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WellMed Trans inclusivity in health care Oceana Maund Scottish Trans Community Engagement OfficerScottish Trans ■ Established in 2007 ■ Funded by Scottish Government Equality and Human Rights Fund ■ National project within the Equality Network ■ Work to improve the equality and human rights of all trans peopleTransgender People ■ Umbrella’ terms: Trans = Transgender ■ Gender identity and/or gender expression differs from gender assigned at birth ■ Although not everyone “under” the umbrella may personally identify as trans, we need a way to define who we’re talking aboutTrans Women and Trans Men ■ Intense need to live fully in different gender ■ Often, but not always, take hormones or have some surgery ■ Older terminology = transsexual people Trans woman: Trans man: Assigned male at birth Assigned female at birth Female gender identity Male gender identity Transitions to live as a woman Transitions to live as a manNon-binary people ■ Don’t identify simply as a man or a woman ■ Often use gender-neutral titles: “Mx” is the most common ■ Many non-binary people use gender-neutral pronouns: they, ey, per, zie… ■ Might take hormones or have surgeries – all trans people make individual choices about medical interventions that are right for them ■ Various terms: genderqueer, genderfluid, agender, non-gendered...Cross-dressing people ■ About gender expression rather than gender identity ■ Expressing aspects of self or exploring gender ■ Mostly content with birth gender ________________________________________________ ■ Drag ■ Performance art or comedy ■ Usually drag artists are not trans peopleWhat is trans health care? ■ Transition related care ■ Primary care ■ Specialist care ■ Third sectorNegative Healthcare Experiences Have you experienced the following from healthcare staff? YES Used wrong pronoun or name by mistake 55% Said didn’t know enough to provide trans-related heal54%are Used wrong pronoun or name on purpose 26% Used hurtful or insulting language about trans people24% Belittled or ridiculed you for being trans 18% Showed unprofessional curiosity about your body appea16%ce Refused to provide healthcare due to you being trans 12% Asked to see/examine your genitals when it was unneces7%ry UK Trans Mental Health Study 2012 http://www.scottishtrans.org/trans_mh_study/ Gender Identity Clinics & Mental Health Did the time you waited for your first appoint at the GIC affect%you in any of the following ways? Poorer physical health 15.5% Poorer mental health 67.3% Lower self-esteem 62.2% Drug and or alcohol abuse 13.1% Feeling more isolated or exclude 58.2% Less likely to access other services 29.9% Self-harmed 29.1% Attempted suicide 13.1% Gender identity services ■ The current waiting time for a first appointment at Sandyford GIC is 47 months Supporting Transgender Patients ■ Don’t assume that you know which pronouns and titles people use – ask what they prefer. ■ Don’t assume that all transgender people have medically transitioned, that they are “out” as transgender, or that you will be able to “tell” if someone is transgender. ■ Remember that not all trans people are the same. ■ Don’t assume that children and young people are “too young to know” they are transgender – respect and affirm their identities too.Supporting Transgender Patients ■ Don’t assume that the reason they have come to see you is related to their being transgender. ■ Be open; listen to individuals’ needs and concerns. ■ Maintaining confidentiality and privacy is vitally important. ■ Think about how you call for people in waiting rooms – ensure that you don’t accidentally use old names or titles. ■ Discuss with each individual what information they would like shared with staff and relatives, and what information they would like to keep private. ■ Discuss with people what information you would like to share with colleagues and why.Supporting Transgender Patients ■ Respect their choices about whether they want that information shared. Don’t pressure people into sharing information that they do not want to share. ■ Recognise that trans people may not be out to all relatives and friends, and be mindful of this when using names and pronouns around trans people’s visitors. If in doubt, use gender neutral language to avoid outing a trans person to relatives or friends. ■ Discuss with people what language they like to use when talking about their bodies, and respect and use that language.Supporting Transgender Patients ■ Monitor practice, seek out and keep up to date with issues, research, and good practice ■ Support and signpost staff to training and resources on transgender awareness. ■ Diagnostic scales can often be different for men and women. Talk to trans patients about which scale it makes sense for them to use, and be mindful of the fact that this will likely be different across individual trans people. ■ If you identify any systematic barriers to working with trans patients, let your manager know.Supporting Transgender Patients ■ Support transgender people to change their CHI numbers if they want this to reflect their gender identity. Practitioner Services at NHS National Services Scotland can change these if they have been having problems doing so with their GP. ■ Support transgender people to complete forms in ways that best suit their identities. If forms only allow two options for gender – find out if you are able to leave this blank, and let non-binary people know that this is an option. When forms do not allow people to answer in a way that reflects their identity, be sympathetic and understanding.Further info ■ You can find our most current research reports at: https://www.scottishtrans.org/resource/research/ ■ ScotPHN Health Care Needs Assessment of Gender Identity Services: https://www.scotphn.net/wp-content/uploads/2017/04/2018_05_16-H CNA-of-Gender-Identity-Services-1.pdf ■ “What we want people to know” – video of Scottish trans people explaining what they’d like the general public to know about us: https://www.youtube.com/watch?v=a0dF0YWP2Js30 Bernard Street Edinburgh EH6 6PR Telephone: +44 (0) 131 467 6039 www.scottishtrans.org Email: info@scottishtrans.org ScottishTrans scottishtrans.org scottishtrans