Discrimination, compounded

 

Moira Clunie is a community advocate whose work focuses on making New Zealand more accepting and inclusive towards both rainbow communities and people who experience mental distress.

Moira chairs the Board at rainbow peer support service OUTLine, serves on Auckland Council’s Rainbow Communities Advisory Panel, manages advocacy for the Mental Health Foundation and is currently undertaking Masters research focusing on rainbow community leadership and suicide prevention.

As we wind down from Auckland Pride Festival and gear up for Wellington Pride in March, Moira gave us an insight into why those in our rainbow communities who live with mental distress can face dual discrimination – and how the mental health sector can help to address this.

“It might seem obvious these days to say that there’s nothing wrong with LGBTQI+ identities.

New Zealand is increasingly accepting of people whose sexual orientations, gender identities or sex characteristics differ from majority norms.

We have laws providing marriage equality and the right to self-identify gender, and protecting against discrimination in most cases (the law is due for an update to include gender identity, gender expression and sex characteristics as grounds for non-discrimination).

The idea that there is anything harmful or pathological about being gay, lesbian, bisexual, transgender, intersex, takatāpui, fa’afafine or queer is becoming less common, and less socially acceptable.

Sadly though, this is far from the full story.

Rainbow New Zealanders still face high rates of isolation, violence, bullying, and employment discrimination.

Our healthcare system creates barriers to gender-affirming care for transgender people, and carries out medically-unnecessary surgeries on intersex children.

These and other experiences of social exclusion and discrimination mean that rainbow New Zealanders live with minority stress, which leads to disproportionately high rates of mental distress.

Lately, the Like Minds, Like Mine campaign team have been talking about intersectionality – the idea that people who belong to more than one marginalised group face additional burdens of discrimination, as well as particular forms of exclusion that arise from their intersecting identities.

For example, a transgender refugee in New Zealand might face discrimination related to their immigration status, ethnic background and gender identity. They may also face exclusion from rainbow community spaces because of racism or misunderstanding, and may be rejected from their diaspora community because of transphobia.

Similarly, rainbow people who experience mental distress can face intersecting discrimination related to their identities and experiences. This can create barriers to getting support for recovery, forming a positive sense of identity, and finding belonging within communities. For example, within health services:

• Identity discrimination creates barriers to accessing support for recovery. Rainbow people can face direct or unintentional discrimination from health and social services because of inadequate policies and professionals’ attitudes or lack of skills. Last year’s Out Loud Aotearoa report shares a range of stories from rainbow New Zealanders about their experiences with mental health services. For many, professionals’ judgement or ignorance meant that effective support was not available.
• Mental distress discrimination creates barriers to accessing gender-affirming healthcare. Too often, transgender people cannot access gender-affirming healthcare if they are currently experiencing mental distress. For example, a diagnosis of depression may be used as a reason to deny hormone access. This situation is perverse: research shows that being able to access gender-affirming healthcare significantly reduces rates of mental distress, and yet transgender people cannot access support to affirm their identity unless they can demonstrate recovery from distress.
• Identity is misunderstood as a mental health problem. Sexual orientation, gender identity and diverse sex characteristics are sometimes seen by health and mental health professionals as unhealthy, pathological, or at the root of any presenting mental health problems. While gender and sexual diversity have historically been classified as mental health problems (homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders in the 1970s, and transgender identity was removed from the International Classification of Diseases last year), diversity is still often seen as a symptom of mental ill health, or as a problem that causes distress. In some DHBs, gender-affirming healthcare is accessed through mental health services, reinforcing the sense that people’s identities are disordered or problematic.

Last year’s Mental Health and Addictions Inquiry recognised the importance of addressing mental health discrimination, and recognising the harms caused by intersecting discrimination. Its report He Ara Oranga noted “the harmful effects of discrimination on the basis of ethnicity, culture, disability and gender identity” and recommended increased focus on social wellbeing and a national strategy for mental health promotion, including addressing discrimination and prejudice.

While rainbow populations have not been a specific focus of the Like Minds, Like Mine campaign, issues of dual discrimination have been addressed at times over the last 20 years.

The campaign has included stories about recovery, identity and rainbow peer support which have built understanding about rainbow issues within the mental health sector.

Commissioned research on young people’s experiences of discrimination found that mental health discrimination cannot be seen as separate from racism, homophobia and other intersecting discrimination.

The To Be Yourself project trained Youth One Stop Shops to work effectively with rainbow young people who experience mental distress.

In 2019, I’d love to see further action to address this.

Where to from here?

Given the specific forms of discrimination that rainbow people face when they have experience of mental distress, I think there’s a strong argument for including them as a priority in the next Like Mine, Like Mine strategic plan.

More generally, I’m hoping to see the Government’s response to the Mental Health and Addictions Inquiry include a strong strand of action to address discrimination, and a focused approach to rainbow mental health that includes national standards, consistent training and sustained funding for the rainbow peer support sector.

Finally, I’m hoping that the Royal Commission of Inquiry into Historical Abuse in State Care and in the Care of Faith-based Institutions will provide a safe forum for those who faced rainbow-negative abuse in mental health services to be heard. As a nation, acknowledging the mistakes we made in pathologising people’s identities will allow us to move on to a future where we all belong, and are all included for who we are.”