Gender minority and health sector: promoting mental health with better medical education

This article was exclusively written for the Sting by Mr Kai-Yuan Cheng, a PhD student at University College London. Mr Cheng is affiliated to the International Federation of Medical Students Associations (IFMSA). The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one. Gender minority is a diverse community that encompasses a wide spectrum of identities, orientations, and expressions that do not conform to the conventional sexual and gender roles. Members of gender minority groups are often at risk for poorer mental health, which includes depression, anxiety, suicidality, and substance abuse. This inequity of health is far from inherent and is rooted in complex social contexts. According to the minority stress theory, the experiences of exposing to prejudice, discrimination, and bullying are psychological stressors that eventually lead to mental health problems among members of gender minority groups.¹ Health professionals and health professionals in training are not exempted from these minority stressors. Ironically, studying and practicing in environments that are supposed to have stronger awareness of health does not protect them from the negative treatment to gender minorities. One nation-wide study in the United States investigated family practice programme directors’ attitude toward gender minority applicants.² Although the majority of responding directors showed accepting attitude toward homosexuality, it was also reported that one in four directors admitted that they “might” or “most certainly” rank an applicant known to be gay lower than a heterosexual one. On the other hand, gay and lesbian medical students also fear that “coming-out” may potentially impede their chances of matching residency programme. These results suggest that the clinical working environment remains, until today, unfriendly and intolerant to people with non-mainstream sexual orientations. The discrimination is not only felt by the recipients of health care services, but also their providers. Health professionals not only have to interact with the health regime, but essentially be part of it. If that regime is explicitly or implicitly hostile toward gender minorities, members of gender minorities would find it difficult to establish a coherent identity as their internal drives conflict with external discipline. Medical profession is a cycle. Medical students are mentored by senior physicians and mature to become future senior physicians who take on the mentorship. To create an environment that promote mental health for all health professionals regardless of their self-placement on the gender spectrum, we must put effort into raising health professionals’ gender awareness. Studies have shown that clinical exposure to LGBT patients is associated with a more positive attitude toward LGBT community.³ Unfortunately, studies on the status quo of medical education suggested that much more await to be done. One study that surveyed deans of medical education of Canadian and American medical schools found that one third of these medical schools have dedicated zero hour of their teaching time on LGBT-related content during the clinical years.⁴ It is therefore hardly surprising that people who identify themselves as gender minorities find it depressing working in the health sector. Health professionals and gender minorities are two groups of people who are known to be at risk of poorer mental health. Measures have to be taken as early as possible, in medical school and other institutions for health professional training, to create a health sector that is both gender friendly and mental health promoting. References:

1. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin. 2003;129(5):674.
2. Oriel KA, Madlon-Kay DJ, Govaker D, Mersy DJ. Gay and lesbian physicians in training: family practice program directors’ attitudes and students’ perceptions of bias. Family medicine. 1996;28(10):720-5.
3. Sanchez NF, Rabatin J, Sanchez JP, Hubbard S, Kalet A. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. FAMILY MEDICINE-KANSAS CITY-. 2006;38(1):21.
4. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education. JAMA. 2011;306(9):971-7.

About the author Kai-Yuan is a PhD student at the University College London working on a project regarding the mental health of gender minorities in Taiwan. Kai has an enduring passion in mental health, global health, and gender study. His master dissertation was on depression among gender nonconforming children. He graduated from medical school in Taiwan in 2016. Kai served as the president of FMS-Taiwan from 2013-2014, as the plenary chair of the IFMSA AM2014 held in Taiwan and was part of IFMSA’s delegation to the 69th World Health Assembly.