It is now a widely recognized and accepted fact that trans persons and gender nonconforming individuals are a part of most of the cultures all over the world. This, however, has not completely worked towards their advantage. Unique hurdles are always thrown in their ways, be it at their workplace or while accessing basic health care. Apart from an already deteriorated physical and sexual health, their mental health has also emerged to be a major cause for concern – the vitality of which has been severely undermined through the years with little progress, especially in India. The internal stigmatization and isolation of trans persons in India has made this patient cohort tragically vulnerable to a plethora of mental illnesses; the most common being depressive spectrum disorders, anxiety and substance abuse.
Personal and social barriers which involve lack of family support, community level barriers such as discrimination of HIV-positive trans persons within their own communities and other institutional difficulties, barriers in obtaining voter identity cards and ration cards has only proven to have a destructive effect on their mental health.
Rejection and lack of support from the families and society, gender dysphoria associated with extreme stressful experiences, child sexual abuse, early discontinuation of schooling, forced marriages, lack of livelihood opportunities, sexual and financial exploitation by the police, and lack of legal measures for protection are some of the characteristics of transgender persons.
Health Care Barriers:
However, the root cause of evil are the health care barriers faced by trans persons which do not make seeking help a viable option for them. Acknowledging such barriers is pivotal to understand their individual needs. Due to poor mental health awareness, trans persons in India are not even aware of available intervention and management techniques.
Apart from inferior services, health care barriers also prevent trans persons receive timely treatment due to insensitive hospital policies and outpatient registration and admission procedures. Regular operating hours are also inconvenient for a patient cohort that is majorly involved in sex work.
A recent study reported that about 62% of the transgender respondents have problems with their family members, 56% of them have discontinued their education at either primary level or secondary level; majority of the transgender persons opt for the sex industry, 54% of them have the habit of consuming alcohol and 26% of them have severe depression. A cross-sectional study of 50 trans persons in Mumbai showed that 84% of the participants met the criteria for gender identity disorder according to DSM-IV-TR.
Self-harm as well as suicidal behavior has been extremely common amongst trans persons as a consequence of poor mental health. 31% of trans persons in India end their life by committing suicide, and 50% of them have attempted for suicide at least once before they have reached the age of 20. Forms of self-harm committed by this patient cohort may involve the slitting of one’s wrists and other areas, excessive drinking, eating and drug use, harmful sexual behavior, etc. Causes of suicidal behavior include psychological distress caused by low self-esteem, emotional fatigue, gender dysphoria, bullying and victimization as well as concerns regarding physical conditions such as sexually transmitted disorders.
The psychological autopsy of suicides among transgender persons has revealed that factors such as the end of a relationship (64.3%), serious altercations with family members (14.3%), refusal to get gender/sex reassignment by the family members (9.5%), financial problems (9.5%), being diagnosed with HIV positive in the past few days/weeks (2.4%) have triggered the act of suicide among the victims.
Intervention and Management:
Health care professionals must focus on designing tailor made interventions and coping strategies for trans persons in India. There must be non-discriminatory and trans-friendly policies that allow trans persons to fully utilize any and every kind of help available to them. An all inclusion policy should be maintained on behalf of the health care system in India which will act as a catalyst for trans persons to achieve better mental health.
However, in the recent past, multiple organizations like Sangama, Samara, Jeeva, Aneka, IDF and the Karnataka Women Development Corporation of Bengaluru, Sahodari in Tamil Nadu, The Humsafar Trust in Maharashtra, etc. have risen to aggressively support and provide assistance to trans persons in India in the form of helpline services, clinical services, information and referral services, legal and advocacy support, drop-in-centers, alternative employment services and financial assistance, soft-skills training and self-help group formation.
The transgender population has always been perceived as a difficult population to reach. This does not have to necessarily be the scenario if health care professionals become more involved in equipping themselves with population-specific data. An understanding of the social plight of trans persons in India, which has contributed to their deteriorated mental health, can help dissolve real and imagined barriers.
*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.
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by Shruti Venkatesh
Shruti Venkatesh is a Research Associate (Mental Health) at One Future Collective.*
Photo by Joel Filipe on Unsplash