First trans PULSE survey reveals sites of struggle

Mental healthcare, lack of access problematic

This week, conversations about those who our healthcare systems fail or do not properly support are of the essence. This means elders, infants, and those who are immunocompromised, the latter group being partially composed of people living with HIV/AIDS, of whom many are LGBTQ+ elders all-too familiar with government negligence during an outbreak. Healthcare for LGBTQ+ people is still certainly affected by HIV stigma, but additionally has always included barriers to healthcare for 2-Spirit, transgender and nonbinary people.

Transphobia and violent transmisogyny continue to have some of the most immediate effects on physical, material safety for LGBTQ+ people in 2020. In Canadian healthcare in particular, as a new set of research data has revealed, it seems that trans and nonbinary people are particularly living with poor mental health and lack of access to public spaces, including doctor’s offices and hospitals.

In the summer of 2019, a survey called Trans PULSE, a “national community-based survey of the health and well-being of trans and non-binary people in Canada,” was released, according to the Trans PULSE Canada website. This research effort was funded by the Canadian Institute of Health. Trans and/or nonbinary people (some nonbinary people identify as transgender, some do not), often face unique challenges when accessing medical care; many of these issues go back to healthcare providers’ lack of knowledge about trans people and gender identity or LGBTQ+ people in general. Some trans patients even find themselves stopped from accessing certain health needs due to a heightened risk of violence if they were outed as trans. In response to this, Trans PULSE, originating in Ontario in 2005 as a province-specific project, later evolved into a national survey when researchers realized that there were “whole provinces and territories without any source of all-ages data on trans and non-binary people.”

The first report on the results of the trans PULSE survey were recently released—one of several to come—on Mar. 10. The Carillon held a phone interview with executive director of UR Pride Jacq Brasseur, who was involved with the early development of the survey. In order to accurately reflect the populations it surveyed, the Trans PULSE team assembled what it called “priority population consultation teams,” groups of people who were members of the surveyed populations and could provide unique input on the wording and questions in Trans PULSE. Brasseur, being a nonbinary person who has prior experience working with LGBTQ+ community organizations in the north, was a member of both the nonbinary and rural/remote consultation team(s) which began recruitment in January of 2019. They praised Trans PULSE’s approach for being “really ethical and community-driven,” as those on the teams all belonged to the communities they consulted about. Consultants were “able to provide insight into the actual survey questions…. are they worded appropriately, are there things missing?” The existence of the survey itself was also significant: “it’s the first national transgender health survey ever, and that’s just really really amazing.”

Unfortunately, said Brasseur, under one hundred people in Saskatchewan responded to the survey because Trans PULSE has a comparatively small presence here as opposed to Ontario, where the Ontario PULSE survey made it already established. But they say they hope Saskatchewan will have a chance to run other surveys that are province-specific to reach more people, especially those in rural areas. When asked about their first impressions of the result report, which can be read in full here, Brasseur’s first, lighthearted impression was that in Saskatchewan, only three per cent of trans people who took the survey identified as straight or heterosexual. “That tells us a lot about trans communities,” they laughed. They also noted that “Canada-wide, 48 per cent of people who responded … are nonbinary identified or similar … [so] almost half of trans and nonbinary people are nonbinary. Often, when we talk about nonbinary or gender issues and nonbinary people are left out, there’s [the response of] like, there’s not that many [of them] … so it’s awesome to see that.”

The serious concerns and needs coming out of the results, however, centered on two areas: mental health and access to public spaces. “59 per cent of trans or nonbinary [responders] rated their mental health as fair or poor,” Brasseur summarized. “[Which is] something we need to be cognizant of; mental healthcare is one of the biggest healthcare needs [for trans people] across the country.”

There were also relatively high numbers of trans people in Saskatchewan who identified as people with mental illness, as well as autistic or neurodivergent. “Looking at the percentage of autistic folks who are trans and nonbinary, that speaks to [a need for] reaching out to autism-related service providers … a lot of [mental health professionals] tend to forget about LGBT people or tend to assume LGBT people don’t have any unique needs.” Notably, the survey revealed that one in three trans and nonbinary people had considered suicide in the past year, and one and twenty had attempted suicide.

UR Pride has already launched Monarch Mental Health, an 2SLGBTQIA+ focused mental health initiative, with this need in mind, as well as a weekly social support group. “I think trans and nonbinary people across the country just don’t have equitable access [to mental healthcare]…. our Resilience support group that meets on Wednesdays has been getting larger every week, in direct response to meeting social supports.” Brasseur encourages those who are able to make a donation to Monarch Mental Health, as it is only partially supported by the community initiatives fund.

As for public space access, “over 70 per cent of people who answered the survey … avoid three or more different types of public spaces for fear of harassment or outing,” said Brasseur. “Trans and nonbinary people in Saskatchewan, and in the country, often don’t feel safe leaving their house – this speaks to trans people not [being] able to access public spaces.” While they joked that right now many people weren’t leaving their houses, this statistic is disturbing because it implies a high level of social isolation and avoidance. UR Pride attempts to tackle this by educating public spaces about trans inclusion, and Brasseur encourages the general public to do the same, especially in mental healthcare. “All of us can ask the mental health practitioners that we know, how much do you know [about trans and nonbinary people?] The biggest number of the requests we [at UR Pride] get from the public are from health providers not knowing the answers to questions their clients ask.” Brasseur said this indicated room for professional development opportunities, both for healthcare providers and those who can advise them.

Additional desired surveys or assessments specific to Saskatchewan, Brasseur said, would include a closer look at Indigenous versus settler experiences of healthcare, as 20 per cent of people who answered the survey in Saskatchewan were Indigenous –which is “really great,” they say. This was the highest percentage of Indigenous responders in the provinces. As 90 per cent of responders were from urban areas, they also said hopefully more people in remote locations can be reached.