Since my post on Wednesday, June 24, Please Hold, Your Medical Transition is Important to Us, the Globe and Mail has reported that “Ontario to expand access to publicly insured sex reassignment surgery” The article has very few details as to a timeline and what the new regulations will say. The article also states that “[t]he government is not planning a formal announcement” about the changes. The article also points out that there will be a review of the regulations in order to find “the best way to increase access beyond CAMH.” To my mind this raises more questions than it answers. What will the new regulations look like? How well will they follow the WPATH Standards of Care (SOC)? Another question that notably was not answered was the question of WHEN the new regulations will be put in place. What is the consultation process that will take place with regard to this increase in access?
The question of what the new regulations will look like is particularly important. Ideally, they would follow the WPATH standards in terms of who is allowed to make the referral for surgery. For genital surgeries two referral letters are required as well as some other conditions including having other mental health conditions well controlled and one must have one year of Real Life Experience in the desired gender role. (WPATH SOC7) While there are concerns about the requirement for RLE, these are the standards that surgeons look to before performing the various surgeries. My concern is that the new regulations will continue to severely restrict trans people’s choices when it comes to who they can see for transition related care and surgery referral. When the selection is limited it becomes more difficult to find someone that one can work with in a holistic fashion. Ideally we should be able to work with a mental health professional who can also help us work through issues in other areas of life if needed. For those who are ready, they should be able to get their referral fairly quickly.
When will these new regulations come into effect? This is a very good question. My instinctive reaction is that I will believe it when I see it. There were reports in 2012 that there were to be new centres opened across the province, the announcement was pending, then got cancelled and nothing happened. Thus I’m not holding my breath until I see more concrete details as to what their process and timeline will look like. Even then, until something happens I remain skeptical. Just because this has come to light, doesn’t mean we do not need to maintain the effort to have the new regulations finalized and in place sooner rather than later. This is a question of life or death for too many people.
Which brings up the question of the consultation process. The Globe and Mail article mentions that the head of CAMH, and the head of the Adult Gender Identity Clinic there both agree that there needs to be more access. For consultation to be truly effective it needs to look beyond the entrenched world of the existing world of medical professionals and involve those who have had the experience of dealing with medical transition. It is far too easy for regulators to only look at the bureaucratic and academic side of health care and forget that their decisions are actually impacting on the lives of real people.
I, for one, would object to a proposal that would require people to travel great distances to access care. Even with regional centres many people would still need to travel long distances. For those in Northern Ontario this is the norm for many health care needs. As part of this discussion the issue of access to providers must be addressed, and not just looking at access to surgery referrals.
Right now my suggestions for the new regulations go beyond just the regulations, but include policy and practice:
- Allow for the recommendation for funding and referral letters to come from professionals as outlined in the WPATH standards of care. I do realize that one of whom would likely have to be a medical doctor given the way the Ministry of Health and Long Term Care operates, although I would hope that wouldn’t be a requirement.
- Include a policy mandate to work to have surgery performed in Ontario. Some of the surgeries are available in Ontario, but genital surgery is not.
- Increase what is covered by the provincial health care plan. At the moment chest contouring is not covered for those who are medically transitioning and need to have mastectomies. For many permanent hair removal is not cosmetic, but critical for who they are and impacts on their ability to live, and can be a significant source of dysphoria with their bodies.
- Have a fund for those who have to travel for health care access. This should be for anyone in the province who has to travel to another community to access health care, surgeries, etc and is not limited to those who are seeking transition related care!
- Ensure that training for medical professionals, nurses, doctors, mental health professionals etc is included in the curricula while they are receiving their training at universities and colleges.
I am sure that I will have others come to mind as I continue to think this through and speak to others who have struggled with the current health care system for trans people in Ontario. For those who are able, I encourage you to be active and help work toward better access to health care for trans people in Ontario.