First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA

ABSTRACT

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a “gender therapist,” only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.

KEYWORDS:

• Gender-affirmative practices
• gender nonconforming
• legal climate
• mental healthcare
• transgender

Note

Declaration of conflict of interest

This work was supported in part by grant MH108897-01A1 from the National Institutes of Mental Health and grant 1U54GM115458-01 from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare that they have no conflict of interest.

Acknowledgments

The authors would like to express their gratitude to Gabrielle Albeck for her assistance with data collection and coding.

Notes

1. The cell counts for these analyses are available upon request.

Additional information

Funding

National Institute of Mental Health (MH108897-01A1). National Institute of General Medical Sciences (1U54GM115458-01).