Ellen Lovell 3rd January 2018
In a country where suicide rates have been falling pretty much across the board, why are so many transgender people still at such a high risk?
Trans and non-binary people, those who identify with a gender separate than the one they were assigned at birth or don’t identify with a particular gender, have always been key in the fight for LGBTQ+ rights. But in a world where trans people are seemingly being recognised and accepted increasingly often, up to 46% are attempting suicide.
In the UK, some people are forced to wait up to two and a half years after being referred by their GP for their first appointment with a gender identity clinic. Long waiting times after that first appointment also mean it could be up to four years before life-changing surgery. While Sean Bride, who identifies as trans, has a close family and friends and speaks regularly to a therapist, other people in the same situation without that network might be in trouble. “My appointment with the NHS gender identity clinic definitely had an adverse effect on my mental health. After that appointment I was depressed for weeks. For someone in a worse place than me, it could have caused total crisis.”
While Sean did not want to go down the traditional route that many trans people do – such as taking hormones and then receiving gender reassignment surgery – they do want top surgery, a procedure in which breast tissue is removed to flatten the chest. While being trans isn’t distressing to them, the hoops they are forced to jump through to be considered for surgery by medical professionals are. Even privately, where cis men can simply elect to have breast tissue removed, trans men are subjected to multiple invasive psychiatric assessments.
I was told by psychiatrists that I needed to change my title and preferably my name as ‘proof’ that I’m not living as a woman
“When booking in privately, I was told by the psychiatrists there that I needed to change my title and preferably my name as ‘proof’ that I’m not living as a woman. I’ve changed my legal name to something more masculine (from Sian to Sean), and though I had been thinking about it, it was despairing that I felt I was forced to do that.”
Despite now feeling like their mental health is stable, Sean is no stranger to mental health crises. “I have a history of self-harm and psychosis, and have attempted to end my life twice.
“I am now on a great med combo and in therapy and generally happy and stable. I try and stay away from comments sections and honestly the more trans I feel the happier I feel. I know a lot of this comes from my relative class privilege and whiteness, and because I am not trans/femme.”
Sean also feels safer from being subjected to street attacks than other trans people. “I have passing privilege; I look fairly queer but I live in London, which is huge and cosmopolitan, and people will just assume I’m a woman.”
Losing friends and becoming estranged from family after realising she is transgender is something that still affects Roodi Annabell Newbould. She plays roller derby, a sport that is generally seen as welcoming to trans and non-binary people, and her teammates are now some of her closest friends. “The only people I have are [roller derby friends]. That’s pretty awful. But amazing that I’m lucky to have [them]!”
The outside world does not help. Sexual abuse, name-calling, exclusion, physical abuse
For Roodi, the wait for this medical care is more than just frustrating. It could be deadly. Being in a body that does not match the gender she identifies with causes her extreme frustration, and she finds herself feeling “constantly empty and repulsed” by her body, leading her to use troubling coping mechanisms such as self-harm. “I have cut, starved, binged and even attempted suicide because of the way I look,” she says.
“The outside world does not help. Sexual abuse, name-calling, exclusion, physical abuse. Again, these lead to mental health and possible suicidal thoughts.”
This is combined with long waits for treatment and support.
“Many times I feel like giving up and harming. [Sometimes it feels like it would be] easier not being here at all, rather than the uncertainty and time span of ever being the person you feel,” she adds.
Surgery and, especially, hormone therapy have both been proven to increase how trans and non-binary people feel about their bodies by 85%, and increase their overall life satisfaction by 82%. If the treatments that women like Roodi need were more readily and speedily available through the NHS, she feels she would have never reached such a low level of satisfaction.
It’s hard to want to exist when your existence isn’t accepted or respected
The issues with the medical services for trans and non-binary people seem to be a never-ending frustration. Ellis is non-binary and they find it frustrating when looking for mental health treatment. “[People view me] as a woman and I often get placed in women’s groups. It’s hard to advocate for my identity whilst trying to advocate for my right to access services too.” To already be struggling with your gender identity and then to be forced into women’s groups can be distressing, and endlessly damaging, Ellis says. “It is exhausting and with very few services dedicated to or understanding of trans mental health, it’s hard to want to exist when your existence isn’t accepted or respected.”
Things do seem to be improving for many trans and non-binary people. Carrie Marshall, who is trans, recognises that outside of the medical industry, “the world’s actually getting better”.
But while strides for acceptance have been made over the last couple of years, many transgender and non-binary individuals still feel a lot of fear over living as their preferred gender identity; especially when they feel as though they do not “pass”, meaning that it is often obvious that they were not assigned their preferred gender at birth.
You’re constantly aware of the potential for others to spot you and pick on you, or worse
Carrie says: “Someone like me – 6’1” with a shape like a rugby player drawn by a lunatic – is never going to be mistaken for a member of Little Mix. And that means you come out all over again every time you open a door: every time you go on a train, go into a shop, have a night out… you’re constantly aware of the potential for others to spot you and pick on you, or worse.”
In the year since Carrie has been living as herself, she hasn’t experienced too much obvious discrimination in public, but recognises that it’s still hard not to focus on those few negative experiences over the overwhelmingly positive ones. “In a year of being visibly, unapologetically myself — often while looking like an explosion in a charity shop — I’ve experienced just one abusive drunk, a handful of giggling teenagers, one comedy double-take… and one disapproving family member; women, in particular, have been amazing about the whole trans thing and I really wish I’d come out twenty years ago when I was still cute.
I really wish I’d come out twenty years ago when I was still cute
“But your brain tends to focus on the bits that aren’t. And it’s all too easy to then listen to the wee voice in your head that says ‘you know, this is never going to get better. You’d be better off dead’.”
These thoughts are echoed by thousands upon thousands of trans and non-binary people all over the world, and while one stray thought about death isn’t enough to push someone over the edge, if those feelings repeat themselves often enough, it can become impossible to drown them out. This can force trans and non-binary people into making a difficult decision; do I live as my true self and face ridicule and discrimination, or hide and try to deal with these thoughts?
Alongside their difficulties with the NHS, Ellis feels stuck in that catch-22 situation too. “Both hiding my identity through necessity and being open about it at times have caused varying degrees of mental health problems. I think mostly I feel anxiety; how can I judge if a person will accept me? Will I lose my job? Will my friends change how they see me?” These are all thoughts that cisgender people, or people who identify with the gender they were assigned at birth, rarely ever experience.
“I find that my mental health was worse before I told my friends that I wanted to be referred to not as a girl, but just as a person,” Sam, a non-binary person who isn’t out to their family, points out.
Trying to suppress being trans doesn’t work any more than trying to pray the gay away
Carrie agrees: “Trying to suppress being trans doesn’t work any more than trying to pray the gay away. But it’s hard, because if you haven’t come out you’re constantly self-policing to make sure you don’t give away your secret identity.
“Derren Brown describes not-coming-out as carrying a bag of rocks around everywhere. When you finally put the rocks down the sudden lightness is astonishing.”
Do not suffer in silence
While simply existing as a transgender person can be an uphill struggle, there is always support available.
Samaritans 24/7 suicide helpline – 116 123
Switchboard, an LGBTQ+ specific helpline – 0300 330 0630
Ellen Lovell 3rd January 2018