The Ministry of Health says it’s failing to provide adequate healthcare to transgender people, an internal memo released to The Wireless shows.
The memo, which was received by Health Minister David Clark and Associate Health Minister Julie Anne Genter in late February, says demand for gender-affirming healthcare is growing, and “limited” public services are not keeping up.
The Ministry says the model of care provided to people undergoing or considering gender transition needs to be reviewed, and improving the “patchy” accessibility and suitability of healthcare is a potential priority.
The memo, which was released under the Official Information Act, aims to provide advice on LGBTQI policies to the ministers.
This admission and statement of intent is significant for Rainbow Wellington spokesperson Jem Traylen, who has been campaigning for trans healthcare for years.
She says the decades-long waiting list for gender-reassignment surgery is only a part of the problem - what’s lacking is a holistic healthcare system that provides wrap-around support.
A review of the model of care is required.
That would mean better training for GPs, more funding for counselling, and improved education for workplaces supporting transgender employees. Or GPs being able to recommend patients to endocrinologists and psychiatrists, shorter waiting lists to see specialists and more help in the regions.
Instead, Jem describes the current system as “a few bits and pieces here and there that aren’t talking to each other”.
The Ministry’s memo says: “While gender reassignment surgery is topical, it should be looked at in the context of a broader spectrum of transition-related healthcare to transgender people. A review of the model of care is required.”
Within that model, the memo says issues that need to be addressed include what “minimum level of care” DHBs should be required to provide, potentially allowing people to transition without requiring a mental health signoff, and how gender reassignment surgery can be provided nationwide.
The memo, sent by the Ministry’s strategy and policy department, also serves as a rare confirmation that an increasing number of people are seeking gender-affirming healthcare.
“The demand for health services to support people undergoing or considering gender transition is growing significantly, but public health service provision has not kept up with demand,” it says.
Yet Jem says, based on conversations she’s had with officials, there won’t be specific provisions or funding for transgender support in next month’s Budget. She says the transgender community will be “very disappointed”.
Last year, the Labour Party’s election campaign committed to ensuring “formal equality under the law, especially for trans and intersex New Zealanders”.
The party’s Rainbow policy seeks to improve access to important services and healthcare and to assess the need for gender reassignment surgery as an elective health service.
“You have no idea how healing it was to hear that - [the trans community] had gone through a process with the party and contributed to a well-written policy, and we thought it would only be a matter of time before this crisis is fixed,” says Jem.
She believes Labour recognises the importance of transgender healthcare, and calls Jacinda Ardern the most queer-friendly Prime Minister, yet since the election, she says the party has been resting on its laurels.
She says there has been relatively little discussion about improving the lives of transgender people.
“I was at an event on the Transgender Day of Remembrance in November and a journalist asked the Minister of Health about transgender healthcare funding and was told “no comment,” because it wasn’t a part of the 100 day plan.”
The Wireless approached Associate Health Minister Julie Anne Genter for comment, but after sending through specific questions to her office, was told she would not be available for any interview.
The Health Minister David Clark also declined to comment, as Rainbow health recently became Genter’s delegation.
Jem says there are massive gaps in terms of recognising the trans community.
In January, a research paper was published in the NZ Medical Journal showing a significant jump in the number of people seeking hormone therapy in Wellington. It was the first formal time the prevalence of transgender people in New Zealand had been assessed.
At the time, The Wireless asked the Ministry of Health if it was satisfied with its care and support services available to transgender people, and was sent a statement that disregarded the question.
Media coverage and research papers still rely on a 2012 study - Youth’12 - that showed one in 30 young people either identified as trans or were unsure of their gender. Almost one in five had attempted suicide.
Meanwhile, gender identity questions were omitted from this year’s Census.
Statistics New Zealand is developing a framework so it can include questions on sexual orientation in 2023, yet no such work is underway on gender identity.
It’s easy understand why many transgender people feel undervalued and unsupported.
“I’ve been told by another activist in the health industry that when the news media recently reported on the long waiting list for surgeries, it triggered a couple of suicides,” says Jem.
“And it makes me think twice before speaking to you. How can I even speak about this without discouraging people?”
A NEW AND SCARY WORLD
There was relief when earlier this year, the Counties Manukau District Health Board appointed Dr Rita Yang, who became the first New Zealand-based plastic surgeon capable of gender reassignment surgeries since 2014.
However, the DHB says there are no plans for Dr Yang to carry out the surgeries.
Currently, each DHB is responsible for finding overseas specialists for surgeries. Last year, the Ministry of Health estimated just the 19th person on the waiting list would expect to have the procedure in 38 years.
The process costs upwards of $20,000 and many, like 26-year-old Rosie Muir from Christchurch, are having to do their own research to find foreign clinics willing to perform the surgery. Rosie raised almost $4000 on Givealittle and went to Thailand.
Within the public health system in New Zealand, a psychological assessment is needed before certain treatments can begin.
Primary health care nurse Kieran Monaghan works for Evolve, a youth health & social support service that offers sexual and mental healthcare, counselling and social support.
He says the waiting time to access a publicly funded assessment via a DHB in the Wellington region is 8-9 months. Private assessments can happen more quickly, but cost between $600 and $1000.
“Medications such as puberty blockers can be vital, preventing things like menstruation or the development of secondary sexual characteristics such as a deeper voice and Adam’s apple, which can cause gender dysphoria,” he says.
“Research indicates that starting these medications in a timely way can minimise distress and increase the likelihood of greater healthy adult development.”
A lot of people are having to rely on word-of-mouth.
In May last year, Waikato University lecturer Dr Jaimie Veale was awarded $238,000 by the Health Research Council to investigate the barriers transgender people face, and their experiences of the health system.
She says overseas more people working in primary care, such as GPs, are being given specialist training and are able to prescribe hormones. This reduces the stress on endocrinologists and reduces waiting lists.
She agrees that there needs to be better “wrap-around support”.
“Transgender people need to know that their GP will be able to help them in a manner that is both competent and not discriminatory.”
She says often, people don’t know where to go.
“A lot of people are having to rely on word-of-mouth and online forums. There are agencies and organisations out there, but they may not be well-resourced so they slip under the radar.”
Nurse Kieran Monaghan describes it as “chronic underfunding”.
“There are some gains being made in the major centres in terms of the available clinical interventions, but it appears services are less visible or available in the provinces. It seems like there’s a lot of migration towards the bigger cities.”
He says the needs of gender diverse young people are much greater than the health system - this is a wider social issue.
“Gender diverse youth often experience a lack of positive whanau support, transphobic opinions, increased risk of violence and discrimination, greater risks of homelessness and poorer educational experiences at school, and have to navigate rigidly gendered bureaucratic processes.”
He would like the Government to consider an attitude shift from pathologisation to affirmation. “That means seeing young people as the expert on their own identity and recognising their right to self-determination and bodily autonomy.”
If the Ministry of Health’s warning that a new model of care isn’t immediately heeded, Jem says simply improving access to expert counselling must be an urgent priority.
“If everything else is broken, at least good counselling and support can help someone endure.
She has also campaigned for better support for workplaces when an employee transitions.
When she was transitioning, her employer “didn’t really know what it was doing - all they had was two pages of advice from the Department of Labour”.
“They did their best, but at times it seemed like figuring out what bathroom I had to use was their biggest priority.”
By speaking to The Wireless, she’s worried about discouraging transgender people embarking on their own journeys.
If she could tell those reading this anything, it would be that help is on its way.
“This Government will eventually sort this problem out, we just don’t know when yet. I hope there will be policy announcements later this year and I believe we will get something in next year’s Budget,” she says.
“Any day can be really tough, but you can get through this. There is help out there. There are agencies and organisations that are very helpful - the telephone counselling service OUTLine, for instance. There are youth services in the Rainbow sector that provide great support - Evolve and Rainbow Youth, for instance.”
When Jem came out, she was living in “the most queer-friendly part of the country” - Wellington’s Cuba Street.
“And I was still too scared to walk out the front door as my feminine self. I started having friends around for dinner, then walking 100 yards down the road to pick up some food, and I tried to push my boundaries every week.
“Some days are really cruddy, and some are better than others. And you’re not the only one going through this. You’ve just got to keep on and stay true to yourself.”
LOOKING FOR SUPPORT?
OUTLine - A free counselling and support service.
Evolve - A health and social support centre for youth.
Naming NZ - An organisation to help transgender, gender diverse and intersex youth with updating their identity documents to correctly reflect their sex and gender.