“Why Would They Listen to You? You’re Just a Crazy Trans Person” - Understanding the Experiences of the Trans Community When Accessing NHS Mental Health Services: A Thematic Analysis

Background: There are significant health inequalities for the trans community in the UK, resulting in worse access, experiences and outcomes compared to their cis peers when accessing mental health services. With the current anti-trans rhetoric in the UK media, the mental health of trans people is further negatively impacted, with an increased risk of difficulties including depression, anxiety, and suicidal ideation. There is little research exploring the experiences of trans people when accessing support for their mental health, and no research specifically exploring experiences within NHS services.

Aims: To understand the experiences of trans people accessing NHS mental health services, with consideration of what happened, how this was understood, and how it was navigated.

Methods: Taking a critical realist stance, this research utilised a qualitative methodology. Eight white British participants aged 21-32, who identified as trans and had accessed NHS mental health services, engaged in semi-structured interviews. The transcripts of these interviews were analysed using reflexive thematic analysis.

Results: Four superordinate and four subordinate themes were generated. Participants approached services with low expectations, based on personal, professional, and shared community experiences. They shared positive, gender-affirming and negative, harmful experiences. They made sense of their experiences by considering systemic issues within the NHS, such as lack of training, knowledge, and resources. Also, the stage of their own journey and how they present to others, acknowledging the importance of ‘passing’. The participants coped with their experiences largely through self-advocacy before, during and after their appointments.

Conclusions: The study is limited by a relatively small sample, all white British and aged under 35, but the implications for clinical practice, training and policy within the NHS are still significant. Most notably the need for increased awareness, training and knowledge within the NHS.