Identifying strategies that trans and non-binary people use in response to the barriers of mental health care in Aotearoa/ New Zealand

Abstract

Trans and non-binary (TNB) people have significant mental health disparities in comparison to their cisgender peers. These disparities highlight an important need for research in Aotearoa in order to understand them and work towards their mitigation. General healthcare has received some attention within research, as has gender affirming mental health care, with a gap being identified in research on TNB people’s access to general mental health care. The Counting Ourselves Aotearoa New Zealand Trans and Non-binary Health Survey is the only of its kind and the first survey in Aotearoa to have collated data on TNB health and wellbeing. This thesis questioned the strategies TNB people use to navigate the well- documented barriers to mental healthcare (MHC) in Aotearoa. To do so, data were sampled from the Counting Ourselves 2022 dataset, focusing on open-text box responses in relation to sections of the survey that asked about access to MHC services and providers. A qualitative, thematic analysis was completed, chosen due to its positioning of the researcher as a “subjective storyteller” sharing the rich meaning amongst the perspectives and experiences of participants. Guided also by the transformative framework chosen because of its focus on creating equitable outcomes for marginalised communities, transforming oppressive systems and recognising the resilience of the research participants. Control of Disclosure, Provider Selectivity, and For the Future were identified as themes of this study, explaining the overarching patterns of meaning found in the shared experiences of the survey’s participants. In response to barriers, to the lack of competent providers, the long waitlists with the public health systems and the worries of gatekeeping or of being discriminated against, TNB people are creating pockets of reactive self-determination, autonomy and resilience for themselves. This involves TNB people; controlling disclosure and choosing not to tell MHC providers (MHCPs) everything about their gender unless they are confident that the provider is competent and safe, being selective with providers and choosing to only access providers who are trans friendly, affirming, and knowledgeable, and in some situations, choosing to put up with the negative interaction, and challenge them ‘for the future’ aiming to leave the space better for the next TNB person to come. The identified strategies enable further understanding of what aspects of MHC access and MHCP interactions are creating negative experiences for TNB people. Control of disclosure identifies that the worry of, and actual experiences of uncomfortable, unknowledgeable or discriminatory provider reactions to the disclosure of gender identity is a negative experience leading to the development of strategically not disclosing gender to prevent and/or control the exposure to these negative experiences. Provider selectivity shows that experiencing long waitlists to MHC, as well as providers who are not competent in the provision of MHC for TNB people, is a negative experience and has created the need for strategic selectivity with provider access. By conceptualising negative experiences, we can then formulate that a positive experience would be a safe, appropriate, knowledgeable facilitation of and response to the disclosure of gender and increased provider accessibility and competency. This research builds on current understandings of MHC whilst offering a new angle of inquiry, focusing on the voices of TNB people and their shared experiences, and straying from the often-found discourse positioning providers as the experts on all topics. By doing so, it offers a tool for students and MHCPs to use to direct efforts when working towards equitable MHC access and provision for TNB individuals and the community.