How inclusive of Trans Persons is the Mental Health Care Act of 2017?
First published at NewsnViews.
“Sex is what you are born with, gender is what you recognize and sexuality is what you discover.”
Being trapped inside a body that doesn’t feel like your own, experiencing gender and sexuality in a completely different manner from what is expected of you, and the constant fear of being ridiculed, discriminated and outcasted from society — the life of a trans person in India is no less than a daily battle waged against not just society, but also themselves.
Apart from a dissonance between gender identities, the Trans community suffers from mental health issues due to various socio-cultural stressors which include familial pressure to conform to gender norms and coming to terms with their personal identity. Going through such traumatic experiences can trigger in them poor self and social acceptance as teenagers. Traumatic transitions, physical, verbal, and sexual abuse from family and others, and constant discrimination can add to these pressures.
The reality of most trans persons in India highlights the same situation where they live in poverty, beg on the streets, or turn to sex work where they are abused by customers and the police. Most of them are runaways and have no close familial ties. All these can more often than not result in low esteem, anxiety and depression.
It is a note of poignancy that not even one detailed study has been conducted on the predominance of mental illnesses among transgender persons in India, and their experiences with Mental Health Professionals. The stakeholding agencies that have worked with the community have pointed out the high occurrence of mental health problems and an absence of a comprehensive access towards mental health resources.
A 2010 report from UNDP India states, “Mental health needs of Hijras/TG communities are barely addressed in the current HIV programs. Some of the mental health issues reported in different community forums include depression and suicidal tendencies, possibly secondary to societal stigma, lack of social support, HIV status, and violence-related stress.”
According to one study conducted by Vikas Jayadeva, 48% of hijra participants in one survey suffered from psychiatric disorders — ranging from alcohol abuse and dependence to depressive spectrum disorders. This study brought to light the shocking revelation that despite the incidence of psychiatric disorders in participants, none of them had ever had psychiatric consultation for these issues. Seeking help is not a viable option for trans persons due to the perceived and real stigma from mental health professionals.
The reason why trans persons face trouble while reaching out to mental health professionals is that most counsellors still conform to the idea that gender and sexuality are binary and not on a spectrum. What is perhaps worse is that they still believe that being a trans person is suggestive of a psychiatric issue or illness.
Even though the Government has introduced the Transgender Persons (Protection of Rights) Bill, 2016, which attempts to safeguard against discrimination, and provides employment, education and healthcare facilities for trans persons, it completely overlooks the issue of mental health along with provisions and access to counseling or therapy in dealing with societal and mental stressors.
A pilot study assessing emotional distress and quality of life among transpersons in South India suggests that about two-thirds of the transpersons community experiences a significant amount of anxiety symptoms, while almost all of them have significant depressive symptoms. The symptoms of anxiety and depression often occur together.
The social rejection and violence that many trans people experience appears to be the primary source of their mental distress. This matters because of its implications on how trans people are treated in a healthcare setting, as well as how they are viewed in society.
With the implementation of the Mental Health Care Act of 2017 (MHCA 2017), the government has recognised the prevalence of mental health issues among the trans community, and this is being hailed as a ray of hope since the act emphasises non-discrimination on the basis of gender, sex and sexual orientation in receiving mental health care. Incorporating positive measures such as access to public healthcare, insurance cover for mental health patients and most importantly, the decriminalisation of suicide attempts, will be an affirmative move towards helping trans people address their mental health.
The MHCA 2017 with its Advanced Directives state that every person will have the right to specify how they would like to be treated for mental illness in the event of a mental health situation. While it has been considered as an exemplary feat for mental health patients, it does not safeguard trans persons who are often misdiagnosed as schizophrenic patients as they express the need to change their assigned gender. The Act has not provided any guiding principles to the counsellors or therapists on sensitisation of their behaviour when dealing with trans patients.
Conversations with the members of the trans community have revealed that there is a lot of ignorance and prejudice among mental health professionals in treating trans patients, especially when it comes to the transitioning and gender affirming period. They believe that practitioners behave as gatekeepers where they treat them inhumanely, stripping the trans community of their right to choose their own gender.
While addressing Gender Dysphoria, mental health professionals should screen for co-existing mental health concerns that might be present such as anxiety, depression, obsessive compulsive disorders, self-harm, etc. Tackling and managing the co-existing mental health concerns can facilitate to a great extent the resolution of Gender Dysphoria, and the making of informed decisions about medical interventions, and improvements in quality of life.
In India, the counselling component is fairly weak across the board in health services, especially with regard to mental health issues. This is one of the biggest challenges for the country — to develop community-based interventions to address the mental health and counselling requirements of trans persons.
There is virtually no counselling available at the government level. The patient is just advised about when they have to eat their medicines, and what nourishing diet has to be practised. There is no quality counselling to equip the patient to cope with disease, mental stress and other arising psychological problems.
There is a need to educate mental health professionals in order to make them more empathetic towards the needs of the trans community. From holding training programs for mental health professionals in understanding and acknowledging the sensitivity of the issues faced by the LGBTQIA+ community, to promoting mental health practices among transpersons, these will only help in creating a safe space to address and seek help along with paving the way for an open dialogue on the already stigmatised issue of mental health.
Mental health professionals can further understand trans issues by learning about local trans communities and individuals, advocacy, public policy, and issues relevant to the clients and their families. Additionally, knowledge about sexuality, sexual health concerns, and the assessment and treatment of sexual disorders is ideal.
One Future Collective is the outreach partner for the Trans Diamond Festival. This article series, across platforms, is a result of the ongoing effort of Make Room India and One Future Collective to discuss issues of the transgender community and build an ecosystem towards strengthening the trans rights movement in India.
Feature Image Credit: h heyerlein on Unsplash
Sofiya Shah is a Volunteer Researcher at One Future Collective.
Jayadeva, Vikas. “Understanding the Mental Health of the Hijra Women of India.” PsychiatryOnline, 1 May 2017, psychiatryonline.org/doi/10.1176/appi.ajp-rj.2017.120504.
Kaplan, Ami B. “Basic Issues in Transgender Mental Health.” Transgender Mental Health, 8 Apr. 2015, tgmentalhealth.com/basic-issues-in-transgender-mental-health/ ( a short outline of issues that arise for transgender individuals).