Mental Health Services still lacking

Trans students continue to face barriers in mental health treatment

McGill Counseling and Mental Health Services (CMHS) has undergone a number of structural changes recently, some due to complaints from patients, and mobilization on the part of student representatives and campus organizers.

Most recently, CMHS shifted to a ‘stepped care model,’ but despite efforts on the part of CMHS to become more inclusive and anti-oppressive, many trans students have noted that their experiences with the service have been less than ideal.

In an interview with The Daily, Khloe,* a current McGill undergraduate student, described their experiences working with a number of therapists and psychiatrists at the clinic. They noted their discomfort discussing issues of queerness, transness, and racialization with their service providers, despite the fact that these issues often interact deeply with their experiences of mental illness.

When they met with their first psychiatrist, they explained, “I just didn’t trust [him] at all [and] just like could not tell him the most basic things about myself, like the fact that I was queer, that I was trans.”

A sense of distrust has permeated their relationships with therapists, creating a barrier between Khloe and their clinician. This distrust was created, according to Khloe, through the lack of incorporation of trans positive behaviors in the atmosphere of the sessions. For example, therapists normalized the gender binary.

When asked if the therapists leading a group therapy session asked for pronouns when meeting Khloe for the first time, Khloe said that “it just wasn’t a thing that was talked about.”

Furthermore, Khloe said the therapists did not respect their pronouns even after they had asserted them.

This created a client-patient relationship that wasn’t open to hearing about Khloe’s experiences with oppression. “I feel like like being non-binary or being queer are important aspects of my identity, and therefore my mental health, and if I can’t talk about those things in therapy, what the fuck am I supposed to be?” they said.

Another trans student who uses the Services, James*, told The Daily that when he initially accessed the services, the first clinician he saw turned him away because of a lack of knowledge about providing healthcare for trans patients, despite the fact that James was not seeking care regarding his transness.

As a result, James saw a student doing a practicum or internship who did not have training for treating transgender people and did not help with the original issue he sought help for.

“That was my first useless experience,” he said, “and I was so burned by that that I just didn’t go back for two years.”

These testimonials play into past criticisms of the Canadian medical system, with many saying that despite seeking care that has nothing to do with their gender, providers sometimes feel that if they do not understand trans issues, they will be unable to provide services.

Unfortunately, this results in many trans patients being reduced to their gender identity; trans people, like anyone else, experience health problems that have nothing to do with their sexual or gendered characteristics.

James went on to note that when he recently returned to access CMHS, although his new clinician was also unfamiliar with trans issues, “he seemed to have done a lot of reading, he mentioned some of the things he’d been reading and showed me,” he said. “He’d been doing his homework, which I really appreciated.”

James commented that this made him feel much more comfortable, though he worries about trans folks who might approach Counseling and Mental Health Services early on in their transition. These patients, who might not have access to information and resources about transness, could experience harm at the hands of a mental health service provider lacking knowledge about trans issues.

“If I think back to the person that I saw years ago, the first person I saw, she had worked with so many trans people she knew the right language to sort of lead me to where I needed to understand myself and things like that,” James said. “So [a clinician] with that kind of experience, I think is invaluable [for trans patients early on in their transition.]”

Trans patients are still facing these challenges in sessions at CMHS despite numerous efforts on the part of administration to improve services.

Associate Director of Counseling and Mental Health Services, Giuseppe Alfonsi, told The Daily that improving the inclusivity of their services was one of the Services’ main goals.

He noted that feedback was an important part of their new administrative model and he takes it very seriously: “I literally record every single feedback I get. I try to contact every single feedback,” he said. “But I’ve had a gap where I haven’t heard anything.”

As it stands, patients can only provide feedback through an online forum. Alfonsi added that “the first thing I would say [we need to work on] is figure out a kind of more proactive feedback system. Meaning, do we reach out on purpose to students who come from marginalized experiences? Do we design […] a kind of more formalized assessment for those students’ needs?”

In 2013, all Mental Health Services staff received a three-day training with Françoise Susset and Pierre Paul Tellier, both health care providers who work closely with trans communities in Montreal. Following this training, Tynan Jarrett, Equity Educational Advisor (LGBTTQ) at the Social Equity and Diversity Education (SEDE) office, has delivered training sessions each year to the MMHS staff on competent trans care.

In an interview with The Daily, Jarrett discussed the contents of these trainings. These trainings addressed a number of issues including the importance of asking pronouns, not assuming anything about patients’ relationships to gender or transitioning, and how gender intersects with other aspects of one’s identity, such as race, class, and ability.

When asked why trans folk continue to face difficulties at CMHS, Jarrett and Alfonsi both noted that often this type of education takes a long time to take hold.

“The health system is embedded in broader social systems, which means that…health care providers, even relatively explicitly liberal health care providers […] are going to be raised […] in a classist, racist, sexist, transphobic, homophobic society […] and that stuff is going to seep in,” Alfonsi said. “So you have to constantly exert energy to kind of roll that back.”

Creating a change within the culture of CMHS is a difficult task that requires the commitment of all staff members. Alfonsi indicated that most, if not all, clinicians at Mental Health Services were open to feedback and eager to provide the best care possible to patients.

Jarrett emphasized that the only way to improve is to continue educating the staff and make it a priority to hire clinicians who either are trans, knowledgeable in trans issues, or both. Alfonsi told The Daily that hiring was indeed a priority for the Services.

Both Alfonsi and Jarrett were optimistic regarding the potential for CMHS to improve.

They both think this is a moment of change for the Services in improving their care, not only to better serve trans patients, but also to improve on issues of racism and classism.
Beyond education and hiring, important next steps could include providing more trans-specific services and resources, as well as improving the clarity and ease by which students can provide feedback.

*Names have been changed.