment and understanding surrounding transgender healthcare. This is evident such as when the authors say “the Biden administration, Congress, and state and local governments should increase funding and support for entities providing LGBTQI+ family acceptance models” This shows the authors direct appeal to these officials through them calling them out the appropriate action they should take highlighting the word “should” meaning that it is not in place now but it should be. The authors, Medina et al, all have a lot of expertise in the field as some of them are policy analysts showing they are well versed with problems that currently exist in the government and work diligently to provide solutions to solve it. Also, they have conducted many LGBTQI+ research projects in their careers further showing that they are very knowledgeable in this area. This article has a very formal tone with it being very thorough in their points but also keeping it respectful at the same time. It follows the format of a scholarly article as its genre and through a website medium. The stance of the article is the disparity in healthcare for transgender people arises from social determinants, and they significantly contribute to the high cases of mental health problems in this population.
Social determinants have huge effects on transgender individuals. These people often experience high rates of poverty, which contribute to healthcare unaffordability. Moreover, these people also experience high instability rates, which disrupt care. They are also discriminated against by the medical providers whenever they seek medical health. Their struggles are mainly seen as attempts to draw attention, and in most cases, they are left to solve their issues on their own. According to Safer et al. (2016), whenever an individual is verbally harassed by a doctor or is misgendered, the individual may be less likely to seek care, may it be urgent or routine. It leads to long-term consequences on the individual; for instance, whenever a transgender individual fails to seek healthcare services after experiencing suicidal ideation, one may end up attempting suicide. It is an indication that the experiences of transgender people lead them to keep away from healthcare institutions, which affects their health. It may lead to the onset of mental health issues, making the number of transgender people with mental health problems escalate.
Transgender individuals face rejection from their families, which contributes immensely to their poor health outcomes. Transgender individuals tend to have strained relationships with parents, and many of them have reported that they were kicked out of their homes upon their parents’ knowledge that they are transgender (Cerretani, 2020). On the other hand, others run away from their homes for fear of their parents’ reactions. This shows that most transgender people move out of their homes before they are old enough. Therefore, they are in need of parental guidance, but circumstances force them to move out. Consequently, they experience homelessness, have no parental love and guidance, and at a young age, they are left to fend for themselves. Such individuals become hopeless in life, and they are more likely to misuse drugs or attempt suicide. This information indicates that parents have not yet come to terms with the fact that being transgender is not a child’s choice but a biological occurrence. There are gaps in knowledge, and society is yet to understand about transgender and what makes individuals move along that path, despite the many challenges.
Transgender increasingly experience a negative encounter with the law and also face mental health issues whenever they are incarcerated. It can be argued that the police may target transgender individuals during discretionary interactions. In most instances, women of color who happen to be transgender are often police targets. Medina et al. (2021) indicate that police are fond of stopping individuals even when they have not violated the law, and black women are among their targets. Therefore, whenever a black woman happens to be transgender, she is misjudged and considered a sex worker, which creates grounds for them to be accosted. Whenever such women are in possession of items such as condoms, this becomes a justification of the arrest and evidence of prostitution. This explanation indicates that the transgender population has a higher contact rate with the criminal system, and their number is likely to be twice that of cisgender people. The criminal justice system does not consider the gender transgender individuals identify themselves with, and whenever placing them in prison, they often consider their assigned gender at birth. There are higher possibilities that such individuals will be assaulted when in prison. Additionally, transgender individuals are harassed whenever placed in a general population prison. While some receive transition care when they are living everyday lives out of prison, this care is discontinued in prison, making them undergo a confusing experience. This confusion may contribute to mental health issues because these transgender individuals feel that they do not fit in the society, regardless of their efforts. No one cares about their experiences and challenges during their difficult times because transgender is considered beings with no morals or respect for religion. It is also important to note that many LGBTQ individuals living with HIV/ AIDS, and whenever they are in detention, they do not often receive the appropriate care.
Most transgender individuals do not have accurate identity documents. The state-level restrictions have created barriers to transgender individuals because it has come up with restrictions to identification changes. Individuals are expected to have approval from medical providers, and in other instances, a court order. In case an individual has a criminal record, more barriers exist. Discrimination highly affects transgender individuals’ ability to obtain the authentic names of their documents. In most cases, an individual whose identification does not reflect the names they are currently using is most likely to face verbal harassment. If one is a student, it is highly possible that he will discontinue education because fellow students will make fun of his name and identity. The incongruence between gender identity and the identification document is linked to mental health issues because an individual develops anxiety, adverse response to the constant gender-based mistreatments. This is an issue that affects many young people.
The transgender population requires more than the usual care because they need hormone therapy or surgeries. Regardless of their need for extra services, they lack access to care. Additionally, there are a few providers with expertise in transgender medicine, which is an indication that the health system pays little or no attention to the needs of the transgender population. According to Bradford et al. (2013), transgender medicine is often not taught in a conventional medical curricular. This shows that few physicians, if any, have the knowledge concerning transgender treatment. Most of the surgeries transgender individuals require are expensive. It is important to note that the functional barriers that include lack of income or insurance affect their access to healthcare services. Transgender individuals have reported that they have been denied insurance coverage because of their identities.
Compared to cisgender, transgender individuals are often treated with less courtesy and respect. In most cases, whenever one learns that an individual is transgender, their attitude changes. People may act as if they are afraid of them, while others see them as dishonest individuals. Most importantly, transgender individuals receive cold treatments. According to Medina et al. (2021)), stress from such experiences causes the dysregulation of cortisol, thus, affecting various body functions. A person’s mood, metabolism, cardiovascular health, and the immune system are often affected by the change in cortisol. People who experience this often had suicidal thoughts and may also be involved in non-suicidal self-injury. About 82% of transgender individuals have contemplated suicide during their lifetime. The suicidal thoughts occur because they feel the need to eliminate their negative experiences.
The minority stress model appropriately explains the high rate of mental health problems in transgender people. The persistent effect of living in an unsafe environment, whereby one is expected to hide his identity to fit in the society and avoid stigma, makes transgender people to be dissatisfied with life (Garey, 2013). This has become a public health problem that brings about pronounced disparities between the transgender and others. Whenever individuals experience a hostile environment full of discrimination and stigma, they are more likely to develop mental health issues, such as depression and anxiety. In a study by the National Center for Transgender Equality, it is important to note that about 46% of transgender people have experienced verbal harassment linked to these people’s gender identity (Xavier et al., 2004). This makes discrimination and inequality a major social determiner that bars transgender individuals from accessing healthcare services or from coming up with activities that may alleviate their problems. Transgender individuals’ minority status makes them face social and economic inequalities. Most people do not want to have a transgender individual working for them because they believe that this might drive the clients away. Religious people also have a negative perception of transgender and contribute significantly to their discrimination. This is among the things that make transgender be economically unstable. They lack resources to seek appropriate medical assistance. Additionally, the isolation transgender people face contributes to the onset of mental health issues. Most people do not want to associate with them, and they experience challenges trying to make friends. It is painful whenever one tries to make friends but ends up rejected and probably criticized. While it is possible to cope with such issues, most people end up feeling lost, rejected, and this may contribute to the onset of mental health issues. Were people in the society more accommodating, transgender individuals would not be facing these problems that have in a few instances led to the early deaths of the people.
Transgender people are considered a high-risk population, especially for mental and physical health problems. Mental health and physical problems emanate from the amount of stress these people experience on a daily basis. This is because they encounter regular harassment and discrimination. Transgender individuals are considered immoral and unethical by most people, and this occurs out of ignorance. As a result, they are more likely to experience barriers to access to healthcare. Most individuals who lack social support and experience discrimination are more likely to indulge in drugs. They find that their solace emanates from alcohol, or other drugs, which contributes to the onset of mental health issues. This is because society tends to push transgender individuals away and make them feel unwanted. They devise coping mechanisms, and the use of drugs becomes the most accessible, making transgender individuals a high-risk population to mental health issues.
Connection of the issue to world Experiences
Medina et al. (2021) use real-life stories to connect transgender discrimination to real-world experiences. One of the transgender patients indicates that doctors treat him as if he is not a human with rights. Most doctors do not believe their patients and often tell them that their ailments are mental, even in instances when the symptoms are visible. Being transgender should not warrant mistreatment and lack of appropriate care from healthcare providers. However, this illustrates the challenges transgender individuals have to encounter whenever they seek medical assistance. While doctors and other healthcare providers are expected to be knowledgeable, they often illustrate the lack of cultural competence.
Religion is often used as an excuse. Many young people have been denied a chance to have their gender-affirming surgeries on the pretext that their religious directives are against such a procedure. Medina et al. (2021) argue that while transgender individuals are hopeful that they will eventually be assigned the gender that aligns with their identity, religious individuals come up with church regulations prohibiting their churches from dealing with the transgender population. This type of rejection and exclusions lead to self-pity and may drive an individual towards suicidal thoughts.
Recommendations
It is important to note that the transgender exclusions taking place do not comply with the law. There is a need for the healthcare system to understand that transgender-specific exclusions are not in line with federal law compliance. There should be an enumeration of the ways the application of medical necessity should occur. Medical insurers have also contributed to the spread of discrimination in healthcare, and to eliminate this, insurers should state their plans cover the care of gender dysphoria. The present exclusion seen in Medicaid programs should be removed. And come up with overage protocols, allowing gender-enhancing care. Whenever the state leads in illustrating to the people that the transgender population is recognized and respected, the wider society will also follow suit. Transgender individuals will receive the appropriate treatment, which will work positively towards restoring their self-esteem and confidence and minimizing chances of mental health issues.
Explicitly clarifying the importance of the protection of transgender patients in healthcare is vital. Gender diverse patients should not be discriminated against in an institution expected to cater to the people’s wellbeing. The healthcare system needs to clarify how healthcare providers should provide care for transgender individuals. This is because of the range of illnesses transgender individuals often battle. It is notable that transgender individuals are highly likely to suffer from various diseases, including mental health issues, HIV/AIDS, and drug use problems. It is vital that whenever they seek healthcare services, they are treated without their gender identification creating a barrier. Cultural competency training would help healthcare providers look at these issues from a neutral point of view and help them recognize and respect diversity.
Access to transgender identification documents is a vital recommendation.
Gender-incongruency has led to various adverse outcomes. It has posed a barrier to their access to services. Among healthcare-related services, it is important if states would eradicate the intrusive and burdensome requirements for transgender individuals to have court orders whenever they need to prove their identification. There should be steps facilitating transgender individuals to access identity credentials that meet their needs. This will prevent the confusion that has been occurring that often subjects transgender individuals to humiliation.
The transgender population has been facing discrimination, especially related to healthcare access. In most cases, they are not covered by medical insurance and often experience challenges paying for their surgeries. These people are not judged depending on who they are but on what they are. A doctor would gladly offer the best services if he does not know that an individual is transgender, but upon this knowledge, the doctor is prone to change his attitude towards a transgender person. Changes should occur to ensure that transgender people live a more fulfilling and satisfying life and eliminate the mental health problems because of the challenge they face. Access to transgender identification documents is one of the vital changes to eliminate gender-incongruency. Cultural competency is another important recommendation, which would ensure that doctors and other healthcare providers respect transgender individuals and offer appropriate services to them.
References
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