It’s 2025, and every day this year, the calls for surveillance, imprisonment and outright eradication of trans people have gotten louder. In the United States, there are rumblings that the Supreme Court will revisit the legalization of gay marriage. The U.S. Supreme court is currently weighing whether to overturn Colorado’s conversion therapy ban. The collective mental health of queer and trans people is in a pressure cooker. As the oppressive social and legal conditions that shape our lives continue to intensify, mental health practitioners who work with LGBTQ2S+ people will be forced to ask themselves with increasing frequency: “What does it mean to practice ‘queer mental healthcare’ within a system that has historically been weaponized against queer and trans communities?”
This is a system that is today being turned against us with growing ferocity. On a practical level, mental health professionals are going to be forced to consider what they are prepared to risk, and what rules they are prepared to potentially break, in order to protect and serve the well-being of extremely vulnerable queer and trans clients.
Over the course of the 2010s, the queer mental health landscape underwent a significant transformation thanks in large part to the efforts of service users, advocates, clinicians, researchers and policymakers, who fought for queer-positive and gender-affirming models of care. In that same time period, we saw a growing overall awareness of anti-oppression and abolitionist values. These ways of thinking about and providing mental healthcare pushed back against the default assumption in the fields of psychology and psychiatry that being queer or trans was itself a form of mental illness—and questioned the role of health professionals as enforcers of social norms with the power to lock people up or take away their children “for their own good.”
Among the biggest accomplishments of decades of advocacy was the fact that the mainstream mental healthcare establishment dramatically altered its stance on queer and trans people: conversion therapy meant to make queer people straight—or trans people cis—was banned and outlawed in many jurisdictions, and gender-affirming models of care for trans people were adopted by many healthcare institutions. It also became far more common for mental health professionals themselves to openly identify as queer or trans, as doing so was no longer so intensely stigmatized in professional circles.
Yet even with these positive developments, the field of mental healthcare has continued to exist in uneasy tension with queer liberation. In the first place, the legacy of decades of homophobia and transphobia embedded in mental health disciplines has not been so easily undone, as evidenced by the massive resurgence in popularity of psychological theories once considered widely debunked.
For example, the idea that trans women can be categorized as either “failed” gay men who transition in order to attract straight men or “autogynephilic” men with a fetish for imagining themselves with vaginas is now widely cited by anti-trans activists, including some professionals and even certain conservative-leaning trans people. Moreover, new anti-trans theories have been developed, most notably the notion of “Rapid Onset Gender Dysphoria,” which suggests that many people, especially teens, are now identifying as trans because of “social contagion,” a theory that bears more than a passing resemblance to the age-old stereotype that queer and trans people are out to corrupt the youth.
On an even deeper level, the fact is that mental healthcare as a discipline has never really managed to resolve the tension between its dual roles as a form of quasi-medical support and a form of social control: practitioners and institutions remain obligated to follow laws and regulations that have the potential to harm, rather than help, their patients. As anti-trans hysteria, anti-queer sentiment, and overall fascism continue to rise across the globe—and as legal dictates follow—it will become increasingly necessary for those involved in the field to develop strategies for principled, collective resistance.
Providers must ask themselves what to do in situations where anti-queer directives compel them to act in unethical ways.
Even in the best of times, mental health providers who valued anti-oppression and LGBTQ2S+ rights have had to ask themselves questions that mainstream professional associations were loath to answer. For example: Is it right to call the police when a client might be at risk of self-harm, knowing that queer and trans people, and especially those who are racialized, may also be at higher risk of police brutality? What are the consequences of participating in holding trans patients in hospital care against their will, knowing that they are more likely to experience gender-based violence and discrimination in hospital systems? What are the alternatives in situations like this?
Today, providers also need to ask themselves what to do in situations where anti-trans and anti-queer directives may compel them to act in unethical ways. For example, so-called “parental rights” campaigns are demanding that school professionals such as counsellors and teachers notify parents any time a student comes out as queer or trans, even if the student has specifically requested the opposite, a practice that puts some young people at risk of increased suicidality and familial abuse.
Many jurisdictions have already adopted policies to this effect, and it’s reasonable to fear that mental health professionals who work with youth outside of school settings may soon be confronted with similar demands.
Unfortunately, schools are just the tip of the iceberg: In the U.S. and Britain, hospital-based providers of gender-affirming care to youth have already shut down in response to the changing political climate. Indeed, the U.S. federal government has demanded that any organization receiving federal funding shut down programs oriented toward supporting queer and trans people. In a world where authoritarian extremism has been established as the new normal, it’s entirely possible that any kind of queer-positive approach to mental health will be forced back into the margins. It is therefore key that practitioners consider how to most effectively push back.
Principled non-compliance is a simple yet profound place to start. Where governments demand that mental health professionals betray their ethics, professionals may decide to just say “no.” The effectiveness of non-compliance is often increased by strength of numbers, and so organizing communities of practice here is also key. One therapist, social worker or psychiatrist refusing to follow an unjust law or policy is at a high risk for legal consequences but a thousand—or ten thousand—united, defiant professionals are harder to shut down.
Organized groups of mental health providers can also effectively pressure professional associations and institutions to take ethical stances that affirm queer and trans rights. There is great potential in the possibility of mental health professional associations partnering with labour unions to fight against queerphobic legislation and demand the right to continue providing life-saving care to queer and trans communities. We have seen the precedent for this kind of solidarity between labour and healthcare associations in other contexts, such as the Association of Ontario Midwives’s declaration of support for the Canadian Union of Public Employees in its struggle for pay equity for education workers. As always in the fight for civil rights, the strength of many people united is essential.
Yet the strength of many is made of the strength of individuals, and fighting for the future of queer and trans mental health calls for courageous practitioners. There is always a risk in the struggle for justice, and mental health professionals may risk their licences and livelihood to do what is right. The question is: What makes such a risk meaningful? What makes it worthwhile?
The answer lives in the core principles that are the foundation of every health discipline: to do what is good, and to do no harm. To uphold the autonomy and freedom of individuals as much as possible. And to uphold and defend justice for all. These principles aren’t supposed to be abstract. They’re a calling, a way of life that practitioners of the healing arts are meant to embody and that become all the more important in troubled times.
Let’s hope that every mental health professional who believes in queer and trans rights remembers that. Real people, and real lives, depend on it.
