April 19, 2019

Is the Mental Health Care Act 2017 Inclusive of Trans Persons?

“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 completely different from what is expected of you, and the constant fear of being ridiculed, discriminated and outcast from the society, the life of a trans person in India is no less than a daily battle waged against not just the society, but also with themselves.

Apart from 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 poor self and social acceptance as a teenager. 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 poignant that not even one detailed study has been conducted yet on the predominance of mental illnesses among transgender persons in India, and their experiences with Mental Health Professionals. The stakeholder agencies which have worked with the community have pointed out to the high occurrence of mental health problems and absence (Contrasting. Please recheck the statement) of a comprehensive access towards mental health.

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 done by Vikas Jayadeva, 48% of hijra participants in one survey suffered from psychiatric disorders, ranging from alcohol abuse and dependence to depressive spectrum disorders. The study brought to light a shocking revelation that despite the incidence of psychiatric disorders in participants, none had ever had psychiatric consultation for these issues. Seeking help is not a viable option for these individuals due to perceived and real stigma from health professionals.

The reason why Trans persons face troubles in reaching out to MHPs is because most of the counselors still conform to the idea that gender and sexuality are binary and not a spectrum. What is worse is that, they still believe that being a Trans person is a psychiatric issue or an illness.

Even though the govt. has introduced the Transgender Persons (Protection of Rights) Bill, 2016 which attempts to safeguard against discrimination and provides employment, education and healthcare facilities, it completely overlooks the issue of mental health and 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 transgenders in South India suggests that  about two-thirds of the transgender community experience significant anxiety symptoms, while almost all such persons have significant depressive symptoms. The symptoms of anxiety and depression often occur together.

The social rejection and violence that many transgender people experience appears to be the primary source of their mental distress, as opposed to the distress being solely the result of being transgender. That distinction matters because it has implications on  how transgender people are treated in a healthcare setting, as well as how they are viewed in society.

With the implementation of Mental Health Care Act 2017, the government  has recognized the prevalence of mental health issues among the Trans community and this is being hailed as a ray of hope since  the act  emphasizes on 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 decriminalization of suicide attempts will be an affirmative move towards helping Trans people address their mental ailments. (Or rephrase) .

The MHCA 2017 with its Advanced Directives states that every person will have the right to specify how he 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  Transgender people 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 counselors or therapists on sensitization of their behavior when dealing with transgender patients.

Conversations with the members of trans community has revealed that there is a lot of ignorance and prejudice among MHPs in treating trans patients, especially when it comes to 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, MHPs 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 greatly facilitate the resolution of Gender Dysphoria, possible changes in gender role, the making of informed decisions about medical interventions, and improvements in their quality of life.

In India, the counseling component is fairly weak across the board in health services, especially regarding mental health issues. This is one of the challenges for the country to develop community based interventions to deal with mental health requirements and counseling requirements of transgenders/hijras.

There is virtually no counseling worth the while available at the government level. The patient is just advised about when he/she has to eat the medicines, and what nourishing diet has  to be taken. here is no quality counseling to equip the patient to cope with  disease,  mental stress and other psychological problems arising out of it.

There is a need to educate the professionals and make them more empathetic towards the needs of the Trans community. From holding training programs for MHPs in understanding and acknowledging the sensitivity of issues faced by the LGBTQ community to promoting mental health practice within the community will not only help in creating a safe space to address and seek help but will also pave way for an open dialogue on the already stigmatized issue of mental health.

The MHPs can comprehend on the matter further by becoming knowledgeable about local transgender communities and individuals, advocacy, and public policy issues relevant to these 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.

by Sofiya Shah

Sofiya Shah is a volunteer researcher at One Future Collective.*

Photo by H Heyerlein on Unsplash

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