Transgender Advocacy: A Mental Health Perspective

Mar 9

Over the past month, legislation has been introduced in at least 20 states, including South Dakota, that has the potential to directly impact the transgender community. Many of the bills address topics such as transgender youth participation in sports, gender-affirming mental health care access for trans youth, and bans on updating birth certificates. ¹

Here at Kimberly Keiser and Associates, we recognize the value of advocacy for the communities that we serve, and thus, feel there is an opportunity to offer a mental health perspective to these important, and potentially life-changing, conversations.

Current South Dakota Legislation

South Dakota has seen both of these bills presented in legislation this 2021 season:

House Bill 1076 seeks to ban transgender individuals from correcting their birth certificates to accurately reflect their gender marker. The bill was moved to the 41st day of the legislative calendar after a unanimous 6-0 decision by the Senate Health and Human Services committee . This effectively shelves the proposal for this year; however, there is still the possibility that the bill could be revived by what is referred to as a “smoke out,” in which a third of the chamber’s representatives vote to override the wishes of committee members, bringing the bill back to the floor for a full vote.

House Bill 1217 seeks to “promote continued fairness in women’s sports” by preventing transgender girls and women from participating in girls’ sports. The bill would establish that teams and/or sports be specifically designated as male, female, or coeducation. More specifically, female sports would only be available to athletes that are female based on their biological sex assigned at birth. This would apply to any sport or team that is sanctioned or sponsored by a public school or an institution of higher education under the control of the Board of Regents or the South Dakota Board of Technical Education.

Important Terminology and Data

Below, we have gathered terminology and data that can help increase understanding of the topics at hand. By familiarizing yourself with this terminology and data, you can reduce harmful misinformation that is out there pertaining to the trans community. It also provides a framework for understanding the impact of marginalization on the trans community from a mental health perspective. Please note that a lack of funding and representation may impact this data, meaning it may not be entirely representative of the most accurate picture.

Terminology

Transgender: An umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth.
Cisgender: A descriptor for people whose gender identity or expression corresponds to the sex one has been assigned at birth.
Gender identity: a person’s internal understanding of their own gender.
Gender expression: a person’s outward presentation of their gender (ex: their demeanor, actions, and/or how they dress)
Transgender women: people who were assigned the male sex at birth but identify as women.
Transgender men: people who were assigned the female sex at birth but identify as men.
Gender Dysphoria: a condition in which a person has marked incongruence between the expressed and experienced gender and the biological sex at birth. ²

Data

Population
- 1.4 million adults identify as transgender. ³
- 0.7% of adults ages 18-24 identify as transgender. ³
- 0.5% of adults ages 65 and older identify as transgender. ³
- 0.3% of the adult population in North Dakota, Wyoming, Montana, and South Dakota identify as transgender. These are the lowest percentages in the U.S. ³
- 2,150 (0.34%) transgender individuals (18 and older) reside in South Dakota. ³
- 1.8% of youth identify as transgender. ⁴
Mental Health
- Adults
  - 39% of transgender adults were currently experiencing serious psychological distress, nearly eight times the rate in U.S. population (5%). ⁵
  - 48% of transgender adults have seriously thought about suicide in the past year, compared to 4% of the US population. 82% have had serious thoughts of suicide over the course of their life. ⁵
  - 71% of respondents who have attempted suicide have done so more than once in their lifetime, with 46% of those who have attempted suicide reporting three or more attempts. ⁵
- Youth
  - 35% of transgender youth have attempted suicide in the past year. This is 5x’s higher than their cisgender peers (7%). ⁴
  - 44% of transgender youth have considered suicide in the past year. This is 2.75x’s higher than their cisgender peers (16%). ⁴
  - 53% of transgender youth felt sad or hopeless for two weeks or more in the past year vs. 30% for cisgender youth. ⁴
- Victimization
  - Adults
    - 1 in ten (10%) of those who were out to their immediate family reported that a family member was violent towards them because they were transgender. ⁵
    - 8% were kicked out of the house because they were transgender. ⁵
    - A majority of respondent who were out or perceived as transgender while in school (K-12) experienced some form of mistreatment due to being transgender. ⁵
      - 54% were verbally harassed.
      - 24% physically attacked.
      - 13% sexually assaulted.
      - 17% experienced such severe mistreatment that they left a school as a result.
  - Youth
    - 31% experienced sexual violence in the past 12 months. ⁴
    - 24% threatened or injured with a weapon at school in the past 12 months. ⁴
    - 27% felt unsafe going to school in the past 30 days. ⁴

Potential Impact of Bills on Mental Health and Well-Being

It is important to understand that being transgender does not equate to a mental disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, gender dysphoria, which not all who identify as transgender experience, is a diagnosis that warrants therapeutic interventions according to the DSM-5. The American Psychological Association (APA) states:

“A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance in society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression, or related disorders at higher rates than nontransgender person.” ⁶

In short, a large portion of individuals who identify as transgender experience relief and positive outcomes when they are affirmed in their identity, treated with compassion, and given access to the same rights as the cisgender population.

The proposed legislation would, in essence, actively contribute to the discrimination and degradation of transgender individuals by codifying discriminatory practices into law. The bills would serve to separate a small percentage of the population that already struggles with marginalization and amplify the lack of social acceptance in our society, which we know according to research, largely contributes to LGBTQ+ mental health struggles.

Additionally, not allowing individuals to change their gender marker on their birth certificate or forcing transgender females to participate on a male team could pose safety risks by outing people to various agencies, individuals, and peers. This could also increase the risk of violence and/or other forms of victimization.

We have an opportunity to create a world where all individuals have a seat at the table through unification rather than division. We have an opportunity to prioritize the happiness, well-being, and safety of those we share this life experience with, to ensure we all have the potential to flourish and thrive. Unfortunately, the proposed bills do not support this as written. Now is the time to prioritize the safety and health of all humans, regardless of identity, despite our politics, the nuances of our beliefs, or our (mis)understandings.

Kimberly Keiser and Associates stands in solidarity with the transgender community, and our providers are available for therapeutic services to provide support, care, and encouragement.