Better Mental Health Services for Trans-Persons in India

There is a need for understanding, training and infrastructure.

There is a population of an estimated 25 million people, globally a population of 0.5%, who are trans- an umbrella term for persons whose gender identity does not conform to their biological sex. India has one of the largest population of trans people in the world, with an estimated population of 5 lakhs.

Trans persons, not just in India but on a global level, are vulnerable to multiple aspects of discrimination, abuse and violence. From acceptance at home to accessing rights, the trans have had to face excessive struggles to what they really deserved as humans. The stigma and discrimination subjects them to multiple issues with respect to their well-being which includes rejection at home, struggle for societal identity and acceptance, access to health care and well-being and to ingress fundamental human rights. The history of trans struggles date back to the Puranic and Vedic literature, however, it was only on April 14, 2015 that the Supreme court of India legally recognised the trans community, and directed both the Centre and State governments to take needful action in order to uplift the community which is one of the most marginalised, misunderstood and underprivileged in the country.

Transgender, transsexual, and gender non-conforming individuals are a part of cultures around the world. Yet, the transgender population encounters several unique obstacles in accessing health care. There are diverse mental health problems affecting the trans community varying from early childhood care to geriatric mental health challenges. More than half of the 25 million trans people in the world suffer from depression. While mental health issues have their biological causes, systemic discrimination against trans members of society poses equal risks to their mental well-being. The transgender community in India is highly vulnerable to mental and physical illness, in large part due to limited economic opportunities, lack of understanding and stigmatised attitudes. Depression, sexual abuse, alcohol dependence and several mental disorders, forced prostitution and begging, HIV, AIDS are some of the plethoras of health problems faced by them. Despite increased health risks, these transgender individuals face an increased number of healthcare challenges. Understanding the barriers that prevent the Indian transgender community from receiving medical care is important so that health care professionals can more adequately address the unique needs of transgender patients in India and around the world.

Despite the sanctioned recognition of the trans community, apart from a few states, most of India continues to neglect the well-being of trans people. The Central Ministry of Social Justice and Empowerment works on ways of reaching out to the community. However, the physical and mental health services for trans communities remains to be restricted in growth and availability.

There are several challenges specific to the mental health of trans persons that the community faces in India:

1. In a published study of The Lancet Psychiatry, researchers found that being transgender is not a mental illness. In India, however, little medical research has been conducted on the issues of trans persons and the notion that being transgender is a mental illness continues to pervade.
2. Sex change therapies are a practice even today despite the known fact that it is incorrect and impossible to medicate someone in order to conform to their biological sex.
3. The assessment before the sex reassignment surgeries and access to hormone treatment remain at the merciful approval of the practitioners, some of them who continue to give a diagnosis of Gender Identity Disorder (the revision of Gender Identity Disorder in DSM IV TR has evolved to that of Gender Dysphoria in DSM 5 which implies the treatment of distress, depression or anxiety due to the non-conformity to the gender and does not involve any techniques or therapies to dissuade the personal choice / preference of an individual to identifying with a gender).
4. Post-surgery and post hormone treatment, care and counselling is missing, which is a crucial aspect in order to build and settle the transformations in the patient
5. Unrequired ECT (electro convulsive therapy), tying the patients to beds and institutionalisation are resorted to for convincing patients about the ‘consequences of sex change’.
6. Many mental health professionals and medical practitioners lack an understanding of the LGBTQ spectrum health issues. Thus, an expertise in treating their concerns is missing.
7. Practitioners also have personal biases in taking up trans patients for therapy or treatment.
8. Counselling and psychotherapies also need a branch of specialisation in order to understand and appropriately address the concerns and mental health issues of trans communities that are amplified due to multiple concerns.
9. Schools and colleges lack a curriculum to understand the sensitivity of the health problems and other concerns of the trans community.
10. Gender dysphoria clinics are a far-fetched dream.

Though transgender people can access information more easily today, many uneducated trans persons in India continue to risk their health due to lack of proper medical support.

The overall understanding, well-equipped training and accommodative infrastructure are a requirement in order to address the increasing mental health needs of the trans community. They deserve an equal stand to access mental health care in India, as also reinforced by the Mental Health Care Act 2017. Denial of health care access is the breach of their fundamental human rights. It is time that inclusion is practised as is spoken about. Inclusion of mental health care, too, is of optimum necessity.

Pragya Lodha is the COO at One Future Collective.

Featured image: David Pisnoy