The COVID-19 pandemic has had a disproportionate impact on 2SLGBTQ+ people who continue to face higher rates of homelessness and worsening mental health.
According to survey findings of an ongoing study being led by Dr. Alex Abramovich, Independent Scientist with the Institute for Mental Health Policy Research at CAMH, 2SLGBTQ+ young people (14-29 years) are at risk of, and experiencing, homelessness in the Greater Toronto Area and surrounding areas, and approximately 36% of respondents had attempted suicide during the pandemic.
For transgender people, the pandemic has also greatly reduced access to gender-affirming health care. According to the report, among transgender participants, 64% reported having to postpone or cancel transition-related medical appointments and 50% had to postpone or cancel a transition-related surgery or surgeries due to COVID-19. This has had detrimental impacts on the mental health of transgender people.
“Even prior to the pandemic, 2SLGBTQ+ people already experienced higher rates of depression, anxiety and suicidality. The impacts of the COVID pandemic have resulted in worsened mental health for far too many 2SLGBTQ+ individuals,” said Alex Abramovich, CAMH independent scientist and the lead author of this report published in The Public Library of Science (PLOS).
While the pandemic has worsened the negative impacts on this group of people who already face significant barriers, a lack of access to safe healthcare for transgender people was a serious challenge before the onset of the pandemic. According to a Trans PULSE Project, 21% of transgender people reported avoiding a visit to the emergency department because of previous stigma and discrimination they faced as a result of their gender identity.
Recognizing the gap in access to safe and affirming health care for transgender people, in 2018, CAMH, in partnership with Sherbourne Health and SickKids, launched a new initiative focused on trans and gender-diverse healthcare through ECHO Ontario Mental Health.
“ECHO Ontario Mental Health is about increasing capacity across the health care system in Ontario so that people can get the care they need closer to home,” said Carey Lawford, Social Worker in the Adult Gender Identity Clinic.
Through virtual training and capacity building using multipoint video conferencing, this initiative has provided a trans-affirming space for health care providers from across the province to learn from one another about medical transition, with a focus on delivering trans and gender-diverse health care to their patients.
In 2017, the Gender Identity Clinic was expanding virtual care to accommodate clients that were being referred from all over the province. The clinic saw a large influx of referrals and questions from primary care providers across the province as a result of new policy changes that would enable them to refer clients to gender-affirming surgeries. It quickly became apparent how beneficial ECHO could be in supporting primary care providers with this policy change. Through the efforts of the Gender Identity Clinic and funding from the Ministry of Health, this ECHO has been successful in achieving its intended goals.
Since its launch in May 2018, ECHO Ontario Trans Gender and Diverse Healthcare (ECHO TGDH) has delivered 57 sessions to 270 providers from 192 organizations across Ontario. Following their participation in the ECHO group, care providers reported an 80% increase in their perceived competence to deliver transgender and gender-diverse healthcare to their patients.
“This program has significantly increased our teams’ knowledge and ability to meet the needs of our gender diverse patients. We no longer have to send our patients 6+ hours out of town to get the health care they need.” –Participant Social Worker, ECHO Ontario Trans & Gender Diverse Healthcare.
The pandemic has had some positives when it comes to changes in the health care system for trans patients. Due to some primary care providers like family doctors having more downtime, registration doubled in the first Trans & Gender Diverse Health Care ECHO cohort after the start of the pandemic.
“Clinicians not directly contributing to the fight against COVID-19 perhaps had more time and/or greater flexibility from home to pursue professional development,” said Lawford. “ECHO Ontario Mental Health creates this wonderful community of practice and decreases social isolation, which has impacted all of us. We meet weekly over Zoom and pool together our resources to find ways to support the trans patients who need care.”
While there is much work that still needs to be done to further increase healthcare capacity for transgender people, CAMH is encouraged to see the positive steps that this ECHO group has made towards increasing access to gender-affirming health care across the province.