Emerging from the Shadows

There has been much focus over the last decade on the challenges and successes in the school system in Ireland to adapt to the needs of trans young people. This article demystifies the complexities of trans healthcare, physical and mental, through a review of the research. It also highlights the experiences of families of trans people and outlines some of the supports available for trans young people and their families.

Introduction

It is an enormous honour to be asked to contribute to Ireland’s Education Yearbook about transgender young people’s experiences in post-primary schools. There has been much focus over the last decade on the challenges and successes in the school system to adapt to the needs of trans young people. I hope this article will help you to meet the needs of this marginalised group in the Irish post-primary school system. I am also conscious that Covid-19 has impacted society in many ways and that many of us have experienced unprecedented challenges. School closures have been very difficult for teachers. In this article I highlight some of the ways that the pandemic has affected the lives of trans young people.

On a positive note, 2020 has seen the launch of the first trans-specific research into the experiences of young trans students in post-primary education. I will highlight some of the key findings, including peer-reviewed research into the healthcare aspects. Much of the information on trans healthcare has been portrayed through a sensationalised and polarised lens; I aim to demystify the complexities of trans healthcare for young people. Finally, I want to draw attention to the experiences of families of trans people, highlighting the challenges and messages of hope that emerge constantly in my work with these resilient families. I write this article as a first-person narrative to acknowledge my personal connection to these experiences, as I am not fully detached from this work.

Transgender Equality Network Ireland (TENI) has been working with primary and post-primary schools in Ireland since 2013. During those seven years, there have been many learning opportunities for both the school system and ourselves as a trans NGO. We greatly appreciate the school management bodies, teacher unions, National Association of Principals and Deputy Principals (NAPD), and others who have acted as a bridge from us, as representative body, to the schools, towards the outcome of young trans people feeling supported in their schools.

TENI’s aim is to facilitate the needs of young people to engage with schoolwork, and to reduce anxiety to allow them to remain in the school environment. TENI’s approach has always been a ‘wrap-around’ one in which the young people are central. We focus on meeting students’ holistic needs, which includes collaborating with those around them to better support them. Our first step is often taken with the school itself through a guidance counsellor, pastoral carer, or principal or deputy principal. TENI arranges to bring the key people together on a visit to the school, which includes a one-hour trans information presentation to the staff. During this visit, TENI engages with key teaching and supporting staff members, the young person, parents or guardians, and in some situations their local Child and Adolescent Mental Health Services (CAMHS) healthcare provider.

This holistic, person-centred approach enables the young person to focus on schoolwork rather than the uncontrollable stressors they may experience. In our experience, schools are mainly supportive of the young person and view that support in a pastoral role, ensuring that equitable conditions for attaining education are readily available.

It can be challenging for TENI to relay vital information to school staff in the short time allocated. We are working on initiatives to allow more time for teaching staff to facilitate their needs. In 2018, TENI partly addressed this issue by hosting the first Transgender Education Conference in Waterford, funded by Healthy Ireland. This full-day event was attended by over 200 school staff; presenters included management body representatives, researchers, teaching college lecturers, young trans students, and healthcare professionals. An evaluation highlighted that similar conferences need to be held throughout Ireland. This was the plan before Covid-19.

Research findings

Since late 2017, TENI has partnered with the University of Limerick and the Irish Research Council to research the post-primary-school experiences of transgender and gender-diverse youth in Ireland. This robust and rigorous project included several workshops and engaged fifty-four participants, including young trans people, parents, and stakeholders such as school staff. The project team included Dr Ruari Santiago-McBride (research fellow), Dr Aoife Neary (principal investigator and academic mentor), Dr Breda Gray (consultative academic mentor), and Dr Vanessa Lacey (placement mentor). 

The research identified vital information from a variety of voices and perspectives. Here, John comments on his lack of prior knowledge about trans issues:

I had not really thought about [gender diversity] until this particular student [transitioned]. … My initial reaction was, I do not understand. I do not understand that. You need to explain that to me more. And I had a conversation with her, and it made sense. It just made sense. (John, school leader, co-educational community school)

The key findings included robust evidence that all the young trans and gender-diverse [TGD] participants felt marginalised in their schools. This was linked to (a) lack of discussion on gender identity, (b) absence of representation of TGD people, and (c) lack of LGBTI+ supportive spaces. These factors contributed to a sense of shame about their gender identity, because trans issues were not validated in any way in the school environment. Subsequently, TGD young students decided to repress their identity, which had a negative impact on self-esteem issues and minority stress, and ultimately school retention. 

The comment below from a young trans person emphasises the positive impact of a principal who was open to trans information:

The principal was very considerate, very understanding. She knew I was having trouble, struggling a bit. She was just very understanding about it. She knew it was something that wasn’t really addressed by the school and needed to be. So in that sense, she was very eager to please, she was very helpful. (Molly, eighteen, co-education community school)

Most informants said they ‘came out’ to a member of school staff. Some had a negative reaction, when the staff member seemed to invalidate their gender identity. However – and extremely positively – most young people said that their coming out to a member of staff received an affirming response. In research on the experiences of young (and older) trans people, positive experiences are not often highlighted. This finding needs to be acknowledged, highlighted, and celebrated, and TENI applauds Irish school staff for taking such an affirming approach, in the main. This response has major significance, as it facilitates the young person to remain in school and seek the necessary supports to attain a full education. 

Another key finding highlighted the challenges in transition experienced by respondents. Negative experiences include misgendering, misnaming, restrictive uniforms, bathroom accessibility issues, staff prejudice, peer bullying, barriers to sports, and lack of supports. It is vital that these be addressed urgently in the Irish post-primary school system and that appropriate school policies and practices be ushered in.

The recommendations from the young people in this study emphasised the urgency of making changes to uniform policy concerning gender identity, single-staff toilets, zero tolerance of transphobic bullying, and the establishment of LGBTI supports to ensure that schools are a welcoming environment for trans people. Other key recommendations included that their identified names and pronouns be respected and used, to validate their identity; that there be proactive periodic engagement with young people and stakeholders; and that designated staff members liaise for the young trans person during the vulnerable period of transition.

The need for training in this area for all staff members was another key finding. TENI welcomes further engagement from schools to liaise with them – we can offer the wrap-around support necessary. 

[My child] wouldn’t eat breakfast and wouldn’t have had a cup of tea, so that he wouldn’t have to use the toilet. Which is pretty dire, isn’t it? (Esther, parent of a fifteen-year-old trans boy)

The comment above shows the direct impact of barriers to accessing appropriate toilet facilities in schools for trans youth. A similar comment was made at the education conference in Waterford in 2018. It is very common for young trans people to restrict their intake of food and liquids. This has serious medium- to long-term physical effects on their growing bodies, as well as major negative psychological effects.

Overarching this report are the key recommendations for future directions in the school system: establishment of a working group with key stakeholders; development of gender-identity and gender-expression policy for all Irish schools; and explicit inclusion of gender identity in schools, including teacher pre- and post-service training and inclusion of trans people in the school curriculum. Addressing these goals would potentially meet the needs of young people who experience gender identity issues and help them feel comfortable in their school environment, which will support them in realising their full potential. 

Access to transgender healthcare was also reported in the study. All trans respondents and parents said they had negative experiences with this. Currently in Ireland, there is a HSE-funded service for adults that is based in Co. Dublin. To access it, one can be referred by a GP, but waiting times are reported at more than two years. For adolescents struggling with their gender identity, there is a start-up service in Our Lady’s Children’s Hospital in Crumlin (OLCHC). This service has a limited number of staff and currently no mental health specialties.

Mental-health assessments are offered by the Gender Identity Service in the UK (GIDS), also known as Tavistock. This service is funded through the HSE Treatment Abroad Scheme, as it is deemed a medical necessity and is not currently available in Ireland. The current pathway for adolescents (and children) is to be referred to their local CAMHS teams by GP, and then a consultant referral to GIDS. It usually takes about six months. Once GIDS receives the referral, there is a further two-year wait for a first assessment. The international protocol for prescribing puberty suppression is at least six assessments with an experienced clinician and informed by a multi-disciplinary team. A young person may therefore have to wait three to four years to receive support and undertake an assessment that may or may not lead to puberty suppression.

Less than 50% of young people assessed by GIDS continue on to puberty suppression. It is considered only after prolonged assessment and with multidisciplinary team support. Current research indicates that this treatment option is deemed a medical necessity for some young people, as it allows them to focus on other aspects of life without experiencing significant anxiety about their incongruent developing physical body (De Vries et al., 2014).

Despite misinformation in some elements of the media and social media in Ireland, there is no fast track to puberty suppression, and those receiving treatment options recommended by the Endocrine Society are few. There are only twenty adolescents currently on this regime, and all have been through an extended and rigorous waiting time and robust assessments. This evidence suggests that OLCHC is prescribing puberty suppression supervised by qualified clinicians to 0.0004% of the Irish population. The same treatment is given to children who undergo precocious puberty.

I hope this section has demystified some aspects of trans healthcare. If you need any further information, I would be delighted to help; my email is vanessa@teni.ie. 

Families of trans young people

Families play a crucial role during all stages of gender transition (Emerson, 1996; Lev, 2004; Zamboni, 2006; McGuire et al., 2016). They form a key part of the assessment, and their involvement and support are crucial for positive outcomes for their child, whether they go on to medically transition or not (Olson et al., 2015). It is important to ensure that the young person’s gender identity is validated in all aspects of life, including at school and in their families. Family members are essentially the spine of the support network for their vulnerable young person, especially given the high rates of suicide and self-harm among trans young people (McNeill et al., 2012, 2013).

TENI’s wrap-around model is one of the most important areas of our work, and we regularly see the impact of acceptance or rejection on the development of young trans-identifying people. We wholly acknowledge the challenges for families of gender-transitioning loved ones to accept the gender-identity changes. Families can experience a range of effects, including grief and loss (Norwood, 2013; Wahlig, 2014; McGuire et al., 2016). Some effects can bring confusion or conflict and are at times perceived as transphobic, whereas in many situations family members may lack understanding of the issues.

TENI engages closely with parents, family members, guardians, and healthcare professionals to put scaffolding in place to support those loved ones close to the trans young person. In 2011 TENI developed TransParenCI (Trans Parents Connect Ireland), which offers crucial supports to families of trans people. There are currently six TransParenCI groups in Ireland (Dublin South, Dublin North, Waterford, Cork, Kerry, Cavan/Monaghan), who meet each month – online during the pandemic.

TENI also provides several workshops annually, including a residential weekend for families of trans people, which includes a seminar on healthcare featuring healthcare providers, workshops on mental health, and an evening celebration event for all the family. The key component of this weekend is ‘universality’ (Yalom, 1995): families do not feel alone but can share their experiences with others.

TransParenCI has a subgroup named Transformers, aimed at young people aged thirteen to twenty. This initiative is a key part of TENI’s work, and we are very proud of TransParenCI and Transformers. TENI offers many workshops to Transformers, focused mainly on developing resilience, because of the lack of control that trans young people may experience.

I hope you now have a better insight into some of the challenges facing young trans people in post-primary schools in Ireland. TENI endeavours to support young people through their challenges, and the Transformers are vital in ensuring that proper, evidenced supports are available. For instance, in the earlier days of public health restrictions due to Covid-19, we offered weekly online support rather than the monthly groups, to ensure that our young people were supported during this unprecedented period in all our lives.

Our Transformers facilitators recognised that many young trans people were experiencing less anxiety rather than the expected increase during the restrictions. The main factor in this was that trans young people, required to stay at home, were not experiencing the real and perceived negative daily comments about their gender identity. Unfortunately, as restrictions were lifted, the anxiety became worse than before, due to the false sense of security experienced in that period. 

Our current focus is on helping our trans young people develop resiliency and confidence to re-emerge into society, especially the school environment. We have developed an initiative called ‘walk and talk’, where we organise walks in nature and talk about mental health, while adhering to public health measures. We were unsure how the young people would experience the initiative, but evaluation indicates rave reviews. We aim to continue these each month, and hopefully we can keep providing the vital support needed to help fill the seemingly uncontrollable aspects in their lives. In the school environment, TENI will continue to support educators as always, and we look forward to supporting you in helping our young trans people emerge from the shadows. Thank you!

REFERENCES

De Vries, A.L., McGuire, J.K., Steensma, T.D., Wagenaar, E.C., Doreleijers, T.A., and Cohen-Kettenis, P.T. (2014) ‘Young adult psychological outcome after puberty suppression and gender reassignment’, Pediatrics, 134(4), 696–704.

Edwards-Leeper, L., Leibowitz, S., and Sangganjanavanich, V.F. (2016) ‘Affirmative practice with transgender and gender nonconforming youth: Expanding the model’, Psychology of Sexual Orientation and Gender Diversity, 3(2).

Emerson, S. (1996) ‘Stages of adjustment in family members of transgender individuals’, Journal of Family Psychotherapy, 7(3), 1–12.

Lev, A.I. (2004) Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. New York and London: Routledge.

McGuire, J.K., Catalpa, J.M., Lacey, V., and Kuvalanka, K.A. (2016) ‘Ambiguous loss as a framework for interpreting gender transitions in families’, Journal of Family Theory and Review, 8(3), 373–385. DOI: 10.1111/jftr.12159

McNeil, J., Bailey, L., Ellis, S., and Regan, M. (2013) Speaking from the Margins: Trans Mental Health and Wellbeing in Ireland. Dublin: Transgender Equality Network Ireland.

McNeil, J., Bailey, L., Ellis, S., Morton, J., and Regan, M. (2012) Trans mental health study 2012. Scottish Transgender Alliance. www.scottishtrans.org/wpcontent/uploads/2013/03/trans_mh_study.pdf.

Norwood, K.M. (2013) ‘Grieving gender: Trans-identities, transition, and ambiguous loss’, Communication Monographs, 80(1), 24–45. DOI: 10.1080/03637751.2012.739705

Olson, K.R., Durwood, L., DeMules, B.A., and McLaughlin, K.A. (2015) ‘Mental health of transgender children who are supported in their identities’, Pediatrics, 137(3). DOI: 10.1542/peds.2015-3223

Wahlig, J.L. (2014) ‘Losing the child they thought they had: Therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child’, Journal of GLBT Family Studies, 11, 305–326. DOI: 10.1080/1550428X.2014.945676

Yalom, I.D. (1995) The Theory and Practice of Group Psychotherapy. Basic Books.

Zamboni, B.D. (2006) ‘Therapeutic considerations in working with the family, friends, and partners of transgendered individuals’, Family Journal, 14(2), 174–179. DOI: 10.1177/1066480705285251