This guide provides a summary of the services and programs that support the mental health and well-being of gender-diverse and sexual-minority youth in Ontario. It aims to help youth, their friends, family, caregivers and service providers find their way around these services and systems.
For a glossary of terms that gender-diverse and sexual-minority youth may use to describe themselves, visit Rainbow Health Ontario’s website at http://www.rainbowhealthontario.ca/glossary.
What is gender?
Gender identity refers to how a person feels about how they fit with what society considers masculine or feminine. People have a wide range of gender identities, all of which are equally valid and worthy of respect. Every person has the right to determine their own gender identity and to have that identity respected by others. A person’s biology—such as their genitals, chromosomes, or hormones—does not determine their gender identity.
Gender expression refers to the ways in which individuals send signals about gender, such as the clothes they wear, the way they talk, or the way they act. Gender expression and gender identity are different things. A person’s gender identity does not determine their appearance or behaviour. Every person has the right to determine their own gender expression and to have that identity respected by others.
Who are gender-diverse youth?
When a child is born, doctors and parents typically label that child as a girl or a boy. However, there is no way of knowing whether the child will grow up to agree with the gender identity they were given as a baby. People who agree with the gender identity they were given at birth are called cisgender.
Some people go on to reject part or all of the gender identity they were assigned at birth. People who do this may use any number of labels to identify themselves. Some of these labels include gender-independent, gender-creative, transgender, genderqueer, non-binary, or agender. In this document we use the term gender-diverse to refer to a wide range of identities and life experiences.
What is sexual orientation?
A person’s sexual orientation refers to how they define their sexual attraction to others. Every individual has the right to determine their own sexual orientation and to have that decision respected by others. A person’s sexual orientation is not determined by their sexual history. It may also change over the course of a person’s life.
Who are sexual-minority youth?
Sexual-minority youth are those who do not identify as “straight” or heterosexual. Again, there are a wide range of identities that sexual minority youth might use to describe themselves, including lesbian, gay, bisexual, pansexual, demisexual, queer, or asexual.
While the terms are sometimes confused, gender identity, gender expression, and sexual orientation are three different things. A person’s gender identity or expression does not determine their sexual orientation.
What do sexual-minority and gender-diverse youth need?
Gender-diverse and sexual-minority youth will not inevitably encounter mental health problems. Research shows that gender-diverse and sexual-minority youth do much better when their families and their communities support them. For more information about how family and community support can help gender-diverse youth, see “Impacts of Strong Parental Support for Trans Youth” at http://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vFINAL.pdf.
Gender identity, sexual orientation, and mental health
Having a gender-diverse or sexual-minority identity is not a mental health concern. These identities do not result from parents’ actions or a traumatic event. Variation in gender and sexual identities is part of what defines us as human beings. Youth tend to do well when they are allowed to express their gender or sexuality identity freely and when they are supported by their caregivers.
In Canada, certain roles and expectations are tied to gender and sexuality. For instance, girls and women are expected to be caring and empathetic, while boys and men are expected not to be emotionally expressive. By default, most people expect others to identify as straight/ heterosexual. We know that these expectations are harmful. While our society is becoming more inclusive of gender and sexual minorities, children and youth who do not fulfil these roles or expectations still experience oppression and discrimination. These experiences can contribute to mental health problems for some gender-diverse and sexual-minority youth. They are often still judged or excluded from activities, bullied at school, and face violence at home or in their communities. They may experience intense pressure to look like and act like the gender they were labelled with at birth. They may experience pressure to enter into relationships with someone of the “opposite” sex. For these reasons, gender-diverse and sexual-minority youth are more likely than straight or cisgender youth to:
- Experience depression or anxiety
- Use drugs or alcohol in a way that causes problems for them
- Attempt suicide
- Leave or be forced to leave school early
- Have unstable housing or be homeless
Furthermore, some gender-diverse youth experience mental distress if their physical appearance does not match their gender identity. Sometimes the physical changes of puberty can prompt strong feelings of distress for gender-diverse youth. Medications called puberty blockers can be used to pause puberty temporarily. Older youth may choose to access cross-gender hormones or surgery.
Support for medical transition for gender-diverse youth in Ontario
The World Professional Association of Transgender Health states that access to gender-supportive health services, including hormone blockers, hormones and trans surgery is the best way to treat the distress that arises when an individual’s body does not match their gender identity.
In Ontario, two clinics provide medical transition support services to youth:
- The Hospital for Sick Children in Toronto (Sick Kids) operates the Transgender Youth Clinic. To reach this clinic, call 416-813-7654 x203569 or visit their website at http://www.sickkids.ca/AdolescentMedicine/What-We-Do/Programs/Transgender-Youth-Clinic/index.html.
- The Children’s Hospital of Eastern Ontario (CHEO) in Ottawa operates the Gender Diversity Clinic for youth under 17 and a half years old. To reach this clinic, call 613-737-7600 x3844 or visit their website at http://www.cheo.on.ca/en/genderidentity.
Both of these clinics will accept clients from a wide geographical area—Sick Kids serves those from the western part of the province, and CHEO from the eastern part.
Where can a young person get mental health services?
If a young person has a mental health concern, they or their family can speak with:
- A doctor or a nurse
- A teacher or school guidance counsellor
- A group or organization that can connect them to mental health services
If a young person is having a mental health crisis and is at risk of hurting themselves or others, they can seek care at a hospital emergency department. Unfortunately, there is no guarantee that emergency staff will be prepared to sensitively interact with a gender-diverse or sexual-minority youth.
Youth can also contact a crisis phone line, such as:
- Kids Help Phone (1-800-668-6868) for youth aged 20 and under. Kids and adolescents can call 24 hours per day, 7 days per week.
- Trans Lifeline (1-877-330-6366). Their schedule is available at http://hotline.translifeline.org.
- The LGBT Youth Line (1-888-687-9688), a toll-free Ontario-wide peer-support phone line for lesbian, gay, bisexual, transgender, transsexual, two-spirited, queer and questioning young people. Service is available Sunday to Friday, 4:00 pm to 9:30 pm.
Young people and consenting to mental health care
There is no general age of consent to treatment or counselling; instead, the issue depends on whether the young person is capable of consenting. A young person will be found to have capacity to consent or to refuse consent if both of these requirements are met:
- They understand the information relevant to the proposed treatment in issue.
- They appreciate the reasonably foreseeable consequences of consenting or refusing consent.
Under most circumstances, a health care provider must keep all aspects of a young person’s visit confidential. In certain cases, however, they may be required to share information with an outside party:
- If the health care provider is subpoenaed by court order
- If child abuse is suspected
- To warn intended victims (e.g., if plans to hurt another person are described)
Even if a health care provider is required to share information about a young person with someone else, they do not need to share details like the young person’s gender identity or sexual orientation. Health care providers should only share details about these identities if a young person gives them explicit permission to do so.
Issues of consent and confidentiality can be complicated and are not discussed in full detail here. For more information about consent and confidentiality, see Understanding Common Legal Issues in Child and Youth Mental Health.
Finding the right mental health care provider
Finding mental health services and supports that are inclusive of gender-diverse and sexual-minority youth can sometimes be challenging. A young person or their family may need to make extra effort to find services that are appropriate. In this case, they can consult a service directory. Service directories keep lists of mental health services and other supports in different areas.
Some service directories focus on serving gender-diverse and sexual-minority youth. Others serve all youth, but try to be inclusive of gender and sexual diversity. Many of these services are based in larger urban centres, such as Toronto or Ottawa. However, other services and supports are available online.
Directories of mental health services that are inclusive of gender-diverse and sexual-minority youth
- The Lesbian Gay Bi Trans Youth Line website has an Ontario-wide database of mental health service providers and other supports. The people and organizations in this database are either inclusive of gender-diverse and sexual-minority youth or provide services that are specifically aimed at them. This database can be searched by location, topic, or keyword. The LGBT Youth Line database is available at http://www.youthline.ca/get-support/referral-database.
- Rainbow Health Ontario has a database, also Ontario-wide, that includes mental health care providers who are inclusive of gender-diverse and sexual-minority youth. This database can be searched by location, topic, or keyword. You can find the RHO database at http://www.rainbowhealthontario.ca/service-directory.
- Gender Creative Kids Canada allows visitors to their website to search for mental health providers and other supports by location and a number of categories: language spoken, populations served, and the type of service provider. Visit their website at http://gendercreativekids.ca/providers.
What to expect
Free, publically funded services often have waiting lists. For this reason, it is advisable for young people to get on as many wait lists as possible. We also recommend that the young person or their caregiver regularly contact the organization administering the wait list to (1) give them an update on the youth’s waiting status and (2) see if there have been any changes in the wait time.
Private services are often easy to access very quickly, although the cost of these services can be a barrier. Some private mental health practitioners have sliding-scale spaces that are more affordable; however, these spots often fill up quickly. Some private providers will keep a waiting list for their sliding-scale spots.
It is also advisable to contact the organizations listed in this document to see if there are resources or supports that young people can access while they wait for services.
Supporting gender-diverse and sexual-minority youth
The service directories and organizations listed above can help connect youth with mental health concerns to service providers who can help them. However, supportive relationships and environments are important to making sure that gender-diverse and sexual-minority youth do well. This section lists services and supports that can contribute to these youths’ overall well-being.
Supports and resources for youth and their families
- Many schools and universities in Ontario have gay–straight alliances (GSAs). These groups aim to make spaces friendlier for gender-diverse and sexual-minority students. The website http://mygsa.ca allows the user to search for a GSA near them. The website also has resources for students, parents and teachers.
- Central Toronto Youth Services offers several programs to gender-diverse and sexual-minority youth. These include a support group for youth, a support group for parents, and other programs that offer gender-diverse and sexual-minority youth the opportunity to socialize and learn new skills. You can find out more about these programs at http://www.ctys.org/category/groups. They also host an extensive resource list on their website, which you can access at http://www.ctys.org/category/resources.
- Supporting Our Youth, also known as SOY, is a program run by the Sherbourne Health Centre in Toronto. SOY offers a wide range of programs and resources for gender-diverse and sexual-minority youth. These include programs focused on the arts, creative writing, photography, and hangout spaces for youth. To find out more, visit SOY’s website at http://www.soytoronto.org.
- Toronto-based Delisle Youth Services offers the STARS program, a group for gender-diverse and sexual-minority youth. Visit their website at http://delisleyouth.org/pages/stars-y.
- The 519 Church Street Community Centre in Toronto runs several supports for gender-diverse and sexual-minority youth. Trans Youth Toronto is a drop-in group for those aged 13 and older. The Queer Family Program also provides supports for parents of gender-minority youth. To find out more about these programs, visit http://www.the519.org/programs.
- Gender Mosaic, based in Ottawa, provides support groups for transgender youth. To find out more, go to http://www.gendermosaic.com.
- Centretown Community Health Centre maintains an online list of resources for gender-diverse and sexual-minority youth in the Ottawa area. Access this list at http://www.centretownchc.org/en/programs/lgbtq.aspx.
- The LGBTQ Mental Health Program is an Ottawa-based initiative that provides support and counselling for LGBTQ youth and young adults aged 12 to 25, and their families. Free services in English and French are provided for gender-diverse and sexual-minority youth by an openly gay mental-health counsellor who specializes in sexual orientation and gender identity. For more information, call 613-233-4443 x2109.
- Around the Rainbow is a program of Family Services Ottawa that offers education, counselling, and support services to gender-diverse and sexual-minority youth and their families. They provide an extensive resource list on their website at http://familyservicesottawa.org/children-youth-and-families/around-the-rainbow.
- The Gender Creative Kids Canada website allows the user to search community-building and recreational activities for gender-diverse and sexual-minority youth in their area. The website also includes a list of online resources at http://gendercreativekids.ca/resources.
There are supports and resources other than the ones listed here. If you would like to find out more, please contact one of the organizations listed above. They will be able to direct you to the right place.
Additional resources for service providers
- Rainbow Health Ontario (RHO) offers trainings to help service providers better serve gender-diverse and sexual-minority clients. These include trainings on the emotional and mental health of sexual and gender minorities. A comprehensive list of trainings RHO offers is available on their website at http://www.rainbowhealthontario.ca/training.
- The 519 Education and Training team helps organizations to create environments that are LGBTQ-inclusive, respectful and welcoming. For details, visit http://www.the519.org/education-training.
- Family Services Ottawa provides training for educators and daycare operators through its Around the Rainbow program. Additional information about this training is available at http://familyservicesottawa.org/children-youth-and-families/around-the-rainbow.
- The United States government offers a resource guide for practitioners looking to help families support gender-diverse and sexual-minority children. You can access this guide at http://store.samhsa.gov/product/A-Practitioner-s-Resource-Guide-Helping-Families-to-Support-Their-LGBT-Children/PEP14-LGBTKIDS.
- Mental health care for gender-diverse youth has changed over the years. The World Professional Association for Transgender Health publishes an extensive Standards of Care guide, available at http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926. Numerous professional associations have released statements confirming their commitment to affirming models of care for gender-diverse and sexual-minority youth, including the World Psychiatric Association (http://www.wpanet.org/detail.php?section_id=7&content_id=1807), the Canadian Association of Social Workers (http://www.casw-acts.ca/en/joint-statement-affirmation-gender-diverse-children-and-youth), the American Psychoanalytic Association (http://www.apsa.org/content/2012-position-statement-attempts-change-sexual-orientation-gender-identity-or-gender), and the American Academy of Child and Adolescent Psychiatry (http://www.guideline.gov/content.aspx?id=38417).