A Qualitative Study of Behavioural Health Experiences Reported by Transgender and Gender Diverse People During Inpatient Treatment

Transgender and gender diverse (TGD) adults face higher rates of psychiatric conditions and suicidality compared to cisgender people. Additionally, they confront gender identity-related barriers in accessing and receiving behavioural health care (BHC). Inpatient level of BHC is unique both in terms of treatment milieu and patient acuity. However, little is known about the gender identity-related experiences of TGD adults in psychiatric inpatient settings. The aim of this study is to describe and quantify the lived BHC experiences of TGD adult psychiatric inpatients. Participants were 50 TGD adult inpatients who were interviewed regarding (1) previous gender identity-related barriers accessing BHC and (2) negative and positive experiences during their current inpatient stay. Interviews were audio-recorded and transcribed. Content analysis was performed to identify and quantify themes. Out of the 50 participants, 27 (54%) reported experiencing gender identity-related barriers to accessing previous BHC, the most common of which was services being grouped by gender binary categories. With respect to their time on the inpatient unit, 37 (74%) reported at least one negative gender identity-related experience and 45 (90%) reported at least one positive gender identity-related experience. Common inpatient experience themes included chosen name/pronoun use, working with uninformed providers and barriers accessing gender-affirming items. Results highlight the pervasiveness and nature of gender identity-related BHC disparities as well as identify positive, gender-affirming interactions. These results may be used to inform best practices to help cultivate improved BHC experiences and outcomes for TGD adults.