TRANS HEALTH CRISIS
Running: September 2019
CALL TO ACTION
During the week of September 16, 2019, two alarming news stories came to light regarding the status of trans affirming health care in Alberta.
• The first was the news of the resignation of Dr Michael Marshall, the head of the Gender Clinic at the University of Alberta, as a result of a lack of funding and sustainability.
• The second was the news that all top surgeries now can only be referred by a psychiatrist, where previously it could have been a physician or mental health professional. This has significantly impacted the wait times of those looking to access surgery.
These two stories serve as examples that shine a harsh light on how inadequate trans healthcare is in the province of Alberta as a result of the continuing use of an antiquated, discriminatory and severely underfunded system that causes unacceptable and harmful barriers in timely access to competent care for trans and gender diverse Albertan.
We are calling the Government of Alberta, Alberta Health, Alberta Health Services and the College of Physicians and Surgeons of Alberta to recognize and take accountability for these substantial and dangerous gaps in service and immediately:
• Increase funding for the delivery of trans affirming health care,
• Allocate funding for a province-wide, system navigator specifically for trans and gender diverse individuals (similar to models such as Trans Care BC or Rainbow Health Ontario). This system navigating organization should be community-driven, operate at arms reach from the health care system, and act as a single source of truth.
• And, update and amend outdated and restrictive policies and practices relating to the care of trans and gender diverse Albertans.
HELP US BY DOING YOUR PART
We encourage and call on all Albertans to writing letters containing the same requests as above (please feel free to us this as a template) and sending them to the following individuals-
• Hon. Tyler Shandro - Minister of Health (email@example.com)
• Hon. Leela Aheer - Minister of Culture, Multiculturalism and Status of Women (firstname.lastname@example.org)
• MLA David Shepard - Critic, Health (edmonton.CityCentre@assembly.ab.ca)
• MLA Janis Irwin - Critic, LGBTQ2+ Issues (edmonton.HighlandsNorwood@assembly.ab.ca)
• Donna Manuel - Executive Director, Health Insurance Programs Branch (email@example.com)
• Dr. Neil Hagen - Medical Advisor, Alberta Health (firstname.lastname@example.org)
• Dr. Verna Yiu - AHS, President & CEO (email@example.com)
• Dr. Ted Braun - AHS, Vice President & SOGIE provincial advisory committee lead (firstname.lastname@example.org)
• SOGIE PAC - Sexual Orientation, Gender Identity & Expression Provincial Advisory Committee (email@example.com)
We also encourage that you ‘cc’ us or send us a copy of your letters at firstname.lastname@example.org to help us in our efforts and allow us to post them below on this page as a show of support and solidarity.
• Timely access to trans affirming care saves life.
We see in extensive research including a 2013 study by G. Bauer (et. al) that the risk of suicide attempts by trans and gender diverse individuals as a result of the discrimination, stigma and systemic barriers are a significantly real danger with over 40% reporting having attempted suicide. Of particular note, however, is that over 90% of suicide attempts happen in the waiting period while an individual as identified they need access to trans affirming care and the time that the receive it, but once they have access that number drop to under 2%. This is why it is essential to shorten the time for access to care.
• There is a significant lack to knowledge and empathy in the healthcare system.
In the findings from the Canada Trans Youth Health Survey published in 2018, trans and gender diverse youth face significant barriers in access medical and mental health services. Among those surveyed, over 30% don’t access the healthcare services they need. Notably, when asked about the barriers that prevented them from accessing care, over 60% reported they were afraid of the providers response, and over 30% reported that they had already had negative experiences with providers.
• Alberta’s trans healthcare system is signifcantly out of touch with global standards of care.
When we compare the way trans healthcare is practiced in Alberta against the global standard set by the World Professional Association for Transgender Health (WPATH), we see that our provincial system is unnecessarily restrictive:
In Alberta, individuals accessing ‘bottom surgery’ require a referral and letter of support from 2 psychiatrists.
The WPATH Standards of Care, as well as the surgeons performing the surgeries themselves, only require a referral and letter of support from 1 psychiatrist and 1 healthcare or mental health professional. The additional restrictions placed by the province delay surgeries for years.
In Alberta, individuals accessing ‘top surgery’ are now required to have a referral and letter of support from a psychiatrist.
The WPATH Standards of Care, as well as many of the surgeons performing the surgeries themselves, only require a referral and letter of support from a physician or mental health professional. These new additional restrictions placed by the province delay surgeries for years.
• Trans healthcare in Alberta remains exceedingly specialized, gatekept and challenging to navigate.
Alberta has failed to sufficiently update policies and practices to reflect the evolving societal understanding of gender diversity. Many of the existing practices are still rooted in those created before the release of version 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM) when the medical community still perceived trans individuals as mentally ill (being diagnosed with Gender Identity Disorder) and care was intensely pathologized.
This lack of progress results in our trans healthcare system still being immensely opaque, fractured, and unnecessarily specialized. All healthcare providers have the knowledge and skills, with minimal if any supplemental training and yet over 60% of trans and gender diverse individuals report only being able to have access the hormone therapy they were seeking through a specialists.
Because of this lack of awareness, unity and de-specialization, trans and gender diverse individuals are left struggling to be able to find where to access the support and care they need and are often left to educate and advocate for themselves. Putting the responsibility on the individuals themselves to fight to find the care they need results in significant additional distress on top of an already intensely distressing period. In addition to the significant increase of mental health challenges that this distress creates, it can also put individuals in significant physical danger, with over 20% of individuals looking to access hormone therapy reporting having turned to non-medical sources to access hormones (friends, families, online, etc…).
This unsupervised use can have significant health complications and yet the desperation that drives trans and gender diverse individuals to these types of actions are easily avoidable.
SHOW OF SUPPORT
Send us your letter and add it to our show of support and solidarity today.