The reality is some of our clients and patients from intersex and trans groups will experience suicidal thoughts. Research shows us up to 70% in some groups.

In some groups up to 45% will attempt suicide. Many have completed suicide.
Why – well the answers are multiple: lack of available care, large medical bills, enforced unwanted none consensual surgery and treatment, family rejection, difficulty getting education, employment, accommodation.

Intersex, sex diverse, trans and gender diverse people also experience high levels of discrimination, harassment, violence and may not be legally recognised.

Consequently, this leads to high levels of minority stress, poverty and a population vulnerable to suicide.

Our greatest hurdle in caring for these populations is financial and clinical resources. In public health and institutional care resourses are always extremely limited.
In the private sector there are no limits to resources but we are talking about populations with often very limited budgets.

Therefor practitioners need to be extremely skilled, knowledgeable and concise in their suicide prevention interventions. Referring a client to generalist mental health specialists is not advicable.

There are so many reasons people from these populations become suicide but it is important to bear in mind that minority stress is the major driver of frustration and distress.

If as a practitioner, you try to operate suicide intervention without a profound knowledge of the social background of these population you will come across as inauthentic and have low level of rapport.

Practitioner incompetence has also been one of the major drivers of suicidal ideation for people intersex, trans and gender diverse people.

I started in suicide prevention in this field fifty years ago and have seen many practitioners kill these clients/patients due to lack of knowledge of what they were doing.

As in line with the average population in the Western World, 5% of people will suffer from chronic mental health issues. Do not assume mental illness because someone is sex and gender divers as it is generally a variation in nature.

When someone is suicidal medication with antidepressants and antipsychotic is also not the answer in the short for long. These cause reduced cognitive abilities, chronic brain injury and failure to induce the person to produce their own serotonin, endorphins, BDNF and reduce cortisol.

We need to come back to the basics of mental health care from a sociological perspective following Maslow’s pyramid. This was of course the bedrock of good psychiatrist and psychological care before the introduction of neuroleptics.

1. Immediate referral to a specialist mental health care professional who has had training in helping sex and gender diverse people overcome suicide, is essential and ethical.

2. Fast followup to make sure the emergency consultation has taken place. Lack of interpractitioner coordination is a major problem in health care particularly with GP’s and primary health care practitioners.

3. Referal to social service and housing for help with basic fundamentals like housing, shelter, food, safety.

4. Is there a family or friend support network that can give an extra level of support?

5. Do not automatically order a 48hour closed ward observation unless the client is hypermanic and in danger. Locked wards can add another level of stress for the client.

6. Always get permission for cross referrals.

Go with Peace

Dr Tracie O’Keefe DCH, BHSc, ND is sexologist, clinical psychotherapist and a mental health professional with 50 years experience in suicde rescue in sex and/or gender diverse communites.

Author of:

TransXUall: The Naked Difference (1997), Sex Gender And Sexuality: 21st Century Transformations (1999), Finding The Real Me: True Tales of Sex and Gender diversity (2003), Trans People In Love (2008), Suicide in Intersex, Trans And Other Sex And Gender Divers Groups: A Health Care Professional’s Guide (2021).

Sex And Gender Education (Australia)

https://sageaustralia.org/

Dr Tracie O’Keefe
Intersex, Trans, Suicide Recovery Sydney and Worldwide

https://tracieokeefe.com/intersextra...