SWTP317 - Mental Health in Social Work Practice - Nursing Assignment Help

Assignment Task

Trans and Gender Diverse People’s Mental Health

Those who identify as trans and gender diverse (TGD) experience significantly poorer mental health outcomes when compared to the general population which stem from how negative factors target their gender identity

Importance for Social Work Practice in Mental Health

Recently, there has been contentious discussion on queer issues and specifically, on the rights and ability of transgender people. On an international level, Gender Identity Disorder was removed from the Diagnostic Statistics Manual-5 (DSM-5) in 2012. In early 2019, the World Health Organization (WHO) reframed as ‘Gender Incongruence’ in the International Classifications of Diseases 11th Revision (ICD-11). Further, it was reallocated from the mental health chapter into the sexual health chapter. This recognition supports the notion that the mental health concern is not identifying as another gender than allocated at birth, but rather the negative external factors that challenge their identity. These measures can help depathologise TGD lived experience (Collazo, Austin & Craig, 2014). While social workers are often aware of Lesbian, Gay, Bisexual and Transgender issues (LGBT), specificity to TGD awareness is not clear. Australia has been subject to recent discussion over TGD people’s ability to participate in everyday life from work, sporting, family and even the ability to use their preferred bathrooms (Riseman, 2019). Social workers need to be aware of the mental health needs of TGD peoples, so they can work with them in transaffirmative ways, to challenge discrimination in professional settings and advocate to for the legitimacy of their identity, even before transitioning (Collazo, Austin & Craig, 2014).

Supporting Literature

The literature highlights cisgenderism as a systemic barrier to the mental well-being of trans people. Cisgenderism delegitimises identity within spaces such as TGD intimate circles, professional and the agency’s they interact with (Riggs, Ansara & Treharne, 2015), and within larger legislative framework (Mulé, 2018). Riggs, Ansara and Treharne (2015) model of transgender mental health explains how microaggressions through cisgender discourse affect what are perceived as legitimate gender narratives. This is most commonly experienced through pathologisation when discussing TGD bodies as being ‘disordered’. While identifying this incongruence has benevolent origins, it may delegitimise their gender experiences and harm their mental health wellbeing. Similarly, Mulé (2018) has discussed that governments attempt to absolve their responsibility of health (Foucault, 1979) and in doing so, individualise welfare. Private structures where this responsibility is distributed are overwhelmingly cisgendered, adding to systemic microaggressions Riggs, Ansara and Treharne (2015) discuss. Social workers are engaged with emancipatory practices and Mulé (2018) suggests to affect larger policy and governmental shifts that social workers must engage with upstreaming (Callazo, Austin & Craig, 2014).

TGD peoples experience a range of poorer mental health outcomes that challenge their gender identity stemming from negative life events (Strattus et al., 2019). Strattus et al. (2019) found 74% of transgender people surveyed in Australia were diagnosed with depression and 72% experienced anxiety. In comparison to adolescents, TGD people experience depressive and anxiety symptoms 7x higher and 4x higher respectively (Lawrence et al., 2015). Many TGD people experience cooccurring mental health issues (Lev, 2009). Strattus et al. (2019) reveal that negative life events relating to accommodation, social support, bullying and education are negative drivers of mental health. Riggs, Ansara and Treharne (2015) support this understanding of overt hostile experiences through cisgenderism and the microaggressions that would maintain these perceived problematic identities. Strattus et al. (2019) supports Bolgers, Jones, Dunstan and Lykins (2014) in stating much of these negative mental health outcomes affect deeper internalised transphobia from the TGD individual. Much of this stems from the process the denial and challenge within the transitioning process, both legally and socially.

Transitioning, both socially and legally, positively add to the mental health wellbeing of TGD peoples (Bolgers et al., 2014). While depathologisation on part of the practitioner is needed to avoid cisgenderism, a client recognising self-dysphoria is important for their own autonomy (Riggs, Ansara & Treharne, 2018). Bolgers et al. (2014) celebrate that transitions as a result of this recognition are important for self-identity affirmation. While negative outcomes for life events occur at a high rate for TGD people (Strattus et al., 2019), the social transition grants access to potential self-acceptance. In the same vein, the legal transition provides validation and chances for expression of autonomy (Collazo, Austin & Craig, 2014). Contrarily, Bolgers et al. (2014) emphasises that this process is not without its burden and requires support for the TGD person. The social transition may be hampered by the experiences of minority stress (Austin & Goodman, 2018). Additionally, the legal transition is burdened by the arduous bureaucratic processes including documentation, medical verification, surgery outcomes, financial stress and further problems regarding personal issues with gender (Bolgers et al., 2014). Austin and Goodman (2018) would suggest, while beneficial, transitions need to be carefully managed and supported.

Within the space of TGD communities, Collazo, Austin and Craig (2014) highlight the important emancipatory role that mental health social workers have. While biomedical pathologizing discourse is still prevalent, social workers can assist in affirming and supporting gender experiences. Importantly, they illuminate the need for awareness of issues affecting TGD peoples and be able to facilitate respectful conversations. Austin and Goodman (2018) refer to transition narratives as the dominant discourse. They build upon Collazo, Austin and Craig (2014) in suggesting that social workers require more than awareness. They suggest social workers need to be knowledgeable enough to train medical staff such as psychiatrists and general practitioners (Austin & Goodman, 2018). Through this process, social workers need to be able to engage with TGD specific advocacy. The medical transition is an important reason for a TGD person to be accessing therapy, as psychiatry and the medical professions are effectively ‘gatekeepers’ in this process (Bolgers, et al., 2014). Social workers often are the first point of contact for the transitioning process. They must recognise a TGD person’s strength for accessing health services as they usually are a place of traumatisation, so the social worker is not a gatekeeper themselves. Collazo, Austin and Craig (2014), and Austin and Goodman (2018) highlight the fundamentality of trans-affirmative approach to help safeguard the mental health wellbeing and prevent further cisgenderism (Riggs, Ansara & Treharne, 2015).

Implications for Addressing TGD Mental Health in Social Work Practice

There is rarely federal funding allocated to LGBT health outside HIV/AIDS which does not often address the mental health concerns of the queer community, let alone that of gender diversity (Mulé, 2018). The literature illuminates the pervasiveness of cisgenderism and how it affects the mental health outcomes of TGD people. It provides grounds to recognise disadvantage with TGD lived experiences and exemplifies the role of social workers as trans-affirmative practitioners to improve their mental health outcome. These articles highlight the need for anti-discrimination policy with specificity to gender diverse populations which social workers can be instrumental in (Strattus et al., 2019).

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