KeepHealthCare.ORG – WHO move to reclassify transgender identity will reduce stigma and increase access to health care, B.C. advocates say
Trans people and health experts say a move by the World Health Organization to stop classifying transgender as a mental illness will have positive impacts on the community here in British Columbia.
In late June, the WHO announced it has plans to reclassify transgender identity or gender incongruence as a sexual health condition, as opposed to a mental illness, and trans health experts say they expect gender dysphoria to be taken out of the next issue of the Diagnostic and Statistical Manual (DSM).
“There’s a long, long history of looking at gay and lesbian and trans people as depraved, criminal, mentally ill, and we seem to be witnessing a significant sea change,” said Ann Travers, a sociology professor at Simon Fraser University. “It’s one in a long line of positive changes that move us away from viewing sexual and gender diversity as pathological.”
Travers, who is transgender and uses the gender-neutral pronoun ‘they,’ says reclassifying transgender identity to be a sexual health condition will remove stigma. The change, they said, can be compared to when health professionals removed homosexuality from the DSM and stopped considering it a mental illness.
“I grew up thinking there was something terribly wrong with me, both for being attracted to women and not being gender conforming,” Travers said, adding that as an adult they’ve now built a happy life.
But doctors at Trans Care BC, the province’s provincial authority on trans-specific health care, said there’s no need to worry. The director, Dr. Marria Townsend, said B.C. already treats being transgender as a health issue that requires gender-affirming health care, rather than as a mental illness.
“It’s not going to have implications for the way services are covered in British Columbia,” she said.
Trans Care BC provides professional and educational support to family doctors so that they can provide care, such as hormone replacement therapy, to their transgender patients, she said.
Since about 2012, Townsend said the province no longer requires patients to be evaluated by a psychologist or psychiatrist to get approved for gender reassignment surgery. Instead, nurse practitioners or family doctors — who tend to have shorter wait times for appointments — can provide the evaluations, she said, which is in line with recommendations from the World Professional Association for Transgender Health.
By not considering transgender identity as a mental illness, trans people feel more comfortable accessing health care, Townsend said.
“Historically the approach to care did result in the avoidance of care, people not necessarily trusting the medical profession,” she said.
With the new approach, “we are treating them more respectfully and they are more open to engaging in the health care system because of that,” she said.
Elizabeth Saewyc, director of the UBC School of Nursing and a lead researcher on transgender health, participated in WHO’s consultation process about two years ago when the change was being discussed. She thinks it makes more sense to treat trans people from a physical body approach, than a mental illness approach, and said trans people who are experiencing mental health issues will still be able to access that care, but being trans in and of itself, will no longer “automatically” be something that requires mental health treatment.
“Some of the mental health disparities we’ve seen for transgender people are due not to the gender identity issues but rather to the stigma and discrimination and really unpleasant treatment that they’re getting from the wider society and from family and friends,” she said.
Townsend also said that trans people who are trying to access disability assistance or social assistance because of difficult life or health conditions caused by being transgender, probably won’t be affected.
For example, if someone is having trouble finding work due to discrimination, a doctor can still say on the application that their transgender identity is part of the cause.