Navigating Barriers and Facilitators: Enhancing Mental and Medical Healthcare Access for Transgender and Gender Diverse Youth

Abstract

Background

The transgender and gender diverse (TGD) community is at greater risk of experiencing stigma and discrimination, established predictors of poorer physical and mental health outcomes (Drabish & Theeke, 2021; Kachen & Pharr, 2020). High rates of victimization including exposure to transphobic bullying, verbal and physical aggression, and sexual assault have devastating impacts on TGD youth mental health and can lead to detrimental mental and physical health outcomes (Coulter et al., 2015; Johns et al., 2019). TGD youth face higher rates of depression, anxiety, suicidality, emergency room visits, and chronic health disorders exacerbated by lower primary health care uptake (Abramovich et al., 2020; James et al., 2020; Seelman et al., 2017; Veale et al., 2017). Improving access to mental and medical healthcare is critical to mitigating the negative mental and physical outcome risks that TGD youth face.

Aim

Through a community engaged research partnership with TGD youth, TGD community resource providers, and academic researchers, we aimed to identify barriers and facilitators to receiving mental and medical healthcare for TGD youth.

Methods

Participants (N=40) 12 to 25 years of age participated in a 45-to-60-minute semi-structured qualitative interview. Participants were asked to describe their experiences in the medical and mental health care systems, identify their service needs, describe the barriers and facilitators to care they experienced, and provide suggestions to improve accessibility. Transcript data were analyzed inductively using Creswell & Poth’s (2023) three level analysis framework to identify codes and themes. To increase the credibility, transferability, and dependability of findings the research team adhered to the guidelines for the publication of qualitative studies (Nowell et al., 2017).

Results

A preliminary analysis revealed mental and medical health care shared many common barriers, including negative past experiences with care providers (e.g. invalidating comments, invasive and irrelevant questions, misgendering), patient anxiety, and poor care-provider knowledge of TGD issues. Additionally, mental health care barriers included low financial resources, long wait times, low parental support, transportation difficulties. Facilitators of both mental and medical health care include prior positive interactions (e.g. use of affirming pronouns/name, kindness, connection to resources that support self-determined goals) and referral to competent and trusted TGD care providers from the TGD community. Mental health care was facilitated by opportunities to receive care at school, the ability to engage mental health providers without parental input, and low to no-cost care options. Facilitators to medical care include access to clinics equipped to provide both general and TGD specific medical care. TGD youth suggested health provider education to increase availability of TGD competent care, advertising of available resources, and increased access to free mental health resources to improve their access to care.

Implications

The results of this study can inform practice changes to increases accessibility and uptake of preventative and primary care for TGD youth. Addressing barriers and facilitators to care is critical to reducing TGD youth physical and mental health disparities and has the potential to positively impact developmental and life trajectories of TGD youth.