By Andreu E. Gibson, contributing writer

Trans Day of Visibility (TDOV) is a commemoration highlighting the lives and voices of trans and gender non-conforming (TGNC) people. Feelings about being visible exist on a spectrum, mirroring the community this day is meant to uplift.

“Being visible means being able to be myself in every room, never having to hide any of who I am,” said AJ, a Black trans man living with Bipolar Disorder, ADHD, PTSD and anxiety.

“To be seen by community and accepted as yourself for who you are, unapologetically and without the need to conform to others’ ideas of who you should be or look like,” is what visibility looks like to Jack W., a queer, nonbinary, transmasculine community member and nurse practitioner.

As a Black, queer, nonbinary transmasculine person living with an alphabet of mental health diagnoses and a history of trauma, I’ve struggled to access resources. And, as a certified EMT with a background in in-patient behavioral health, addiction recovery and peer support, I’ve also been the supporter. Both sides have shaped my understanding of the lack of inclusive and affirming mental health care, how the relentless attacks within the U.S. healthcare system have made those needs more apparent, and the negativity that can come with being visible.

‘Setting Aside’ Who You Are To Access Mental Health Support

Accessing mental health services can be challenging. Considering living out loud as a TGNC person has its own set of struggles, this combined with trauma often leads to a need for external support. Yet, that need isn’t always adequately met.

Considering living out loud as a TGNC person has its own set of struggles, this combined with trauma often leads to a need for external support.”

This has been especially true for me, as seeking mental health support has been a triathlon of challenges. I began my physical transition nearly 14 years ago. At the time, in order to access Hormone Replacement Therapy (HRT), a year of appointments with a licensed mental health practitioner and a diagnosis of Gender Identity Disorder was required.

Back then, I was overwhelmed with both gender and past trauma-related struggles that affected my mental health. But there never seemed to be room to address them both, as providers often wanted to “put the trans thing aside” and only focus on what they felt was more important.

Jack shared the negative impact of being forced to label your gender identity as a mental illness. “Being made to ‘sell’ my story to a psychiatrist so I would gain access to gender-affirming hormone therapy was very nerve-wracking,” they said.

Jack said the way people are forced to approach accessing this health care meant not sharing the full truth of who they were. This is especially true for those existing outside the gender binary. “Trans folks often have to tell their story in a ‘respectable’ way to gain access to care…or they may be denied access to life-saving care.”

What’s often misunderstood is that transition isn’t a light decision. It’s often a choice that’s so closely tied to our mental health or physical safety that it’s truly life-or-death. It was clear I couldn’t address all of what I was experiencing. So, I spent that year choking down the rest of my needs to access the care needed to physically transition.

What’s often misunderstood is that transition isn’t a light decision. It’s often a choice that’s so closely tied to our mental health or physical safety that it’s truly life-or-death.”

Once I completed that process and acquired HRT, I was back to closeting my trans identity in an attempt to access adequate mental health support for the remainder of my concerns.  

I’ve found over the years that I am not alone. AJ shared when seeking mental health services, his trans identity was often not acknowledged. “It was always the elephant in the room. It hurt me on several levels to not have it addressed. And, when it was, it was always in a negative way,” he said.

Lasting and Community-Wide Mental Health Implications

After over a decade of being out, I can still empathize with AJ: Engaging with the mental health system for my own care is still daunting. While providers have certainly come a long way, the social and political pressures that target trans people’s access to care is a major setback.

A survey conducted by the Trevor Project found that while 82 percent of trans youth desired mental healthcare, only about 40 percent received it due to social stigma, socioeconomic barriers and cultural factors.

Anti-trans legislation only further stigmatizes our already vulnerable community. In response to having our rights challenged, trans people are reporting elevated levels of mental health distress, as studies show that trans people have the highest rates of depression, anxiety and suicidality in the LGBTQ community. Some providers have retreated from trans-specific care, further decreasing the community’s available resources. This all amplifies the importance of visibility and the impact of these harmful narratives.

Identities Diagnosed Instead of Affirmed

Even though Gender Identity Disorder is no longer an official diagnosis, the trans experience is often still scrutinized within health spaces instead of being acknowledged and affirmed. AJ and I had trouble having the totality of our identities seen, but others struggle with having their identity reduced to a mental illness.

I saw this often working in the hospital, and heard from several people that our time together got them through their stay and that their identities weren’t taken seriously or were over-pathologized. An example was hearing a behavioral health clinical team discuss a non-binary person with schizophrenia. Instead of the staff acknowledging their gender identity, they labeled it as a presentation of that diagnosis. After this encounter, this person completely shut down and isolated themselves from the rest of the patients.

When I had the chance to sit down with them and share my history, they opened up about how they felt dismissed. When leaving, they said that simply sharing space and sitting in solidarity with me was the most healing part of their time there. Realizing the power of healing in solidarity would have lasting effects on my personal and professional journey.

Realizing the power of healing in solidarity would have lasting effects on my personal and professional journey.”

Peer Support As A Lifeline

Much like the patients I’ve encountered, the support from folks with similar lived experiences has reshaped my understanding of trauma healing. I still navigate the traditional mental health system in ways that make sense for me, like medication and an incredible licensed therapist that supports, encourages and affirms all of me. And, community-led peer support has been the current guiding me to a meaningful sense of healing.

It’s allowed me to shift away from the idea that I’m broken and the goal of being “fixed.” Instead, I can self-define my experiences and embrace and engage the ebbs and flows of my existence all while having the support to do so.

With all the struggles being faced around the world, holding on to hope can be exhausting. And for me, there is so much comfort in knowing that I am surrounded by people who understand me. Sharing in these spaces is key, and this is where that power from healing in solidarity comes from. This is what visibility and trauma healing look like for me: the ability to share, have my identities affirmed, honor my own needs, have autonomy and engage in mutual healing.

This is what visibility and trauma healing look like for me: the ability to share, have my identities affirmed, honor my own needs, have autonomy and engage in mutual healing.”

“We can have increased visibility and safety when providers are willing to come out and live their truths. We still have a way to go, but I see more providers leading with their identity to help patients feel safe and more connected to them. That’s all I have ever wanted,” AJ said.

Moving toward affirming mental health support for the trans community looks like honoring the intersectional needs of trans people, allowing us to be the writers of our own narrative, and promoting environments where trans people support each other.

For many in the trans community, it’s not just about being visible, it’s about feeling safe and supported in that visibility. Mental health support spaces are no different. For healing to be a possibility, we need spaces where we can show up authentically.