Dangerous Delays: Helping trans individuals access health services

45 per cent of trans people attempt suicide at some point in their lives.

Timely access to health services related to gender transition is critical. People going through a gender transition often face stigma, discrimination and loss of support networks, which can lead to depression and poor mental health. According to studies conducted around the world, as many as 40 to 45 per cent of trans people attempt suicide at some point in their lives.

“Research tells us the risk is most acute in the time frame after they’ve made a decision to transition, but before they’ve been able to access services to get the process started,” says Kate Shewan, executive director of The Youth Project, a Halifaxbased organization that supports young people aged 25 and under around issues of gender identity or sexual orientation. “Unfortunately, wait times have been a big issue.”

Shewan is the community advisor to a new NSHA research project seeking to improve pathways to health care for trans people in Nova Scotia. The project, supported by a QEII Foundation TRIC (Translating Research Into Care) grant, is coled by Kolten MacDonell, health services manager, NSHA Primary Health Care & Department of Family Practice, & Dr. Jacqueline Gahagan, an NSHA-affiliated scientist and professor in Dalhousie’s School of Health and Human Performance.

“At this time, we don’t have a single point of entry to the health care system for people seeking services related to their gender identity,” notes MacDonell,who manages prideHealth in Primary Health Care. “As a result, wait times for an initial assessment can vary from months to years.”

Trans people often require counselling for gender dysphoria, the distress of living with a gender identity that’s at odds with their sex assigned at birth. Those who’ve decided to transition require a psychosocial readiness assessment before being referred for gender-affirming hormone therapy and/or genderaffirming surgery. Depending on how they access the system, the entire process can take as long as three years.

“We will start by asking trans people and health care p ro v i d e rs w h a t they see as delays in receiving timely care and how best to address them,” says Dr. Gahagan, noting that the researchers are collaborating with Community Mental Health in this effort. “From this data, we’ll be able to form an advisory committee to lead the development of more streamlined processes and triage protocols to reduce delays.”

Ultimately, the researchers and their community stakeholders aim to ensure timely access and improve coordination of care of services that align with the World Professional Association for Transgender Health (WPATH), the current gold standard for patientcentred care of trans individuals.