New guidelines, drafted alongside LGBTQ advocacy groups, require clinics and hospitals to respect patients’ pronouns, gender identity and confidentiality in move hailed by activists

The Israeli Health Ministry has recognized that transgender people do not suffer from a psychological disorder, two and a half years after the World Health Organization did so.

The ministry published this week new guidelines to codify the way the public health system relates to the transgender community, which all hospitals and health maintenance organizations must follow.

According to the guidelines, there is no ethical or professional justification for so-called conversion therapy for the purpose of altering someone’s sexual or gender identity, and they require medical professionals to use the pronouns of the gender with which the patient identifies while addressing them, regardless of their identity documents or physical appearance.

They also require hospitals and psychiatric wards to have at least one staff member who underwent training in order to be conscious of transgender people and to offer hospitalization conditions in accordance with their wishes, such as unisex bathrooms.

The guidelines were signed by the director of the ministry’s mental health services wing, Dr. Tal Bergman, and social worker Danny Bodovsky of the same department. They were drawn up over a three-year period in cooperation with LGBTQ organizations Ma’avarim, which serves the transgender community; Gila Project, a movement for trans empowerment; the Aguda – Israel’s LGBT Task Force and the Lioness Alliance for families of transgender children. The project was launched following many reports by the trans community about discriminatory treatment due to a lack of knowledge.

In one instance, a transgender woman was forcibly hospitalized for over a month in a closed ward at a psychiatric hospital, because the department’s director insisted she identify as a man. The director demanded that the patient stop demanding to be addressed as a woman as a condition for moving her to an open ward, and told her that her psychiatric evaluation would be based on her identifying as a transgender woman and her demand to be addressed with female pronouns.

“Transgender people, or people on the trans spectrum, is an umbrella term used to describe people who span a broad spectrum of gender identities, distinctive from the one they were identified with and registered as at birth,” the rules say.

“People from this population group are at high risk of suffering physical and verbal violence, discrimination in employment and a lack of access to public resources, being treated as social outcasts, which can worsen psychological distress and lead to susceptibility to a high rate of illness relative to the rest of the population,” the guidelines say. “This is particularly noticeable when it comes to mental health.”

Ministry officials noted that gender identity is not a psychological disorder, and that gender dysphoria – depression caused by the incongruence between one’s gender identity and the gender they were assigned at birth – is what is likely to cause distress.

Discrimination from medical staff

The document recommends that, to the greatest extent possible, a transgender patient be placed in their own room, or in a mixed-gender space, or in a room that corresponds to their gender identity that includes a separate place to sleep and bathe. It adds that the patient is to be permitted to use facilities according to their gender, or to make sure there are facilities that are unisex, such as bathrooms, and to designate this with proper signage. The guidelines also include examples of signs that may be used.

According to a study by the Levinsky Clinic and the Aguda conducted by Dr. Sigal Goldin, 64 percent of transgender people have experienced negative or discriminatory treatment by medical staff because of their gender identity.

About 40 percent reported to have been denied medical treatment due to their gender identity, and 36 percent reported suffering verbal violence at the place where they were treated, the study found. About 80 percent reported that they had been apprehensive about seeking medical treatment at some point for fear of being discriminated against by medical staff, while 57 percent reported refraining from seeking medical care for fear of being treated poorly.

Another section of the new guidelines addresses medical confidentiality. It says that “utmost caution must be taken when it comes to exposing information about the gender identity of a patient and about the patient’s physical transition process, especially when providing information to external entities.” It adds, “It must be done in cooperation with and the agreement of the patient and with their consent.”

With regard to minors, the guidelines note that “Children and youths on the trans spectrum are at heightened risk of experiencing verbal and physical violence within the family and in school.” They are also at high risk of “losing family support, suffering from eating disorders, anxiety, depression, self-harm and suicide, sexual harassment, and entering the cycle of prostitution.” Family support has a significant impact on reducing this harm, the guidelines say, as do validating the child’s gender identity and social and/or medical transitioning into their gender.

Ella Amest, co-director general of trans advocacy group Ma’avarim, called the new guidelines “an important and significant step for the community and for the health system. Many of us require psychological services due to our confrontations with transphobia, beyond the more common reasons experienced by the rest of the population, but the system doesn’t always know how to treat us.” 

She added, “The guidelines provide those who work in the field with substantive, clear tools and support from above. We hope that more and more public services will adopt this process and formulate similar guidelines together with trans spectrum organizations”

Or Keshet, the director of government relations for the Aguda, said that “In recent years, a number of cases have come to light of inappropriate and unprofessional service for trans people, such as when the gender identity of a patient was mistakenly listed as a psychological disorder, or when a patient asked to be addressed with certain pronouns and this was not respected. Let’s hope that with the aid of the guidelines, the mental health system will become more accessible for and friendly towards the trans public.”