Guest Editor Pierre-Paul Tellier
This special edition of Clinical Child Psychology and Psychiatry presents manuscripts on health care of gender diverse children, adolescent, and emerging adults. Several of these articles are written by members of The Tavistock and Portman NHS Foundation Trust (2018)—Gender Identity Development Service (GIDS), a “highly specialised clinic for young people presenting with difficulties with their gender identity”. The service was established in 1989 in Great Britain (The Tavistock and Portman NHS Foundation Trust, 2018).
The Guest editor’s paper ‘Improving health access for gender diverse children, youth, and emerging adults?’ begins by outlining definitions of gender and sex, and acknowledges the use of the term “gender diverse” in this paper. It recognizes that situations and consequences affecting gender diverse children, youth, and emerging adults develop due to the discrepancy between a person’s assigned gender at birth and the self-definition of their gender. It has been shown that transitioning individuals accessing care for social, medical, and surgical needs have better long-term health outcomes.
It is important that these youths have access to a broad range of services not only to transition but also for preventive health needs, as well as ongoing care for the various acute and chronic mental and physical problems that they experience. To improve access, a variety of options have been proposed. These include training of students in the health professions, for example, medical students, nurses, social workers, or psychologist by adding appropriate courses to their curriculum, thus increasing awareness and eventually leading to more appropriate care. The implementation of multidisciplinary virtual communities of practice to facilitate case discussions offering support to isolated practitioners is another option. Assessment and care can also be done electronically and has been shown to be effective with managing mental health issues, such as substance use. At this point in time, based on the evidence available in the literature, one can conclude that universal health access, as defined, is a goal that is yet to be met for most of gender diverse youth. Hence, we need to work together, with those that we serve, to develop appropriate, sensitive, and accessible health care for all.
Gender diverse people are individuals who define their gender as different from the sex they were assigned as birth. This incongruence leads to a sense of discomfort within oneself, which according to the DSM-V is called gender dysphoria. The combination of dysphoria, ongoing stress, as outlined in the Minority Stress Theory (Meyer, 2003, Dohrenwend, 2000) and the stigma related to living in a society which traditionally defines gender as binary and rejects the notion of gender as fluid, is associated with psycho-social, mental, and physical health problems. Gender diverse children and young people require support from health practitioner to assist them not only in transitioning, if this is what they choose, but also to manage ongoing and preventive health care in a system which is not always welcoming and frequently hostile to them. In 2012 the United Nations General Assembly called for universal health coverage as a goal in the post-2015 Millennium Development Goal Framework. One step in attaining this goal is universal health access which is not currently being met for gender diverse individuals. Hence, we need to work together, with those that we serve, to develop appropriate, sensitive and accessible health care for all.
improving health access for gender diverse children, youth, and emerging adults?
First Published October 29, 2018 Research Article
From Clinical Child Psychology and Psychiatry