Australian transgender mental health in crisis, but LGBTIQA+ support groups are desperately underfunded

Australia's transgender (trans) community is experiencing depression and thoughts of self-harm at levels never before seen, but many are not getting the help they need because they're afraid to access mainstream services, a new study has shown.

Authored by the University of Melbourne's "Trans Health Research Group, the Trans in the Pandemic: Stories of Struggle and Resilience in the Australia Trans Community" report has found 61% of the 1,019 people surveyed in 2020 experienced clinical depression—that's twice the national rate and much higher than before the COVID-19 pandemic.

The team also found 49% of trans people experienced thoughts of self-harm or suicide compared to 14.9% for the general Australian population who reported thoughts of self-harm or suicide in the initial months of the pandemic.

The survey was carried out in May and June 2020, when there was concern the trans community may be disproportionately affected by social distancing restrictions, and healthcare and employment disruptions.

Report lead author Sav Zwickl said it was already well-established prior to the pandemic that the trans community faced numerous health disparities and was one of the most medically and socially marginalized groups in society.

"Our gender clinic saw very high levels of distress, including a suicide at the beginning of the pandemic. These experiences triggered the study as we all realized the importance of documenting how the trans community were coping during the pandemic," Zwickl said.

"As the research demonstrates, transgender mental health is in crisis. Many trans people are, however, unwilling to access mainstream services due to previous negative experiences or anticipated discrimination. Our community, therefore, relies heavily on safe LGBTIQA+ specific organizations, yet these organizations are often severely under-funded and simply cannot meet the demand."

The authors established that 38% of participants had sought support from a mental health professional compared to the national rate of eight and 19% had sought out a LGBTIQA+ organization.

"Many trans people experience social isolation and discrimination at every turn—from family rejection, to bullying in school, difficulty finding employment, and relentless street harassment and violence. More recently the political and media focus on trans issues has served to exacerbate these issues. Discrimination and stigma are key drivers behind the extremely high rates of depression and suicidality in the trans community," Zwickl said.

Fellow author, Teddy Cook from ACON—the NSW HIV and LGBTQA+ health organization—said the demand for mental health support had reached a level never seen before in Australia.

"Trans and LGBTIQA+ organizations across Australia are facing huge demand from the trans community for inclusive and affirming mental health services and as this research has revealed, just 10.5% sought the help of a mainstream health organization so it's little wonder our services are struggling to meet demand," Cook said.

The report, which coincides with the International Day Against Homophobia, Biphobia and Transphobia (IDAHOBIT), is calling on State and Federal governments to help improve the physical and mental health and well-being of trans Australians by:

• establishing and bolstering trans-affirming specialist trans and LGBTIQA+ community-controlled specific mental health services
• requiring all mainstream services, including primary, secondary, tertiary and allied health, to develop trans-affirming practice, and to ensure trans people can safely access any service without fear of discrimination
• supporting strategies to ensure the safety of trans people to live without discrimination, abuse, or violence across private and public areas of life. This includes home environments, institutions and organizations, and public spaces.

Survey participants were aged 16 to 80, with 29 the average age. Almost 40% were women/trans women, 35.5% were men/trans men, and 25.6% were non-binary. A majority of the authors were trans or gender diverse.