The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project's panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.

Question

Hi! I'm a cis-gendered resettlement worker with LGBTQI+ clients who are in Canada as lone Government Assisted Refugees, without family. I have a few questions.

How to help a trans client (identifies as male) as he moves through hormone therapy and is experiencing frustration, anger/rage, fatigue. He has a great doctor but often forgets that there is a physical reason for some of the changes he is undergoing. I keep reminding him to treat himself as he would a friend, to be gentle and understanding with himself because he has a lot going on.

Also, I have clients who are definitely concerned about the reaction of their own families back home and others from their culture/faith. One gay man was so concerned about it that he dared his family to accept him, which they did not. There are no parents. He told his young siblings who were not prepared, not prepped and who went crazy on him. How do you help others in the same situation?

Finally, what are good strategies for building up community for people who feel so cut off because of their LGBTQI+ identities, on top of other barriers? We talk and they tell me about their isolation, their sadness, that they have gone through hard things. I set them up with volunteers/friends. We look for ways to be involved in the community. We talk about what the future could look like and how to get there.

Vanessa Wright, Nurse Practitioner, Crossroads Refugee Health Clinic, writes:

Thank you so much for asking such brilliant, client-centered questions. It sounds like you are a wonderful resource and provider for your client. Your approach is excellent - in using the 'best friend technique' to encourage balanced thinking, when automatic thoughts or thinking traps present. To help support your client further, I found a great Trans Care website out of British Columbia. The link below takes you to a page that is client facing and reviews various hormone therapies and their side effects, which you may wish to share with your client https://www.phsa.ca/transcarebc/hormones

In addition, here is a fabulous resource run by trans people - to support trans mental health: https://translifeline.org/

LGBT Youth Line: offers confidential support through phone, text, chat: https://www.youthline.ca/

Umbrella Mental Health Network: offers counselling to queer and trans identified: https://www.umhn.ca/

These resources are particularly helpful in many areas of trans care. One of the most gripping feelings for many when disclosing, or sharing one's sense of self, is the sense of isolation and rejection that you referred to throughout your post. These thoughts are stimulated by strong emotions and can create behaviors that further perpetuate these thoughts - and the cycle continues. This is potentially very damaging for individuals who are not surrounded by others who can challenge these thoughts or provide an alternative worldview. 

I think your sense of reassurance, listening and honoring space to be heard, is immensely valuable. I call this supportive counselling - which count for approximately 70% of my work in primary care and I think is the most impactful care I provide. People need to feel connected in various ways and what might work for some, might not work for others. This is where the excellent options you provide come in: mostly around connection: could be anonymous (as listed above with a phone line/chat) or in person with an organization that will reach out, plan in person meetings or phone calls. Check out this group in Toronto that offers group and one-on-one connection with newcomers: https://togetherproject.ca/

Here is another organization that offers a wide range of trans support activities: https://www.the519.org/programs/category/trans-specific

Like you, I only see clients for two years at a time. I think each of my interactions with my clients have the potential for meaningful connection. I feel very privileged to do the work that I do - I think you might feel the same. Happiness and cheer come in many forms - and I learn every day from my clients as well.