Transgender Realities

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Transgender Realities

• Christine Burns MBE

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Who are these people?
Friends
Policeman
Musician
Steelworker
Pilot
Doctor
Politician
Golf Pro
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Targets of Hatred
Every trans person in the UK today has to
undertake a risk analysis that weighs up home
imprisonment on welfare benefits, suicide or the
risk of physical harm, possibly even rape or
murder as the price to be paid for living their
lives in their preferred gender role(1) ...the
suicide attempt rate for trans people is very
high, far higher than the rate for one of the
most mentally vulnerable groups people with
ongoing mental health problems as a result of
childhood abuse or trauma (1)
(1) Memorandum submitted in regard to the
committee stage on the Criminal Justice
andImmigration Bill (CJI 391) November 2007
Press for Change. www.pfc.org.uk
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Gender Dysphoria is not a mental illness

• Transsexual people do not choose their gender
  identity. Transsexualism is an overpowering sense
  of different gender identity rather than any
  sexual orientation transsexual people may be
  heterosexual, gay/lesbian or celibate It is not
  a mental illness. It is a condition considered in
  itself to be free of other pathology (though
  transsexual people can suffer depression or
  illnesses like anyone else)

Government Policy Concerning Transsexual People
Department of Constitutional Affairs(now the
Department of Justice) Dec 2002
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In Britain Today

• There are approximately 5,000 transsexual people
• In a sample of 870 trans people in September
  2006(1)
• 73 had experienced harassment in public
• 10 encountered threatening behaviour from the
  public
• 42 feared losing their jobs upon transition
• A quarter felt obliged to leave their job
• 10 had experienced verbal abuse at work
• 6 had been physically assaulted
• 6 had been refused healthcare
• 1 in 4 said they were made to use
  aninappropriate toilet at work

(1) Engendered Penalties Whittle, Turner and
Al-Alami The Equalities Review, Feb 2007
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In Britain Today

• 2354 Transsexual People had applied for legal
  recognition between April 2005 and 18th Mar
  2008(1)
• Applications average 25 per month 300 each year
• 97 of applications are approved(1)
• About 900 new cases seek help every year(2)
• The NHS carries out 100 gender reassignment
  treatments per year(3)
• Another 200 each year are estimated to go abroad
  for treatment in centres such as Thailand and the
  US

• Gender Recognition Panel Mar 2008
• 600 NHS 300 Private
• Parliamentary written answers February 2006

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Legal Protection

• Sex Discrimination (Gender Reassignment)
  Regulations 1999
• R v North West Lancashire Health Authorityex p
  A, D and G 1999
• Gender Recognition Act 2004
• Equality Act 2007 (Gender Equality Duty)
• Sex Discrimination (Amendment to Legislation)
  Regulations 2008

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Sources of problems in care

• GP knowledge / support and attitudes
• Funding / commissioning issues
• Delays
• Absence of choice
• Lack of local support
• Distances to travel
• Lack of long term care
• Inability of clinicians to see the person

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Care Deficiencies

• In the Equalities Review sample of 870 trans
  people polled
• 6.3 of respondents said they had been refused
  medical treatment because of their trans
  background
• A further 13.2 felt their treatment had been
  adversely affected because of health staff
  knowing about that background (sometimes through
  inappropriate disclosure)
• The other 80 said they thought their GP would
  like to be more helpful but
• 60 of those 80 reported their GPs having a lack
  of appropriate information

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Further Research
More than 25 of the respondents from all the
selected groups reported that they were refused
treatment because a practitioner did not approve
of gender reassignment. Those on higher incomes
had a markedly lower reporting rate of refusal
than those on lower incomes. A maximum of only
30 of respondents across the group categories
reported experiencing the acceptable baseline a
practitioner wanting to help but lacking
information about trans issues. A minimum of
15 and a maximum of 23 of respondents felt that
being trans affected the ways that they accessed
routine non trans-related healthcare. A
minimum of 18 and a maximum of 31 felt that
being trans impacted how they were treated by
healthcare professionals.
ILGA Europe and Transgender Europe April 2008
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Some Quotes

• When they are seeking treatment to transition,
  trans people will start a medical process which
  reduces every aspect of their life and, in
  particular, their health down to the most minimal
  of issues, their trans mental health.
  Practitioners, at every level of medicine, ignore
  the trans persons abilities to cope with ongoing
  crises that would destroy other people, their
  educational standing and the nature of the actual
  illness they are presenting with.

Engendered Penalties Whittle, Turner and
Al-Alami The Equalities Review, Feb 2007
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Some Quotes

• I had to change GP because he just could not
  accept gender dysphoria as being real.
• My endocrinologist refuses to treat, recommend
  or monitor trans people.
• I was put in a side room on the Womans
  Surgical Ward. I was told that before I had even
  arrived on the ward the word had gone out that a
  man was being put on the ward. My stay was made a
  living hell by one Staff nurse who all the others
  seemed to follow.

Engendered Penalties Whittle, Turner and
Al-Alami The Equalities Review, Feb 2007
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NHS Principles

• The NHS will provide a universal and
  comprehensive service with equal access for all,
  free at the point of use, based on clinical need,
  not ability to pay.
• We will help keep people healthy and work to
  reduce health inequalities.
• We will treat every patient with dignity and
  respect.
• We will shape our services around the needs and
  preferences of individual patients, their
  families and their carers.
• We are committed to equality and
  non-discrimination.

NHS Operating Framework 2007/8
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Resources Available
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Professional Behaviour

• Treat with respect
• Maintain privacy
• Provide care
• Seek best practice
• Use the resources
• Behave with maturity

Bad Questions to ask... Calpernia
Addams http//www.youtube.com/watch?vBOjeZnjKlp0
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Web Resources

• Press for Change The Gender Trust
• www.pfc.org.uk http//www.gendertrust.org.uk/
• Department of Health Literature
• http//www.dh.gov.uk/en/Managingyourorganisation/E
  qualityandhumanrights/Sexualorientationandgenderid
  entity/DH_4117240
• Engendered Penalties Transgender and Transsexual
  Peoples Experiences of Inequality and
  Discrimination
• http//www.pfc.org.uk/files/EngenderedPenalties.pd
  f
• Just Plain Sense
• http//podcast.plain-sense.co.uk/