Rainbow experiences of accessing mental health support in Aotearoa New Zealand: A community-based mixed methods study

Abstract

<p>While we know that rainbow people in Aotearoa New Zealand (that is, people of diverse sexualities, genders, and sex characteristics) experience high rates of adverse mental health outcomes, we know much less about the extent to which Aotearoa’s rainbow community members are receiving the mental health support they need. To address this gap I used mixed methods and a reflexive community-based approach to extend current understandings of rainbow mental health support experiences, and to explore how the provision of mental health care can be improved for rainbow people in New Zealand. I first conducted interviews with 34 rainbow community young adults about their experiences of accessing mental health support. My thematic analysis showed that rainbow people across New Zealand faced significant structural barriers to accessing mental health support. Participants understood mental health settings as embedded within a heteronormative and cisnormative societal context, rather than as a safe place outside this context. This, together with a widespread silence from mental health professionals around rainbow identity, meant that participants actively negotiated coming out in mental health settings. Participants shared a variety of perspectives as to whether it should be standard practice for mental health professionals to ask about rainbow identities, but agreed on a number of subtle acts that could communicate a professional or service is rainbow-friendly. Knowledge about sexuality, gender, and sex characteristic diversity, together with clinical skills of empathy, validation, and affirmation, were described as key components for the provision of effective mental health support. I conducted a second thematic analysis of data from a subset of the initial interviews, in which 13 participants discussed their experiences of accessing gender-affirming healthcare. Participants reported a lack of funding for gender-affirming healthcare in New Zealand, and described its provision a “postcode lottery”; the care available was largely dependent on the region participants were living in. Mental health assessments for accessing gender-affirming care were often described as tests of whether participants were “really” transgender, and participants discussed the need to express their gender in a particular way in order to access the healthcare they needed. Thematic analyses of interview data informed the development of an online survey about rainbow peoples’ experiences of accessing mental health support and gender-affirming healthcare in New Zealand (n = 1575). Survey results closely reflected interview findings, indicating that rainbow people have mixed experiences in New Zealand’s mental health settings, and that accessing gender-affirming healthcare is a lengthy and convoluted process. Finally, interview and survey data were used to develop a resource for mental health professionals, to guide their work with rainbow clients. I sought and incorporated feedback from key stakeholders (n = 108) during resource development. I then distributed the resource to mental health professionals around New Zealand, both in print and online. Overall, my research shows that widespread knowledge gaps compromise the ability of New Zealand’s mental health professionals to provide culturally competent support to rainbow clients. Knowledge from this thesis can be used to increase awareness of rainbow community members’ mental health support needs, and to inform mental health professionals’ training and self-reflection around sexuality, gender, and sex characteristic diversity.</p>

‘A little bubble of utopia’: constructions of a primary care-based pilot clinic providing gender affirming hormone therapy

“…Because of this, there is no standardised pathway to accessing gender affirming healthcare across the country. The under resourcing of gender affirming healthcare in Aotearoa NZ, like in many countries, is a key determinant of unmet health needs among trans people and has created lengthy wait times for care (Fraser, 2020;Veale et al, 2019). However, there is a growing recognition of the importance of providing affirming and equitable healthcare across the country; for example, the Professional Association of Transgender Health Aotearoa (PATHA) was established in 2019 to improve healthcare for trans New Zealanders.…”

“…This assessment is usually conducted in one appointment, and the inability to provide service users with ongoing support is attributed to resource constraints. As of 2018, the growing demand for gender affirming hormone therapy in many regions meant an average wait time of one year to receive a mental health assessment through the public healthcare system (Fraser, 2020).…”

Substance use by Aotearoa's Sexual Minority Youth: Self-esteem and the LGBTQ+ Community

“…The needs of a bisexual girl seeking support may be distinctly different to those of her gay boy classmate. Given the evidence provided by this study and others that individuals attracted to multiple genders are at higher risk of negative mental health outcomes (Barger et al, 2021;Költő et al, 2019;Marshal et al, 2008;Statistics New Zealand, 2019), and report receiving lower levels of social support than those attracted exclusively to the same gender (Jorm et al, 2002), a lack of targeted resources in contexts where support is purported to be available may reinforce feelings of isolation and unsafety (Fraser, 2020). Sheets and Mohr (2009) suggest that campus programmes allowing college students attracted to multiple genders to develop their social networks may be the best tool for counteracting negative outcomes while increasing self-acceptance.…”

“…Though many schools already have student-led gay-straight alliances or similar groups, it is imperative then, that clinicians, pastoral care staff and teachers are educated as to the diversity of identities that exist within the sexual minority, as well as the fluid nature of sexual orientation (Fraser, 2020;McGlashan, 2019). Staff educated in this way may be less likely to unwittingly perpetuate biphobia, heteronormativity or heterosexism in their interactions with students and other staff.…”

Mapping gender affirming therapy experiences with transgender clients in Aotearoa

“…Minority stress theory (Brooks, 1981;Meyer, 1995Meyer, , 2003 suggests that profound feelings of distress can result from the stigma of surviving in a hetero-normative and cis-dominant society. Stigma, prejudice and discrimination create intense and often chronically stressful environments that increase vulnerability (Berke et al, 2016) and lead to adverse mental health outcomes (Fraser, 2020), including feelings of hopelessness, associated depression and suicidality (Eisenberg & Resnick, 2006).…”