Reprinted from "LGBT" issue of Visions Journal, 2009, Vol. 6 No. 2, pp. 32-34
Vancouver Coastal Health launched the Transgender Health Program (THP) in 2003 to address the health needs of transgender people. Lukas Walther, coordinator of THP, describes the program as a key hub for information and resources for anyone dealing with gender issues in British Columbia, as well as for their care providers and family. The program offers peer counselling, support, advocacy and educational workshops, and helps connect people with the right service provider for their needs.
Finding the right service provider
Transgender people often need help dealing with emotional stress. This is often the case because many face significant stigma and harassment due to discrimination or transphobia (fear of transgender people). Many trans people feel isolated and approximately 62% experience depression. Some have given up, and one study found that 32% of transsexual people had attempted suicide.1 “Being transsexual can place enormous barriers on a person, affecting every step of their daily life. Without sincere, caring support, it can easily become too much,” says Walther.
Finding a knowledgeable, “trans-positive” service provider—one who understands and supports the identity of transgender individuals—is extremely important in ensuring a transgender person receives proper care. Since transgender people often have depression or anxiety, a skilled practitioner is needed to identify what is and isn’t a gender issue.Trans people run the risk of receiving a diagnosis that doesn’t take personal history or feelings around their gender issues into account. But, according to Walther, depression and anxiety can often eventually melt away when a person’s gender issue needs are met.
Trans people need to be aware that just because a mental health care provider says they’re an LGBT (lesbian, gay, bisexual, transgender) health care provider, it doesn’t mean they have any experience with transgender issues. Their specialty could be lesbian relationships, for example. Walther says people may include the T in the abbreviation LGBT simply because it’s politically correct to include it. But it doesn’t necessarily mean that the practitioner is familiar with transgender-specific mental health concerns, though it may well indicate they are open to learning.
Unfortunately, there aren’t enough practitioners who specialize in transgender issues. So, Walther says, he’s “in a constant state of triaging.” This means the program has to address critical situations first.
“Safety and access are the priorities,” says Walther. If a client has multiple issues of concern (e.g., trauma, mental health, addiction, unstable housing, etc.), Walther refers the person to one of the few practitioners, GPs and/or service agencies that have experience with gender identity issues and whatever else the person may be dealing with. As well, the THP has a community counsellor on staff who works hand-in-hand with the service providers to ensure that all the client’s needs are met.
The Transgender Health Program puts people into relevant, competent care. “It can be salvation when someone gets into the right hands.”
Transgender Health Program, Vancouver Coastal Health
Services for transgender people and their loved ones
Services for care providers
Counselling and support services
The community counsellor is available to help trans people cope with “big feelings” to do with isolation and discrimination, and to provide information about gender transitioning (i.e., sex change). The counsellor offers one-to-one short-term counselling and facilitates regular peer-support groups.
THP peer support groups include groups for transgender and questionning youth, adults and trans-identified sex trade workers. “It can be really powerful to be in a peer group of any kind,” says Walther.
The groups are confidential, and THP doesn’t keep electronic records. There is no pressure to talk or even to stay the entire length of a meeting; trans-identified people can come and simply listen for as long as they want. People are invited to meet with Walther or the facilitator beforehand, or to just drop in for the group. Parents and close friends are welcome to attend the youth group.
Education for service providers
The THP provides education for service providers to help them better serve and address the needs and concerns of transgender people.
THP staff work with organizations or individuals to create custom workshops on a variety of topics that meet their needs. Topics can include how to work respectfully with people who experience differing degrees of gender distress and may have a range of gender-variant identities, barriers to service, safety issues of being visibly trans, an overview of the assessment processes for hormones and surgery, which transition services are funded and which aren’t, psychosocial issues, concurrent disorder (i.e., mental health and addiction) issues, best care practices for both adults and adolescents, and more.
The THP also hosts a group of multidisciplinary specialists who meet once a month to discuss current, complex case studies of people seeking hormone treatment. This is an opportunity for professional service providers to share expertise and to gain training and insight. Walther says that a social worker will likely know something about one part of a person’s life, while their psychiatrist may have a much different perspective. Through hearing the perspectives of the different service providers, care providers are better able to identify their own “blind spots.” “Together, what we get is a very well-rounded picture,” Walther says.
Walther says it’s difficult to find care providers who specialize in, or are interested in, transgender issues. So he invites care providers, who are interested in learning more about serving the transgender population or interested in starting their own trans support or advocacy groups, to contact the THP.
Walther can connect clinicians with other clinicians who work with transgender clients. “There are all sorts of ways of partnering up,” he says.
The Transgender Health Program staff assist transgender people who are involved with the health, social service and/or school systems, according to the needs of the client. For example, staff can inform people about their legal rights within the health and social service systems. They can accompany people on visits to their service providers. They can also help resolve conflicts with service providers or help service providers understand transgender issues.
The THP does advocacy in the school system. THP staff help schools create trans-positive spaces and educate school staff. They also support and advocate for individual youths transitioning while they’re in school.
Staff also advocate to various organizations and service providers for trans-positive and inclusive services, guidelines and policies. Walther says that the THP works with the provincial government in developing inclusive policies to enable service providers to address the needs of transgender people.
A unique resource
The THP is the only program of its kind. This province-wide program can support transgender people living outside the Lower Mainland by phone and by e-mail.
“People call the program from all over the province,” Walther says. “Many GPs [general practitioners] are hesitant to start a patient on hormones, because they aren’t trained in gender issues.” If people can’t find a local doctor to help them, their only option is to seek help in the Lower Mainland. If they do have a local doctor willing to help, the doctor can freely download current clinical guidelines from THP’s website (see sidebar). GPs can always consult with THP’s coordinator for ongoing assistance and guidance as needed.
All THP services are free, including the custom workshops and education services.
All services are confidential; you don’t have to give your legal name and you don’t need a doctor’s referral; just phone or e-mail THP directly.
For more information, contact THP coordinator Lukas Walther at 604-734-1514, extension 2, or at 1-866-999-1514 (toll-free in BC). You can also visit www.vch.ca/transhealth or e-mail firstname.lastname@example.org.
About the authorKailey is a Communications intern at the Canadian Mental Health Association, BC Division and an English Honours and Professional Writing student at the University of Victoria.
Clements-Nolle, K., Marx, R., Guzman, R. et al. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915-921.