Gender fluid, let’s talk about that?

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Published on: 26th March 2019

My name is Penny McMillan and I’m a trainee PWP and equality and diversity champion for steps2change.

I decided that I wanted to get a patient opinion on whether our service users feel we are inclusive and what we need to do as a service to be more responsive to the needs of LGBT+ people.

I discussed this with a patient who presents as gender fluid, they agreed for me to discuss this openly with the service. I proceeded to ask the question “Are we LGBT+ inclusive as a service?”

The patient was very polite and stated that they felt that they had a positive experience with steps2change. We discussed what inclusive meant and how the service met their current needs. Their reply was “by doing what you are doing now”. By me acknowledging that they were gender fluid and being open to discuss this within the sessions, the patient felt they could talk to me about their mental health difficulties and how their life is being affected on a daily basis.

This led me to think about the equality and diversity courses we used to attend whereby the room was crammed with as many people as possible and the only thing that was on our minds was the free lunch. During this training, we were repeatedly told you treat everybody the same no matter what age, race, gender etc. However, no one person is the same as another we all have our differences whether that be age, gender, race or whether we love or hate Marmite. These traits and characteristics make each person unique.
If we treat everyone the same we are not acknowledging these differences or how this may be affecting their mental health. I can only see this as a negative and it would affect the therapeutic relationship.  As healthcare workers, we talk openly about a lot of sensitive subjects like abuse or risk without hesitation. 

This got me thinking if I hadn’t acknowledged that this patient presented as gender-fluid:

  • Would the treatment have been affected? 
  • Would there have been ‘an elephant in the room’?
  • Would the patient have met recovery?
  • Would they have felt comfortable to disclose their mental health difficulties?

I feel this leads me onto our next question we need to ask ourselves which is why we may not be acknowledging what is going on for the patient.  Is this because:

  • We are scared of what language to use?
  • Are we scared of what the patient might say?
  • What if we say something wrong?
  • Do we have a lack of understanding?
  • Do we feel it’s not relevant to the work being done?

I asked myself these questions and tried to understand if I had these concerns when I’m seeing a patient. However, I feel at ease to discuss LGBT+ matters because I've been proactively trying to learn more about LGBT+ matters.

I then decided to look at the patient's thoughts and they were:

  • What if they don’t understand?
  • I don’t know who or what I am?
  • What if they think I’m an alien?
  • Will they treat me differently?
  • Will they even want to get to know me as a person?

Their thoughts mirrored some of the concerns that clinicians have about approaching the subject of gender fluidity. Finally, I asked myself how can we change this, I discussed this with the patient and they said all their concerns about accessing treatment would be solved with six simple words.

Gender fluid, let's talk about that?

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