Good afternoon, and thank you for inviting me to speak to the committee.
I want to start by introducing myself. I am Crystal Fach. I am a 39-year-old queer, polyamorous women, single mother, who works as a professional advocate, educator and front-line support work and co-founder of Diversity ED.
I also smoke, have been impacted by violence, have a history of addiction, have lived in poverty and have had prior suicide attempts. In the LGBTQ community, I know that I have a lot of privilege. I am white, cisgender, able-bodied and straight passing.
Now I would like to tell you why I'm really here today. Early on in my career, I was working with an amazing transgender youth, 17 years old. He came to my LGBTQ youth drop-in. He had to lie to his parents as to why he was attending. His parents were very unsupportive of who he was. He would crack jokes, drop hints, and he knew it was not going to be okay to come out.
One day, he and I started practising coming out at home. The best way I prepare kids for coming out is to role play two different reactions, that of a loving response and that of an angry one. I always make sure my youth know what they are walking into and have a safety plan attached.
My young man's story did not go well. It became heated. He was assaulted and a few days later hospitalized for a suicide attempt.
While in hospital, I started to visit this young man. Nurses called him by his dead name and misgendered him. The psychiatrist did not give him a referral to any type of doctor who would even begin to talk about hormones, and the parents threatened his post-secondary education if he did not fall in line.
I wish I could say that this youth found support and then lived a happy and full life. He did not. He died by suicide within six months of leaving the hospital.
Many people had an opportunity to validate and support this young person, in particular the health care system, the nurses, doctors and psychiatrists. What I know is that if youth have people in their lives who validate and support them, they decrease their risk of suicide by 90%. That is a stat that I have sent forward.
Our health care system failed him, and unfortunately, I see and read of the system failing people every single day. I have spent most of my career working with and for LGBTQ youth and their families. I have also been a family support coordinator and program developer for Canada's first and only transgender drop-in centre, in Windsor.
I come here today not just to share some statistics with you, but to share the stories of the very people that the health care system in Canada has been harming.
Let's start with the system as a whole. We do a disservice to gender-diverse folks when we revolve everything we do around gender: dorms and hospitals, gendered treatment centres, inaccurate genders on health cards. Yes, I know that these can be changed, but their files with previous gender are also attached to the card and gender marker. Changing documents is also expensive and can be unsafe for certain people.
I have another story. A transwoman I have been supporting had kidney stones. We went to hospital together. She wanted an ally to be there just in case. All ID had been changed. She had what uneducated folks call that “passing privilege”, which is really harmful.
When at the desk checking in, she was asked if she was pregnant. The client then came out to the staff that she was transgender. The first thing said by the staff was, “I never would have known you were not a real woman.” This might sound like a compliment, but it's the very opposite. My client was once again told that she is not a real woman.
When asked where she would be placed in the hospital, they refused to answer, which put her in a state of anxiety. Now imagine you are a transgender woman and you don't know if you are going to be put with men or women. Finally they agreed to put her in a women's ward, and then said, “Don't think you're going to get your own room. It's not happening.” This woman never asked for accommodations, but under the law, she very well could have.
While there, the nurses and doctors were told that the client was trans, and she was misgendered by almost every nurse and doctor she came in contact with. The nurses were overheard at their station saying, “Look at it putting makeup on.” She was so uncomfortable and in so much pain—I don't know if anyone here has had kidney stones—that she was more worried about putting on makeup to make the nurses and doctors feel comfortable than sitting in her pain.
This person has experienced kidney stones since. Do you think she'll go back to the hospital? Not in the least. This is not a stand-alone situation. I have many stories of trans folks being discriminated against in hospital.
This person has made three suicide attempts since this incident, and has become housing insecure and is relapsing consistently, and she had almost a year of sobriety before this situation happened.
As for recommendations, hospitals should have a mandatory audit of their spaces, forms and procedures when it comes to services for gender-diverse folks. Some hospitals have already done these audits. The problem now lies with the government's reporting. It is not always necessary to ask for gender information, and when we do we need more options besides male, female and other. Other is not an option.
Transgender is also an umbrella term and will not pull accurate data. Also, if we're not collecting data to measure the needs of transpeople then the government will never have a realistic view of what the needs truly are. We also need data so the government can start investing money into the sectors that service transpeople and their families. We need to stop measuring LGBTQ people as one large group. Sexual orientation and gender identity have different oppressions and are treated very differently in society.
We need to start thinking about putting money into the most marginalized in our community. Funding needs to go to organizations that are trans-led and working on preventive and crisis work for transpeople and keeping them healthy and safe.
Mental health and addictions in our community are at a high level. LGBTQ people experience stigma and discrimination across their lifespans and are targets of sexual and physical assault, harassment and hate crimes. This increases their risk of experiencing mental heath concerns. LGBTQ people are not mentally ill due to their identity; they experience illness due to how they are treated in society.
One of the stats I'd like to share with you is that 77% of trans respondents in an Ontario-based survey had seriously considered suicide and 45% had attempted, and this was in a year. Let’s digest that number for a second: 45%. We have an epidemic in our community and it needs to be treated as such by our government. We no longer get to put our fingers in our ears and let one more gender and sexually diverse person die by suicide. We can change these things.
Trans youth and those who had experienced physical and sexual assault were found to be at the greatest risk. Some research suggests that use of alcohol, tobacco and other substances are two to four times higher in LGBTQ populations, and 37%—this number may have gone up—of homeless youth identify as LGBTQ. That's an alarming number, and we need to be putting more effort into looking at that as well.
We need to stop allowing physicians to ignore or diminish the existence of transgender people. Transpeople need access to hormone replacement therapy. They should not be told to prove they are trans or wait until they are a bit older. Putting off hormones for a transgender person could mean life or death. Gender dysphoria is a real thing that can lead to suicide and significant mental health concerns.
Youth should have access to hormones and hormone blockers when asking for support from physicians, regardless of their parents agreeing or disagreeing. This becomes a child protection issue and medical neglect in my opinion. Hormone blockers are safe and give children and youth breathing room to stop irreversible changes to their body through the puberty process. We need to start making sure that our youth are being medically supported. I don't know how many appointments I went to with youth, having to advocate for them to get the medical attention they need because physicians don't understand how to prescribe hormones or blockers. More education needs to be mandated because we're losing more and more kids, and this is not okay.
Some more recommendations would be more training mandated to the health care professionals, both in hospitals and throughout their early education. Better data collection would be another. We need to start getting stats for transpeople. We can't keep putting all LGBTQ people in one cluster because we're losing so many opportunities to learn more information. We need more LGBTQ visibility in preventive health care initiatives like smoking cessation, suicide prevention, mental health, addictions, and on government committees.
We need to remove unnecessary gender dorms or services. For example, treatment centres are gendered due to fraternizing. This is very heteronormative and excludes non-binary people. No government funding should support marginalizing already oppressed populations. Finally, government-run systems should never be participating in this marginalization themselves by creating physical barriers to access.