On Monday, TENI, the Irish Transgender Equality Network, hosted a trans health forum in the Civic Offices in Dublin. This forum’s purpose was to discuss the current context and situation of trans health in Ireland. It was divided into two parts. To start, TENI’s Vanessa Lacey presented some prelimiary results from the recent Trans Mental Health And Well-Being Survey, which was carried out in July and August of this year, as well as a survey of HSE workers of their knowledge and opinions regarding trans health and working with trans people. After this, attendees were divided into groups to talk about different health issues facing trans people.
The results showed, above everything, the magnitude of issues that need to be dealt with, the impressive work being done largely by volunteers as well as paid staff, and the limits of what can be done without getting the wider community and health service providers on board.
The numbers here are stark. Preliminary results show that over three quarters of trans respondants have considered taking their own lives. Between a third and a half have attempted suicide, and most of these people have made more than one attempt.
And these, of course, are just the people who survive. Over 80% of respondants said that they had thought of ending their lives more before transition than during or after. Our society stereotypes and demonises trans people so much. How many more people would be here today if they had known that transition was a possibility? That meaningful, happy trans lives are possible here in Ireland? We don’t know. Researching suicide is notoriously difficult. But it’s certain that there are people whose lives would have been saved by transition, and that self-harm and suicide among trans people is a major health crisis right now. Something needs to be done. But what?
Discussions at the forum centred on three major areas- trans specific support groups and community, health service providers, and society as a whole. Each of these has its own part to play, as well as its own specific needs and issues.
Trans support groups and community has developed and expanded hugely in recent years, thanks in no small part to the work of TENI. There are now trans support groups, online communities, and social and lobbying groups working throughout the country. The trans community is more connected and visible than ever before. This kind of networking- going beyond simply support groups into forming real, deep community and connections, bringing in families, partners and other allies- was emphasised throughout the room yesterday. Because support and community groups are largely volunteer-driven, however, there are gaps in provision. For example, in many areas there is an age gap between youth groups and support groups mainly attended by older people. Consistent support is difficult to provide, since busy volunteers don’t always have the time and energy to keep up with running groups. Groups can hinge on the work of one or two people, and as people’s lives go on and they have other commitments, support groups can disappear. Keeping up long-term momentum is so difficult in what are often very small local groups. But these groups can be a lifeline.
Health services for trans people in Ireland are a mixed bag. While not everyone who identifies as trans goes through medical transition, for those who do it can be immensely important to their well-being. Unlike in the UK, there is no specific transition pathway in Ireland. We don’t have a gender clinic. There are very few medical professionals here who provide transition services. This means two things- firstly, many people have to travel long distances, taking time off of work or college to access services only available in Dublin. Secondly, a person’s ability to access these services, which may be urgently necessary, can depend on the whims of one or two professionals. There isn’t scope to get a second opinion, or to choose who you deal with. This means that regardless of the professionalism and ethics of the medical care providers involved, they have ended up in a gatekeeper position to transition in this country. This disempowers trans people, leaving them immensely vulnerable.
The lack of a dedicated clinic specialising in all aspects of transition in Ireland is also problematic. People not only often have to travel considerable distances to access medical care, but this is compounded by the different services being provided in different places. Some services, such as laser hair removal, are officially considered ‘cosmetic’. This means that people have to find trans-friendly providers themselves, as well as paying out-of-pocket.
In addition to the lack of dedicated services and service providers outside Dublin, awareness of the transition needs of non-binary people was raised. Even professionals who deal with trans people can be stuck on a particular binary idea of gender as well as specific ideas of who trans people are and what medical pathways they will follow. Non-binary people often seek and need medical transition services too, though. Their needs- and their existence- need to be understood.
But trans people don’t only access medical care for transition-related treatment. They- of course- have to access general medical care as well, and these providers are often utterly unaware of how to deal with trans patients. Over 90% of HSE staff surveyed said that they’d received absolutely no training relating to trans people. They also reported that most of their contact with trans people was as rthe result of unprovoked attacks in public places. While a person might be normally capable of giving their doctors and nurses Trans 101, is it really okay that they would have to do this af ter being assaulted? That victims of assault then have to face even more stress, to have to worry about ignorance or transphobia in the A&E?
After trans communities and healthcare providers, the third group that needs to be educated on trans people is, of course, our society at large. Trans people don’t just show up from nowhere. We all live in local communities, go to schools and colleges, live in neighbourhoods, go to jobs. Trans kids growing up should know that there are other trans people out there, and so should the cis kids growing up with them. They need to know that they’re not the only one out there. The media have a huge role to play here in providing positive and varied non-stereotyped portrayals of trans people. Trans people are part of our society, and it’s time our society started acting like it.