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Stories from the Streets

This week’s snapshot, organisation profile, and stories from the streets all highlight the dire need for mental health support for transgender communites, both before and during this COVID-19 crisis. While community organisations have filled in the gaps to provide this urgent care, our first opinion piece writer of our COVID-19 Trans Resilience Campaign calls for social service and mental health professionals to step up and provide support to trans communities. For the remainder of the COVID-19 campaign every week will end with an opinion piece from trans experts in a variety of fields offering their thoughts and advice to trans communities and our allies.

This last year has been a hard one for all, but especially for the transgender community. Our physical health and safety have been at constant threat. There have been delays in accessing gender-affirming care and many of our livelihoods have been affected due to jobs at risk. Some have been isolated from our sources of social support and been locked at home with people who may threaten our well-being. All this occurring alongside continued stigma, discrimination, and attacks on human rights. We’ve long known the devastating effect of mental health on the transgender community, but with all of these additional issues, how do we prioritize our needs? And whose responsibility is it to ensure that the needs of the community are well met? 

As a social worker I’ve been involved with raising awareness of the mental health needs of the transgender community through various efforts before and during the pandemic. Most notably was the 2018 opening of Alicia Community Centre (ACC) in Singapore. ACC provides resources and counselling services to anyone who identifies as transgender or is questioning their gender identity. From the day we opened our doors, we saw an influx of people seeking support. However, we were completely unprepared for the quantity and complexity of cases we would receive in 2020. 

In addition to self-referrals, we received referrals from hospitals, government agencies, social service providers and other LGB groups. Most requests were for assistance with family violence, suicide risk, and mental health concerns such as anxiety. As much as we were ready to jump into action, the question beckoned – What did we have as a volunteer-led agency that many of these fully-funded agencies and trained professionals could not provide? We were just a small team of volunteer counsellors, all of whom are trans ourselves. Without financial resources and formal recognition as an approved social service provider, there were so many barriers in our way.

One of ACC’s major challenge was that our physical space had to be shut during quarantine. While we immediately moved our counselling services online, not everyone had the privilege to access this. Many were staying in unsafe environments and online counselling placed their safety at risk. This highlights one of the earlier mentioned difficulties of the transgender community during this Covid-19 pandemic. Being forced to stay in a space you feel the most vulnerable causes prolonged anxiety and constant stress, which is detrimental to one’s psychological state. This in addition to being cut off from main support systems and being unable to seek help only heightens those effects. This caused increased rates of self-harm and suicide, and many to become socially withdrawn and/or turn to substance abuse as a form of coping. Mental health services were not accessible and neither was gender-affirming care. Appointments that people had already waited months or even years for were cancelled, and some could no longer access their prescriptions. While we are aware of the psychological impact of being refused gender-affirming care, the sudden stop of hormone prescriptions also impacts brain chemistry. Some experience mood swings, worsening anxiety, depression, or other mental health conditions due to the fluctuations in their hormone levels.

Apart from this, many had lost their jobs and struggled with finding shelter. The Singaporean Government rolled out schemes to benefit people in need but many community members were not accessing this assistance. Although it was largely due to policies not meeting the needs of the transgender community, we also heard of the devastating psychological trauma that many transgender people faced when seeking help from social service agencies. So much so they preferred to go hungry than speak to another ‘helping’ professional. Person after person recounted negative experiences of seeking help from those whose job it was to provide a safe space. One of our beneficiaries shared the time he had been told by a social worker to ‘give in’ to his parents by changing his attire, so he could continue living with them. This was after he sufferred years of physical and emotional abuse.  

As social service and mental health professionals, we are often reminded to look inward and evaluate our own clinical and personal readiness to work with an individual. After all, we are human, with our own personal values, experiences, and biases. When we notice that our humanity might affect our work, we’re told that for the benefit of the person reaching out for help, the best course of action is to refer the case out. We follow the notion of doing least harm. While I agree that this is a critical aspect of working with vulnerable people, I cannot help but notice how often I hear it as a reason why a professional did not feel comfortable working with a transgender individual. We repeatedly hear professionals say ‘I don’t know enough about the community’ or ‘I don’t want my personal biases to impede my work’. Now while I would not suggest they continue working with the individual, my question to the professional is what they are going to do next? Would they choose to train themselves? Would they look inward and question where their biases come from? Unfortunately, even when we have offered training platforms to support professionals, the solution always focuses on the various community groups that they can hand their cases off to. 

Now I want to reiterate that this is a step forward from when there was no communication at all between community groups and professionals, but I would like the sector to consider their roles and responsibilities in working with this population group. Which other vulnerable population do we completely wash our hands off, giving a blanket statement about lack of training, and refer immediately out so we feel better about our own ethical practice, inadvertently overwhelming small community groups and causing their burnout? 

To social service and mental health professionals, I hope this will be a call to step up. Reflect on your practice and develop your skills to assist all vulnerable members of society. I challenge you to be courageous and generous in sharing your expertise to a population group already ostracized from the larger society. 

To our community partners across the region, while our hearts are in the right place, our mental health is also important. How do we offer our help when we too are burnt out and in need of recuperation? The work is tough but we as a community are tougher. Insist that paid professionals provide the service delivery we deserve because as it takes a village to raise a child, it takes an entire society to support the vulnerable.  

Written By: Shan Menon, Registered Social Worker
Volunteer Counsellor at Alicia Community Centre
Singapore 

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