Creating welcoming and inclusive spaces for rainbow whānau

LGBTQA+ university students have unique mental health needs and high rates of mental distress compared to their cisgender heterosexual peers; however, it is likely that many LGBTQA+ individuals remain untreated or receive inappropriate or insensitive care. The aim of this study was to explore the experiences and preferences in mental health care of LGBTQA+ university students in Aotearoa New Zealand. 

Dr Nadia Summers, Whāraurau workforce delivery lead, gives her reflections on an article published in the Journal of the Royal Society of New Zealand titled Is it worth potentially dealing with someone who won’t get it?: LGBTQA+ university students’ perspectives on mental health care by Claudia Garcia and colleagues.  

• While this article focused on university students, the results of this research indicate challenges for rainbow adolescents engaging with mental health services more generally. The conclusion that the workforce needs to upskill in relation to supporting LGBTQA+ (rainbow) young people is an important reminder for those working in the ICAMH space.  
• The research showed there are major access barriers for young LGBTQA+ people in accessing healthcare, and that includes difficulties finding providers who understand LGBTQA+ identities. Providers who don’t understand can contribute to young people feeling misunderstood or unsafe. Young people often felt they had to educate the provider – and therefore LGBTQA+ students preferred providers who shared or understood their identities as it reduced the burden on them. Many emphasised that providers need to proactively develop their own knowledge of rainbow communities and build cultural competence rather than relying on clients to guide them.
• This is important because young people in this research avoided discussing their gender or sexuality with providers due to fear of judgment or invalidation, and experiences of minority stress (e.g., misgendering, discrimination) within care settings, which exacerbated their distress and mental health challenges. We need to proactively address these barriers to accessing mental health services for our rainbow community.
• As the mental health care workforce, we need to ensure we have a good understanding of LGBTQA+ identities and consider how we can create safe spaces with visible affirmations (e.g., inclusive posters, flags, or intake forms that acknowledged diverse genders and sexualities). Increasing the number of LGBTQA+ providers in the workforce would also help young people LGBTQA+ access the care they need.

Providing more inclusive care for the Rainbow Community starts with the first points of contact to your practice–your website, your waiting room, your enrolment forms, and every staff member a patient encounters.  Do the mahi and make sure your practice and your staff are well trained to provide inclusive and accessible care to our LGBTQIA+ whānau.

Don’t make assumptions–you can’t tell someone is gay or trans just by looking at them and you also cannot assume you know their gender or pronouns either.  You must be comfortable asking questions!

Ask questions respectfully and for information and clarification purposes but don’t rely on your patients to educate you.  You should be doing that yourself (and that’s where Pride in Health can help).

If you’ve met one rainbow patient you’ve met…one rainbow patient. Don’t assume that everyone thinks, feels, looks, or acts the same way.

Don’t confuse sexual orientation with gender identity. The former refers to the types (gender/sex) of people someone is attracted to or wants to have sexual relationships with. The latter refers to how a person identifies and experiences their own gender.

Gender Minorities Aotearoa is a nationwide transgender organisation. It is run by and for transgender people; including binary and non-binary, intersex, and irawhiti takatāpui. They support transgender people of all ages, cultures, and backgrounds, and provide one-to-one peer support and information nationwide. Visit their website for information on gender-affirming healthcare in Aotearoa including gender affirming hormone treatment, initiating treatment and guidelines, consent forms, doses and administration information and much more.

Te Ngākau Kahukura works to make communities, environments and systems more safe and inclusive for rainbow people across Aotearoa. They host free webinars on a range of topics to do with rainbow wellbeing and inclusion. One of these includes an hour long webinar about dealing with the limitations of patient management software.

This webinar is for clinicians and people working in healthcare settings in Aotearoa who want to respect the self-determination and autonomy of trans and non-binary people when dealing with the limitations of patient management software.

This webinar is facilitated by Te Ngākau Kahukura with a presentation from Cassie Withey-Rila, an early career researcher at the University of Otago. Cassie did their Master of Public Health at the Department of Preventive and Social Medicine, exploring the positive experiences of transgender and gender diverse adults with their GPs in Aotearoa New Zealand. They currently serve on the Professional Association of Transgender Health Aotearoa (PATHA) Executive Committee.

You can read more and watch the recording here.

Transgender people have both general health needs (such as cancer, long term conditions, sexual health screening, influenza immunisations) and specific health needs that relate to their transition (such as hormone therapy and gender affirming surgery). It is important to note that not all transgender people choose to access gender affirming health care.

Transgender people are often overrepresented in poor physical and mental health outcomes. Few of these poor outcomes are caused by a transgender identity itself, but rather by discrimination from whānau, health services and those in wider society.

The distress caused by the mismatch of sex assigned at birth and gender identity (often termed gender dysphoria) can be effectively reduced when access to timely, gender-affirming health care is available. 

Intersex is an umbrella term used to describe a range of natural variations in the human body; specifically a persons sex characteristics. These variations are seen by medical circles as "atypical", or not the norm. 

But with up to 40 different intersex variations possible and 2.3% of the population having one of these variations, perhaps it is, in fact, pretty normal!​

Sex characteristics can include everything from our hormones and chromosomes, to our internal and external anatomy. The variations of sex characteristics can be present at birth or may become evident in puberty or later in adulthood.