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Modelling Transgender Spiritual Care: Pilot Framework for People Undergoing Gender Transition in NHS England Gender Clinics

This project explores the development of spiritual and pastoral care for people undergoing gender transition. Spirituality and religious involvement correlate positively with improved wellbeing and mental health, and the NHS Contract of Care 2014-15 and the Health and Social Care Act 2008 require medical teams to provide for service users’ religious and spiritual needs. However, there are currently no guidelines or frameworks in use by NHS England to ensure transgender people’s spiritual care. The project addresses this by examining the following questions: What resources, if any, exist for providing a good standard of spiritual care for transgender people? What barriers may exist to providing appropriate spiritual care for people undergoing gender transition in the NHS? What do transgender people consider to be their own specific spiritual needs? How might improved spiritual care for transgender people impact positively on transgender people’s physical and mental health and wellbeing and improve outcomes? How might NHS chaplaincy services provide effective spiritual support for people undergoing transition? What additional training and resourcing for healthcare chaplains is necessary?

Preliminary research suggests that the dominant medical model of care for transgender people may have obscured the spiritual aspects of gender transition. Anecdotal evidence from gender identity specialists suggests that a significant proportion of people seeking gender reassignment within the NHS in England have a personal faith, and that faith and spirituality are impacted by their gender incongruence and transition. This may largely relate to factors external to the affected individual but might also be a feature of minority stress and, in particular, internalized transphobia. However, there have been no studies on transgender spiritual care in the NHS to date, and there are currently no guidelines or frameworks to ensure transgender people’s pastoral or spiritual care in use by NHS England. Spirituality and religion are not mentioned in NHS England’s gender dysphoria protocols and guidelines (NHS England 2013b).

Pre-transition transgender people are at significantly increased risk of mental health problems and suicide (McNeil 2012: 59; Haas, Rodgers and Herman 2014), and transgender people who have mental health problems are less likely than non-transgender people to receive appropriate care. Research on healthcare chaplaincy has demonstrated the importance of spiritual wellbeing for mental and physical health – and religious involvement is positively correlated to wellbeing (Koenig and Larson 2001; Abu-Raiya and Pargament 2012: 337; see also Vivat 2012 and Paloutzian, Bufford and Wildman 2012). Spiritual support may be particularly important given the current long waiting times for referral to gender identity clinics and for surgery (over a year in places, despite the 18-week target waiting time – Healthwatch 2015; UK Trans Info 2014), during which transgender people of faith may benefit from further assistance. As well as formulating a spiritual care framework, to be piloted by the West of England NHS Specialist Gender Identity Clinic (which currently cares for c.650 patients – UK Trans Info 2014), the project will also develop training resources on transgender spiritual care for healthcare chaplains.