Dishonored: trans military mental health
Serving in the military is one of the bravest and courageous choices anyone can make.
In 2021, over 1.4 million Americans make up the Armed Forces.
More people join every day and guess who is most likely to join.
Transgender civilians are 2 to 3 times more likely to enlist than cisgender civilians. That statistic surprises many, but the next one is even more shocking...or is it?
Mental Health and LGBTQ+ ADSM
According to Suicide in Transgender Veterans: Prevalence, Prevention, and Implications of Current Policy, “transgender veterans die by suicide at twice the rate of their cisgender veteran peers and approximately 5.85 times the rate of the general population.”
As unfortunate as this is, I am not particularly shocked. Many people in the LGBTQIA+ community face wrongful discrimination, social rejection, violence, and bullying.
In fact, a high percent of LGBTQIA+ youth struggle with mental illnesses such as Post Traumatic Stress Disorder, Depression, and Generalized Anxiety Disorder.
Active-duty service members (ADSM) and veterans face additional challenges as well. These can include being silenced by superiors, being attacked on base, and being denied transgender health informed care.
These limitations and circumstances can cause veterans to experience higher rates of reported PTSD, depression, and, as stated above, suicidal actions. Research on transgender veterans further shows a higher prevalence of substance abuse, greater BMIs (body mass indexes), and life dissatisfaction.
Okay, so we know the stats and facts, but why is this happening?
The short answer is:
It is because of institutional transphobia.
However, it is more complex than such a short response.
How complex?
The U.S. military has a long history of blatant racism, homophobia, transphobia, sexism...the list goes on.
Most famously is the Don’t Ask, Don’t Tell policy, which according to the Human Rights Campaign, “prohibited qualified gay, lesbian and bisexual Americans from serving in the armed forces and sent a message that discrimination was acceptable.”
The policy got repealed on September 20, 2011, 17 years after its implementation. Irreversible damage has already happened, but the repeal did show progress and promise.
Ten years after Former President Obama demolished Don’t Ask Don’t Tell, the Pentagon announced new transgender ADSM policies.
These policies include:
Allowance of ADSM to transition while they are in the military.
An ASDM may not be discharged against their will or prevented from reenlisting based on their gender identity.
Creating procedures for changing an ADSM gender identity on official filings.
The Defense Health Agency will create and implement clinical guidelines for treating gender dysphoria in service members.
These new policies, announced on International Transgender Day of Visibility, hold services for transgender people at the same high standards cis-gender individuals have had since the beginning.
The hope is that with better practices and safety measures in place, the physical and mental well-being of the LGBTQ+ community within the military will improve.
Unfortunately, we still have a long way to go. Rules and policies within the military branches are slowly equalizing. But outside, similar structures are not seeing a change, especially in veteran mental health care services.
LGBTQ+ Veterans
One main mental health issues trans-identifying veterans seek care for is GD (gender dysphoria), formerly known as Gender Identity Disorder until 2013, and not to be confused with gender dysmorphia. I discussed the difference between gender dysphoria and gender dysmorphia in a recent blog.
While GD is not a mental illness, it does pose mental consequences. As stated by a recent study, “the rate of suicide-related events among [GD]-diagnosed VHA veterans was more than 20 times higher than [rated] for the general VHA population.”
Despite this prevalence of suffering, the VHA or Veterans Administration continues to underserve the community. To say the VHA is equipped to handle everything perfectly would be foolish. Nevertheless, their current programs do not address mental health conditions like GD properly. This failure stems from a lack of educated staff, funding, research, and, frankly, interest.
The VHA has made strides in caring for trans veterans such as:
Granting access to VHA restrooms that align with a person's gender identity (this is bare minimum respect).
Requiring staff to use preferred names and pronouns, regardless of if these identifications are officially recognized (bare minimum respect has to be a rule once again).
Providing medically necessary care, sex-specific care, and transition support through hormone therapy, binders, voice coaching, and more.
But there is a catch when it comes to what the VHA deems as necessary.
According to the National Center for Transgender Equality, “transition-related surgical care cannot be performed or paid for by the VHA regardless of [medical] necessity."
So what does transitional surgery have to do with mental health?
A lot. Transgender individuals can often feel like a foreigner to their bodies. When you do not present how you feel inwardly, this can cause significant emotional distress.
Sometimes, this distress can present as gender dysphoria, low-self esteem, depression, and other mental health manifestations. In severe cases, these problems can lead to suicidal thoughts, attempts, or death by suicide.
Based on its current policy, the VHA does not seem to recognize the benefit of transitional surgeries. While certain people benefit from CBT, medication, and other forms of therapy, not everyone responds to these treatments.
What if you were a transgender veteran who had gone through the messy mental health system and decided that traditional surgery is the best for your health?
What if what stands between you and mental wellness is surgery?
Would you not want to be given access to such treatment?
After everything you did for your country, do you not deserve to be happy too?
I do not think so. I know so. The VHA?
Well, to them treating trans mental health with an informed approach is not...ahem…“medically necessary."
Final Thoughts
As a whole, transgender ADSM and veterans are especially vulnerable to mental health issues and illnesses. That is not a result of their gender identity. It is a result of an inadequate system, shoddy policies, and institutional transphobia.
The only way to protect, respect, and honor these heroes is to give them what every human being deserves:
Equality, Recognition, and Humanity.
You can help make this possible. Share your story as a guest writer. Follow us on Twitter and Instagram to keep up with the community. Most importantly, if you are seeking support check out our resources for students, youth, adults, veterans, allies, and so much more!
Sources:
https://journals.sagepub.com/doi/abs/10.1177/1745691618812680
https://www.liebertpub.com/doi/full/10.1089/trgh.2015.0002
https://www.hrc.org/our-work/stories/repeal-of-dont-ask-dont-tell
