Trans people accessing acute mental health care more likely to experience marginalization
One of the first studies of its kind, showing association between trans people's need for acute mental health care and experiences of marginalization.
Transgender individuals who access acute mental health care are more likely to experience marginalization, present with mood disorders and are twice more likely to be diagnosed with personality disorders than the general population accessing these services.
This according to a Centre for Addiction and Mental health- (CAMH-) led study, “Characteristics of Transgender Individuals Accessing Emergency Department Visits and Hospitalizations for Mental Health,” newly published in the journal Psychiatric Services. The study is the first to use administrative health data to explore how transgender patients access mental healthcare services.
“It’s been theorized that trans people experience a disproportionately higher rate of mental illnesses, substance use disorders and suicidality, not because of their identity, but rather as a result of their experiences with discrimination, oppression and marginalization,” said lead author Dr. June Lam, a Staff Psychiatrist at CAMH. “This study provides further data to support this theory by looking at the experiences of trans individuals who required a mental health-related Emergency Department visit or hospitalization. Ultimately, the findings show an association between trans people who accessed acute mental health care and their experience with socioeconomic marginalization.”
The data collected for this study came from 728 transgender individuals who visited the Emergency Department and 454 transgender individuals hospitalized for mental health-related reasons, and who were aged 16 and above. The data originated from four outpatient health clinics in three cities (Thunder Bay, Ottawa, Toronto) across Ontario. All four clinics have expertise in working with transgender individuals and regularly collect data on self-defined gender identity. Researchers used Health administrative data held at ICES, an independent, non-profit research institute, to conduct this study. For each transgender sample, the researchers created two comparison groups to understand the ways in which the transgender population differs from the general population of those who access acute care in Ontario.
One limitation to the study, according to the authors, was that transgender individuals identified were from clinics in larger cities in Ontario, which may not be representative of the experiences of individuals living in smaller cities and rural areas.
Study co-author Dr. Alex Abramovich, an Independent Scientist with the Institute for Mental Health Policy Research (IMHPR), said: “Typically, when viewing administrative health data, patients are only classified as male or female. This makes transgender people virtually invisible in the healthcare system. We were only able to identify transgender individuals through looking at data where physicians or a health clinic asked their patients how they identify. This research makes a strong case for the need to identify transgender people in the healthcare system. By creating more transgender-inclusive systems and data collection practices, we can integrate inclusive response options to better understand the experience and health of transgender individuals.”
“For a transgender patient, having to teach care providers about the importance of using the correct name and pronouns can be a very disheartening and invalidating experience. While we want to learn from our clients, it’s not their responsibility to teach us – especially when they’re already in crisis. That’s why work like this is so important, as it will allow us to identify and address the service gaps that exist for trans people seeking care,” said Dr. Juveria Zaheer, a Clinician Scientist with IMHPR and Medical Head of the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH. She also emphasized that the best way to provide gender-affirming care is to not only engage with trans and gender-diverse people, but to ensure intersectional diversity in representation from those in the community.
This study concludes that care providers can greatly improve the healthcare services that transgender people receive through examining the unique needs and challenges of this population, ensuring the representation of trans people through inclusive intake response options, and closing the gaps that exist for trans people who access care. It also calls for additional research into experiences of transgender individuals presenting for acute mental healthcare, particularly around the role that marginalization and discrimination may play.
“We can’t collect accurate data if we’re not asking inclusive questions. That’s why I’ve been advocating for a standardized model of care, with consistent institutional forms, that empower transgender people to identify themselves as who they are,” added Dr. Abramovich.
My dementia won’t hold me back. Not Today.
Paul Lea on the challenges and triumphs of learning how to live again. Watch Paul share his full story here.
When Paul Lea had a massive stroke in his late 50s and was diagnosed with vascular dementia, he pretty much gave up on life for a while.
“It was depressing. I got angry a lot of the time. I sort of crawled into a shell and stayed there. For the first six years my life was hell because I didn’t go outside unless my daughter could be with me. My daughter had to basically retrain me how to live.”
Part of what got him back to being a full participant in daily life was a decision he made about five years ago to become an advocate for people with dementia through the Alzheimer’s Society of Canada.
“They were very happy about that because first of all, I have dementia, second of all I’m willing to talk about, and third I am able to talk about it. There are a lot of people in the world who are embarrassed and ashamed. I speak for those who can’t.”
That commitment to advocacy continues at CAMH, where Paul is a member of the patient advisory committee. “Getting involved in dementia research is very important for me because with my journey and experience I can help the direction researchers are going in because of my life experience.”
Anyone who has seen the spark of life slowly fade from the eyes of a loved one knows the heartbreak of dementia.
And they know there is no cure for that heartbreak. Despite all that we have learned about the brain in recent decades, there is currently no effective treatment for dementia and other neurodegenerative diseases like Alzheimer’s. Nothing to stop it. Until then, all we can do is manage the symptoms of disease the best we can with medications and non-pharmacological interventions, or participate in various studies.
All of this makes hope the rarest of commodities for people with dementia and those who love them. But there is real hope in regards to the dementia research taking place at CAMH.
We have learned more about the aging brain in the last 20 years than in the entire history of modern medicine that preceded it. Not so long ago, it was believed that we got the brain we were born with and as it gets older, the only changes that take place in the brain are for the worst. But with modern advances in brain imaging, we can now look inside the brain with unprecedented clarity.
We know through the relatively recent discoveries of cognitive reserve and neuroplasticity that the aging brain is far more flexible and adaptable that we ever thought before. We also now know that proteins called Tau and amyloid plaques, along with brain inflammation play key roles in the early progression of dementia. The more of these deposits that are found in the brain, the more severe the dementia.
Discovering how and why those proteins form in the brain, and what can be done to slow down, stop, prevent or even reverse the damage done to the brain by dementia, is one of the core missions for CAMH neuroscientists who believe that we may be in a golden age of brain research that could see real breakthroughs in dementia research in the years ahead.
“We are not the walking dead,” says Paul. “I think people should support CAMH research because look at all the research that is being done with cancer and heart and stroke. The more people that get involved, the more support there is for these programs, the more research opportunities there will be looking for cures for this disease.”
Paul's story is
part of the featured content within the powerful Today campaign which conveys the momentum that CAMH is creating to prevent suicide and invites people to accelerate it. Visit the campaign website to see other featured content and to learn more.
Resources to support youth and parents during COVID-19
Created for youth, by youth in collaboration with clinical experts to support mental health.
As we enter the back-to-school season, we understand that some parents and families may be experiencing stress or anxiety. CAMH is Canada's largest mental health hospital and research centre, and has compiled resources informed by clinical and research expertise about youth mental health, many of which have been co-developed by youth, for youth. We hope these will be helpful in starting discussions at home about mental health and the pandemic, and can provide support for your families and children.
If you or a loved one are concerned about your child’s mental health, please see a family doctor.
For more information about COVID-19, or resources related to managing mental health during the pandemic, visit the CAMH COVID-19 Hub.
Resources for Parents
Back to school during COVID-19: Helping with children’s anxiety
Back to school during COVID-19: Tips for parents’ well-being
Talking to children about COVID-19 and its impact
COVID-19 Resources for Youth
Coping During COVID-19: Virtual Resources for Youth
Coping during COVID-19: A resource for youth
ABCoping with COVID-19: A resource for youth
Reflection Exercise: Cup of Gratitude
Coping with COVID-19: A resource for trans and non-binary youth