Invisible Barriers: Providing an Inclusive Experience for 2SLGBTQ+ Patients
The population of Canadians who openly identify as part of the 2SLGBTQ+ community is on the rise. According to the Province of British Columbia, 1 in 5 BC teenagers identify as something other than heterosexual. However, 2SLGBTQ+ peoples still experience significant barriers with regards to health care access. In light of this, the health care community has been seeking to standardize inclusive policies and practices.
Last fall, the Mental Health Commission of Canada (MHCC) hosted a national forum in conjunction with Wisdom2Action to discuss the most pressing concerns gender and sexual minority youth face in health care. In June 2019, the Standing Committee on Health delivered a report to the House of Commons on the health of 2SLGBTQ+ communities in Canada including recommendations for best practices going forward. A key point shared through both reports is the necessity for training and education of health care providers regarding the needs of 2SLGBTQ+ patients.
We cannot solve the problems until we are aware of what the problems are, and as of right now, these knowledge gaps often leave a burden of education on marginalized people. The barriers faced by gender and sexual minorities are not always obvious; however, there are simple ways that health care providers can provide low-to-no barrier access to services and signal a safe and inclusive environment while doing so.
So how can health care professionals help remove the barriers to care 2SLGBTQ+ peoples experience?
Familiarize Yourself With 2SLGBTQ+ Community Terms
Briefly, it’s important to understand some community terms. 2SLGBTQ+ is an umbrella term for people who identify as something other than heterosexual and/or cisgender. The acronym might vary depending on location or standardized practices. The “2S” stands for the Indigenous term “Two Spirit.” With regards to health care, transgender people often face the most in-person barriers, which makes their needs and experiences a special area of focus in these discussions. The term “trans woman” refers to someone often assigned male at birth (“AMAB”) who identifies as a woman; trans men are often assigned female at birth (“AFAB”) but identify as men. The nonbinary spectrum encompasses people who do not identify as a binary gender and often use gender neutral pronouns (i.e., “they/them”). “Intersex” refers to people born with variations in sex characteristics beyond what is typically identified in medical communities as “male” or “female.” A person in the community is said to “pass” if they can enter a space and not be identified as marginalized. For trans men and women, this might mean entering a space and having strangers within that sphere automatically use appropriate pronouns for them without having to ask or be told. Conversely, nonbinary people often use the term “going stealth” to refer to the practice of pretending to be cisgender (cisgender meaning, “identifying with the gender assigned at birth”) to avoid stigma or potential harm in unsafe/unwelcoming spaces (i.e., a nonbinary person presenting as a cisgender woman and using she/her pronouns).
Understand How 2SLGBTQ+ Identification Can Impacts Patient Safety and Experience
Understanding these terms is paramount for comprehending the barriers trans people in particular often come up against in health care spaces. Because of the nature of health care, providers often have access to information that can be uncomfortable or harmful for trans people, such as previous names and records of assigned gender at birth. Changing one’s name and gender marker on official government documents is a process that requires time and expense. Often a person will transition socially and even medically prior to completing the paperwork process. If a trans person is “outed” as trans by a healthcare worker using old information when they are otherwise passing in a public space, this can not only cause distress and frustration to the patient but put them in very real danger of harassment by anyone who happens to overhear.
One recommendation would be for healthcare providers to keep an ongoing record of patient pronouns and names-in-use, rather than working off assumptions from medical records. As well, healthcare providers can “signal” an inclusive workplace by wearing nametags with their personal pronouns listed. If cisgender people lead by introducing themselves with their pronouns, it provides a space for trans people to do the same without having to out themselves as trans or, in the case of nonbinary people, pausing to judge whether their pronouns will be taken seriously.
Understanding How 2SLGBTQ+ Stereotypes Can Impact Patient Safety
2SLGBTQ+ people also often experience barriers with regards to assumptions. Though we have supposedly moved past identifying homosexuality as a mental illness, assumptions regarding gender and sexual minority “lifestyles” regardless of individual experiences can result in patient concerns going unheard in favour of whatever fits a stereotypical narrative. For example, bisexual people are often assumed to have overactive sex lives with multiple partners. This assumption has led to bisexual people having their sexual identity essentially treated as a “symptom”—a patient seeking a mental health diagnosis might erroneously have “hypersexuality” listed as a symptom if they mention that they have had relationships with people of more than one gender, confusing the ultimate diagnosis. A solution would be for healthcare providers to treat each patient as an individual, regardless of sexual or gender identity.
Creating a Welcoming and Safe Environment
A welcome environment starts before a patient walks through the door. At the MHCC forum, 2SLGBTQ+ healthcare providers talked about how disheartened they were to hear straight coworkers discuss gender and sexual minority patients disparagingly when they believed they were speaking in an exclusively heterosexual space. If we continue to see 2SLGBTQ+ people as aberrations from a norm, we cannot holistically shift to a workplace mindset that appropriately addresses community concerns. Any patient, any co-worker, any person one interacts with over the course of a day might be 2SLGBTQ+. It is recommended that discrimination policies are reviewed and, far more importantly, properly enforced in the spirit of ongoing education rather than punishment and policing.
Commit to Continuing to Learn
The 2SLGBTQ+ community is constantly growing and evolving. As such, 2SLGBTQ+ allyship is an ongoing learning process. Healthcare providers are encouraged to seek out self-education to remove the burden from patients. Gaps in knowledge are inevitable. However, “I don’t know” is not nearly as valuable a response to a knowledge gap as “I don’t know, but I will find out.”
- MHCC-W2A Rainbow Youth Health Forum Report
- The Health of LGBTQIA2 Communities in Canada – Report of the Standing Committee on Health
- Queer Competency in Health Care Service Provision
Bex Peterson is a nonbinary writer, student, and educator who focuses on the needs of 2SLGBTQ+ peoples, especially those facing mental health concerns. In 2018 they were invited to participate in the Mental Health Care Commission of Canada and Wisdom2Action’s Rainbow Youth Health Forum in Ottawa. They have also presented on topics of “queer competency” to the College of Pharmacists of British Columbia Board as well as the Centre for Child Development in Surrey, BC.