- On this page:
- ‘Being trans’ is not a mental illness
- Referrals to mental healthcare
- Surgery referrals
- Mental health and the Informed Consent Model
- Downloads
What mental health looks like for trans people is very similar to cis people, but with a few important differences.
In order to support and affirm your patients, understanding some of these differences will go a long way to establish a trusting relationship.
We developed a printable fact sheet to assist clinicians working with trans and gender diverse people, it’s available below and offers guidance to help you build a strong relationship with your patients.
‘Being trans’ is not a mental illness
Mental health support is something that people of all genders might need at some point in our lives. Nearly 1 in 5 people in Australia will experience some form of mental health condition in the next year¹, a number that can be even higher for trans and gender diverse people²,³.
The idea that ‘being trans’ is a mental health condition is a myth, and one that is not substantiated by credible evidence. However, some trans people do need or want mental health support for conditions unrelated to their gender, in the same way that some cis people do.
Trans people can shoulder a significant burden of poor mental health outcomes, compared to cis people broadly. This can be predominantly attributable to external experiences of stigma, discrimination, and a lack of access to adequate care. The way trans people are treated can also compound distress such as dysphoria.
While trans people may require mental health support from GPs or mental health specialists, it’s important to frame this as similar to what any person may require during their lives, and not automatically associated with being trans.
Referrals to mental healthcare
Sometimes mental health services are not affirming of trans people and our lives. This may look like not taking our experiences, identity, or language seriously, or causing harm through words or actions. It’s important when referring to any service to ensure that your patient will be supported, but especially for mental health services.
One great way to assess if a service or individual will be the right fit for your patient is to ask them a few questions prior to referral or the first appointment. The below resource provides 10 questions you can adapt to find out if a service is trans-competent and confident.
Surgery referrals
The current edition (8th) of the Standards of care for the health of transgender and gender diverse people, published by the World Professional Association for Transgender Health offers guidance to clinicians working with trans patients, including recommended referral pathways for those seeking particular medical and surgical interventions.
Most surgical interventions sought by trans people, as part of a gender affirmation, require a readiness assessment and referral from either one or two mental health professionals, depending on the type of surgery.
Read more about this, including a sample referral, at our Surgical Readiness Referral page.
Mental health and the informed consent model
In a health setting, the Informed Consent Model (also known as ‘Affirmation Enablement’) means providing correct and adequate information to patients about gender affirming hormones, risks, effects, combinations and how they might work with other medications or recreational drugs. This is so trans people are able to make a decision (or consent) about our own body, health and health care. Clinicians ensure their patients are making informed decisions about their health every day, gender affirming healthcare is no different.
It can be helpful to engaging with your local Primary Health Network Health Pathways on mental healthcare, and for gender affirming care (if localised) to ensure you feel confident providing comprehensive primary care and specialist referral as required.
When initiating or managing gender affirming hormonal care, existing mental health concerns or diagnosis are not contraindicated, provided the patient can make an informed decision.
The presence of coexisting mental health concerns does not necessarily preclude possible changes in gender role or access to feminizing/masculinizing hormones or surgery; rather, these concerns need to be optimally managed prior to, or concurrent with, treatment of gender dysphoria. In addition, clients should be assessed for their ability to provide educated and informed consent for medical treatments. – WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People V7
Surgery for People with Psychotic Conditions and Other Serious Mental Illnesses
When patients with gender dysphoria are also diagnosed with severe psychiatric disorders and impaired reality testing (e.g., psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated. Reevaluation by a mental health professional qualified to assess and manage psychotic conditions should be conducted prior to surgery, describing the patient’s mental status and readiness for surgery. It is preferable that this mental health professional be familiar with the patient. No surgery should be performed while a patient is actively psychotic. – WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People V7
References & Links
¹ Black Dog Institute. Facts & figures about mental health [PDF]. Black Dog Institute.
² Strauss P, Cook A, Winter S, Watson V, Wright Toussaint D, Lin A. (2017). Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Perth: Telethon Kids Institute.
³ Hyde Z, Doherty M, Tilley PJM, McCaul KA, Rooney R, Jancey J. (2014). The First Australian National Trans Mental Health Study: Summary of Results [PDF]. Perth: School of Public Health, Curtin University.
Pride in Health + Wellbeing - ACON
Smith, E., Jones, T., Ward, R., Dixon, J., Mitchell, A., & Hillier, L. (2014). From blues to rainbows: The mental health and well-being of gender diverse and transgender young people in Australia.
