Getting support for mental health

I think I was 19 when I first started taking antidepressants. And I was put on them after just one appointment with my GP. I think, at the time, I just wanted a quick fix, which it wasn’t that. But I wasn’t even offered counselling or anything which really, I should have been. I then, years later, my parents paid for me to see a private counsellor and so that was because the waiting list for the NHS was at least six months at the time. And I’d been on about five different medications that weren’t working for me whatsoever. And then, this year was when I did the group therapy that was through the NHS. I was only on the waiting list for about two or three months, I think and that was an eight-week course. And I mentioned that I came off my antidepressants didn’t I. That was because I went to see my doctor and I was saying to her that they weren’t working for me and that I was feeling really anxious and she just said to me, well, if I was you, I would feel anxious too, if you can understand [Laughs]. And I was a bit like, well, that was rude. But at the same time, it made sense, because I’m like, a pill isn’t gonna fix my social anxiety when it is situational. I think that’s a big thing. A lot of time your kind of rushed through the system. Especially when it comes to medication when for me it definitely wasn’t the right thing.

I think around my second year I went to my GP about getting like referred to the gender clinic and it was, it was kind of all good because sort of I went purely for that reason to be referred and he kept sort of looking through my notes and just bringing up the fact that I had depression and he just kept trying to like prescribe anti-depressants and it took me like it took about a good, I don’t know 20 minutes for him to actually be like no I just want you to refer me to the clinic

I think that the thing that has shifted that depression most significantly is having surgery and having hormones. But it never felt like ‘If I do this thing this depression will go away’. It kind of just happened, and so like, it was like again like in that thing about your body knowing, it’s like I didn’t, when I was that depressed I don’t think I would ever have said to you ‘I’m really depressed because I’m trans’. I think I might have, that would have felt like one of the things I was depressed about, but it does also feel true now looking back that like I’m a lot less depressed as a person since having surgery and hormones. And so, I can only figure that that was causing a significant amount of that depression, that didn’t necessarily feel like it was about transness.

I don’t know if that really makes sense honestly, but it definitely feels very true. And I don’t think it’s the only thing that I was depressed about, but I do think the core, that core sense of like shame and ‘I can’t be who I am’, and ‘I’m always having to hide who I am’, in a really embodied way, not in a kind of, like it wasn’t like a conscious thought pattern, but like as a real emotional experience of the world as opposed to a kind of like, ‘This is who I think I am,’ experience of the world… is really, is really at the core of a lot of that depression.

I think taking care of myself I think I’ve been trying to like sort of eat a bit more healthily and try and leave the house a bit more often, you know, because haven’t been working the past month and I think I’ve been trying to get back into doing things that I used to do but I know for me it’s been a lot of patience just sort of weighing out mental health problems because people think they’ll go away if you do these things, you know, if you eat right, if you exercise, if you socialise if you do all these things they go away and, you know, they don’t, that’s not how it works your brain will pretty much choose when it will go away.

And sort of the past few months I think it’s been a lot of just accepting feelings as they come where like, if you suddenly feel sad you shouldn’t feel ashamed about it you can just be sad. If you’re happy for whatever reason like, I think any sort of emotions you have that come your way just accept them: ‘Well that’s how we’re feeling today but I’m still gonna try and do these things’. It’s a lot of self-motivation, it takes a lot of effort to work on but people I know who are older than me said that things do sort of settle down after a while, you learn how to be more of like, an adult in a stereotypical fashion, you learn to do these things.

I’m still kind of working out like kind of just like ramped up, I was working out like maybe three or four times a week because I guess, I was already like quite fit and so I was able to like, when I started going to the gym I started going like three or four times a week and I was like see how, let’s see how much I can push this because I like bought this, I bought an unlimited membership where I’m like I’m paying for it I might as well just go, so I started like going like maybe five or six times a week and so I was getting quite fit and also just kind of addicted to the boxing because of how it made me feel and also started getting a bit addicted to how my body was looking as well like the changing my body and I’ve always been like quite flat chested but I was noticing that my body was just getting sort of like quite yeah like lean and I was really enjoying like, well I was just, oh this is making me feel things I don’t, like I don’t, I mean I was just very used to either looking in the mirror to present myself as femme to kind of create this sort of like façade to the world that also gave me a certain kind of pleasure but not really paying much attention to my body like I always enjoyed fashion and dressing myself but not for the sake of like making my body look a certain way.

And just well not really like trying to kind of like not think about that actually I just kind of really like have any I don’t think I really had any relationship to like my body in terms of like you know, people like told me that this cis woman version of me that I was like sexy I think I really liked it I didn’t really understand it didn’t really compute because it like wasn’t something that I could see. So I felt quite like disassociated from it but then as I started to train and seeing my body change I really actually started developing a subjectivity in relation to my body where I would look at it and I’d be like okay this is making me feel good which is not something that had ever happened before because I, I remember I’d take notice of boys or girls or whoever I was seeing at the time and I’d just be like I don’t know how to do this I don’t feel, I don’t know what looks good and, and then I started realising what looks good to me was what I was actually achieving through going to the gym and boxing and I was, I think I became quite attached to going to the gym and changing my body and it made me become quite obsessive and also it was a way of spending time with myself with my relationship at home didn’t feel very good, it didn’t feel very healthy.

So in regards to supporting mental health, basically there is none. Well not any that’s provided by the NHS. Like say for example, it doesn’t come as part of your care package, so you have to, in terms of mental health you have to seek that on your own, through like support groups. Like in [City] there’s, there’s a support group although I don’t really, I have spoke to them here and there at times to do sort of focus groups but not ever sort of for the support. But they have been encouraging me, you know I’m free to join whenever. But yeah this is really important because obviously the wait, the long periods of waiting to just have your first ever appointment you would think surely they would do something to support you. So while your referral’s there, it would make sense to have some sort of psychological support because obviously without you being seen most of the time you know you’re not able to you know get on with things, unless you can afford the private healthcare.

So yeah I mean with mental health services, even when you do have access to you know, crisis, mental health and things like that they don’t actually, they’re not trained in this sort of thing. I had to use a sort of crisis mental health service, this was maybe 2018. So I had a bad turn and I’d just had enough and long story short they basically found me and I was in a assessment unit for a week. So when I was there they didn’t really speak to me much, they asked me what was wrong and I said to them I didn’t have access to my hormones. Because at the time I had lost my job and I couldn’t afford my private healthcare. So I said to them would they be able to get me the hormones? And they said that they’ll see. And when they couldn’t – basically the next day they said no they can’t get it – obviously that wasn’t all my troubles at the time because I was homeless at the time as well. So they just kind of told me they couldn’t get it and they just kicked me out. They just said “you are fine” and they just sort of kicked me out. But obviously you know there was more to it than just the hormone situation but even with that they couldn’t, there was nothing they could do to even access this type of thing, like this type of medication. They didn’t have any sort of therapy which was relevant to what I was going through.

So there definitely needs to be, you know a specialised service for trans people. Even just LGBT as well, like because obviously trans people are not the only people who go through, you know a hard time in terms of you know pressure from society and things like that. So yeah definitely there needs to be something done because you know they say that the highest rate of suicide is within trans people and it literally does not surprise me. Being, you know myself I’ve been in that low position. So yeah I can only hope for the future that they start really investing into this sort of thing and training people and I hope that people are you know in those positions are interested enough to specialise in it because it will make all the difference while you wait.

I don’t think people quite know how decent having a good supportive group of friends is, because we all have friends and people we know. But having a really healthy supportive group of friends that [coughs] looks out for each other and checks up on each other and or like that doesn’t be kind of toxic behind your back or doesnt have a bad influence on your life, that’s really helpful. Obviously, it doesn’t cure anything. It doesn’t, it’s not like seeing a therapist, but it helps a lot and having people that take the time out of their day just to say, hey, how’re you doing? How are you feeling right now? How have you been like I was, I was ill off school the other day and I am just still evidently quite sick right now. And I think my mates, I think every single one of them just casually dropped the message just saying that they hoped that I was okay and that they wished me well. it’s very small things that make you feel supported and loved and cherished and valued, but small things go a long way and I think if people have these groups of friends and groups of healthy people around them where they feel like they can talk and reach out for support, that does a lot for you, even if you don’t realise it. And then, yeah. That’s one of the biggest things for me I think.

What’s been specifically helpful when supporting you in terms of mental health?

Other people. Other trans people, because you know, there is that just…Yeah, being able to identify, having that shared experience and having that identification with other people about your experiences and… Yeah, yeah, I think that’s also been hugely important. And I don’t think it’s only just been with like other trans women. It’s also been with like just trans, trans people, generally. So everyone under the umbrella and so non-binary people and gender nonconforming people, people who aren’t even trans. You know like or wouldn’t define themselves as trans. Yeah and like transmascs and transfemmes and… Yeah, you know, my support is 90% social.

LGBT groups which I attend, they’re just really great because not only do you have youth workers who know what they’re talking about if you really need help or advice or something, but also you can talk to other people who may be similar to you or even if they’re not similar to you, you tend to have common knowledge and be able to talk about the same issues and understand each other. And that can be nice and it’s, it doesn’t feel official, it doesn’t feel like, ‘Oh I’m getting help from someone’, you know, or it doesn’t feel like, ‘Oh I’m going to my parents and being a pain’, it just feels like, ‘Hey I can have a friendly conversation with someone who knows what I’m talking about and who can maybe offer me advice because maybe they’ve gone through a similar’, so that’s really helpful too.

I think finding people that I could talk to as they kind of got it, so not so much sort of counselling in the like typical I go and talk about my problems and the person either just listens of maybe sometimes offers a little advice but someone who could actually really like bounce off what I’m saying and share their experiences as well and like talk through really constructively I found really useful. So I found working with one of my youth workers a lot more helpful because she was willing to share bits of her experience as well, it wasn’t just sort of like I was just talking about myself the entire time. And also talking to people, looking at it from like an academic point of view as well so like again my youth worker would sort of share pieces of theory with me and sort of we’d look at the way I’d interact in the way other people interact like really look at it from like not just from like a personal experience of like this person does this and it makes me feel like but academic point of view of like this is a theory of how people interact and being able to apply it when I’m in situations was really useful.

I’d like to see the psychiatrists give up their power over us. I would like to see more trans, I’d like to see healthcare built around trans people’s knowledge and needs of ourselves rather than them just being about having power over us, and us having to jump through hoops in order to acquire the things that we need. I’d like to see more trans people involved in our healthcare, but not necessarily as like psychiatrists, cos we want to abolish psychiatrists, so maybe we don’t want to train as psychiatrists, that wouldn’t be great. Because we’ll be coming to you, and like yeah, it’d be like I generally want to see more just more trans specific services because I want trans services to be like available throughout healthcare services, you know, we need more like easy accessible things, and like I don’t, I feel like there are some things that are really specialist and they’re important, and when it comes to healthcare provisions but also like there’s loads of stuff that could easily be done through a GP, safely and that’d be great. And also like there’s a lot, I think there’s a lot of things about like oh, certain things are irreversible, and like sure, like surgeries maybe are quite, quite invasive and seemingly irreversible, seemingly, I have to say seemingly. But it’s, so much, so many things are like already framed around a fear of doctors getting sued, because, and not about like, and like that is like, I mean like that’s like a comment I’ve heard I think almost like, maybe, like most of the GIC people, people who work for GIC challenge, say, as it’s like are you more worried about that than actually providing the healthcare that people might need.

And, but also it’s okay if people change, like if, like trans is about movement, it’s not just from like one direction to another, like it’s okay if, if hormones work for somebody for some part of their life, and then they decide oh maybe I don’t want to take these anymore. Like that’s fine, like, yeah. We just need to like just be facilitating more, a need for more options. Like people need options, people need to see opportunities, like it’s not, not everything is the end of, is like the life or death, like you know you do this and that’s it. it’s, cos it doesn’t work like that.

Yeah so the old process was you go to your GP, and they refer you to the community mental health team, they tick you off, and then a funding negotiation basically happens, negotiation, and they say, Oh we can work, NHS Wales will fund your transition and they’ll hand over that money to NHS England, and your care will be taken care of by Charing Cross, and you’ll be put on that waiting list. Now luckily we have a, this is I’m hoping the system, like the rest of the UK will also adopt, because I do think it’s better, especially so you get referred to the Welsh Gender Service, and at the moment there’s only one clinic in [city], the hope is to expand that to different parts of Wales, and they will see you for your initial appointment, essentially. And they’ll talk like, you’ll talk to a not a psych, again there’s no actual psychiatrist or anything like that but it’s just someone who’ll like, and they are trained in the gender stuff, and stuff like that.

And there’s, and so there’s no, so your GP can directly refer you, so there’s no like middle person to like negotiate or gate-keep with, and they’ll talk to you and they’ll like they’ll ask you like what kind of care do you want. And essentially and that doesn’t matter if you’re a binary trans person or a non, or a non-binary. So if you, if you have an idea of what care you want, or if you need to be talked through that, like what they can do for you, that is something they can do. Which is much more affirming in care, especially so.

Like so the Welsh Gender Service, they don’t, they don’t they can’t refer you to surgery yet, that’s still done via Charing Cross, so but they can do everything but that. They can do a surgery sign-off, so you can get your initial signature, so they’ll like discuss your options, so they’ll be like for, obviously I’ve only experienced the AMAB trans fem route, so it’ll be like, We’ve got HRT, we’ve got we can refer you to voice therapy, we can obviously get the HRT sorted and we can also think about discussing surgery options in the later appointment when you feel comfortable, or whatever

And so yeah, and so essentially that’s basically it, and then it gets, goes to primary care, which is where it should be realistically, so they’ll be like, okay we’ve told your GP this is what you need, and so your GP will prescribe it to you and they’ll monitor your bloods and stuff, like that, so you don’t have to travel to the Welsh Gender service again and again, and they’ll be like and at the moment like, so the eventual goal of the system is that all GP’s will be able to prescribe and do it, but some GP’s still don’t feel as comfortable doing it yet.

So in the interim, I say interim, I think it may become semi-permanent to an extent, I think it has, there’s a local gender team, and so this is a gender team in each county so like regardless of where you are in Wales there will be a gender team in each county and they will do, they will do the prescriptions and if there’s no nurse that won’t do the jabs in your practice for example, they’ll also do the jabs. they’re like that’s what’s happening to me, so I’m going to the local, I’ll go to the local gender team, and that means especially for people in Wales with terrible travel links especially, like going from North to South and stuff, so if say someone gets referred from the North to the Welsh Gender Service, they may have their initial appointment in [city], but the rest of it will be communicated through the local gender team. So, they’ll just have to see them instead of having to travel.

Which it makes sense to do it in a primary care model, and that’s the hope that like, we’re trying to set the standard and we’re trying, I’m in, helping with talk with people like I’m actively been talking with the government and well the group I’m part of, and like we were involved in putting, getting that statement put out by the Welsh government. And we’re hoping, one of the aims for these future meetings too is to expand the service to under 18’s, because at the moment Wales also doesn’t have an under 18 service. They still have to be referred to Tavistock and go through that route. And we’re hoping to make, essentially give what we’ve got the primary care model we’ve got now, and essentially do it for under 18’s too.