10 demands to CKI! / 10 krav to CKI!

In February 2016 Amnesty Denmark published the comprehensive report ‘Trans peoples access to healthcare in Denmark’ which documented how trans people, who seek treatment, are forced through years of degrading and discriminatory procedures at Sexological Clinic in Copenhagen. After a long and tough struggle, being trans was finally removed from the list of psychiatric diagnoses in Denmark in 2017. Then it was decided in September 2018, in the Regional Council, to move the treatment of trans people away from its current location at Sexological Clinic to new Center For Gender Identity.

Written by Trans People Against Pathologization, pictures by Archibald

On paper this is a big step, but many trans people are concerned that the moving of treatment is only symbolic; as it is the same employees and same treatment methods as in Sexological Clinic, which are transferred to the new Center For Gender Identity. This means that the treatment is not being moved away from the psychiatry. Trans people still have to go through a psychiatric assessment in order to gain access to treatment. It is still obligatory to see a psychiatrist or psychologist, who will assess if a person can be approved for treatment. It is therefore misleading to state that the treatment has been moved away from the psychiatry.

Here we have a message from Senior Advisor and Researcher for Amnesty International Helle Jacobsen:

“It was a milestone in the fight for trans peoples rights that Denmark on the 1st of January 2018 as the first country in the world, removed being transgender from the list of psychiatric diagnoses. But it remains a symbolic act without significance for trans people, if the access to treatment is not changes substantially. Amnesty therefore advice the Minister of Health to ensure that trans people will no longer be forced through psychiatric clinical screenings, but that they are offered treatment based on informed consent. It is worrying that trans people continue to be forced through psychiatric clinical screenings in order to gain access to treatment. It is a violation of their access to health care and discrimination.”

Based on this, we have formulated a number of demands for the Center For Gender Identity, to ensure that trans peoples rights are not violated in the Danish health care system.

To the CKI

It is with heavy hearts that we leave this note today, informing you of our disappointment and anger with the care you have provided to your clients.

We represent the numbers of trans individuals who have experienced huge levels of stress because of the treatment they’ve received by your staff. While we appreciate that you may not wish to believe that your care has been inadequate, we have gathered testimonials from many who have spent their energy sharing their thoughts and experiences with us. You have continued to dictate how our bodies, lives and identities should be treated. You’ve been gatekeeping the treatment you should provide to many trans/non-binary and other gender minority groups because they don’t fit your narrow perceptions of gender. You’ve been ruthless in your questioning, asking about our sex lives, sexualities, gender expressions and other personal matters. If you are the experts you hail yourselves to be, these questions should not be of interest to you. We’re aware of other techniques/frameworks used by your staff to determine whether we are trans in your eyes, many of these being out-dated, insensitive, pathologising and discriminatory. We know you’ve misdiagnosed clients with mental health conditions, which have affected them. You’ve made clients wait months, sometimes years, to receive treatment, while knowing that many of us are reliant on this care to be able to survive and to live fulfilled lives. You’ve made no attempt to help us in the fight to tackle transphobia, gender binarism, racism, ageism, ableism, classism and fatphobia within trans-specific health-care. We want a trans-specific health-care that stands with us in the fight for social justice. Yet you have let us down.

While the CKI is a job for you, this is our lives!

We want you to welcome this feedback, and acknowledge your need to grow. We leave here today 10 demands that we know are mandatory for ensuring that trans, non-binary and other gender minorities across Denmark receive the care we deserve and are entitled to.

We demand:

1. We demand you work with us to demand the government to change the guidelines so that trans-specific health-care be based on the model of informed consent.

2. We demand opening of more centres and points of access to trans-specific health-care.

3. We demand that trans people will be employed as experts by experience, so that we among other things can review the training undertaken by all staff within the centres.

4. We demand that none of the staff from Sexologisk Klinik be employed within the CKI.

5. We demand a trans-specific health-care that is not organized around a bioessentialist view through the binary constructs of sex and gender, anchored in a colonial and eurocentric worldview, and that the trans-specific health-care is continually invested in developing its understandings of gender when called in/out and critiqued by the trans communities.

6. We demand our relationship to our body not be used as the framework to verify whether we should be given access to trans-specific health-care.

7. We demand a trans-specific health-care that doesn’t employ psychiatrists or psychologists, and that you should not go through a psychiatric/psychological assessment to access gender and body affirming treatment. Instead we demand access to free therapy which is completely disconnected from the trans-specific health-care, and which will be offered by therapists who are trained (and receive continual training) in trans-specific care.

8. We demand CKI be held accountable to waiting times for appointments within the centre and that all frameworks for the process that is used by clinicians be made public for continual reviewing (including those for new clients, clients returning to Denmark and those from outside Denmark – including those whose treatment has already been started).

9. We demand open consultations with CKI monthly, rather than 1-2 times a year (see ‘Dialogmøder’ on the website). We expect these meetings to help bring about possibilities of actual influence and change. We also demand that a platform is set up for us to share and view complaints to ensure that the clinicians are acknowledging our needs/rectifying them.

10. We demand easily accessible statistics on the amount of people who are given access to gender and body affirming treatment and of those that were declined, and that the centre be invested in sharing knowledge/research which has been produced outside the centre.

Dansk oversættelse

I februar 2016 udgav Amnesty Danmark den omfattende rapport Transkønnedes adgang til sundhed i Danmark, som dokumenterede, hvordan transpersoner, der søger om behandling, tvinges gennem årelange, nedværdigende og diskriminerende forløb på Sexologisk Klinik i København. Efter en lang og sej kamp, blev transkønnethed i 2017 endelig fjernet fra listen over psykiatriske diagnoser i Danmark. Herefter blev det i september 2018 besluttet i Regionsrådet at flytte behandlingen af transpersoner væk fra dens nuværende placering hos Sexologisk klinik over til et nyt Center For Kønsidentitet.

På papiret er dette et stort skridt, men mange transpersoner er bekymrede for at flytningen kun er symbolsk. Det er nemlig det samme personale og de samme behandlingsmetoder som hos Sexologisk klinik, der overføres til det nye Center For Kønsidentitet. Dette betyder, at behandlingen ikke flyttes væk fra psykiatrien. Transpersoner skal fortsat gennem psykiatrisk udredning, for at få adgang til behandling. Det er nemlig fortsat obligatorisk at se en psykolog eller psykiater, der skal vurdere om en person kan godkendes til behandling. Det er derfor misvisende at sige, at behandlingen er blevet flyttet væk fra psykiatrien.

Her er en meddelelse fra Senior Advisor og Researcher fra Amnesty International, Helle Jacobsen:

“Det var en milepæl i kampen for transkønnedes rettigheder, at Danmark den 1. januar 2018 blev det første land i verden til at fjerne transkønnethed fra den psykiatriske diagnosefortegnelse. Men det forbliver en symbolsk handling uden betydning for de transkønnede, hvis adgangen til behandling ikke ændres markant. Amnesty opfordrer derfor sundhedsministeren til at sikre, at transkønnede ikke længere tvinges igennem psykiatriske udredningsforløb, men at de tilbydes behandlinger på baggrund af informeret samtykke. Det er bekymrende, at transpersoner stadig bliver tvunget igennem psykiatrisk udredninger for at få adgang til behandling. Det er en krænkelse af deres adgang til sundhed og diskrimination”

På baggrund af dette, har vi udarbejdet en række krav til Center For Kønsidentitet, der skal sikre at transpersoners rettigheder ikke krænkes i det danske sundhedssystem.

Til CKI

Det er med tunge hjerter, at vi i dag efterlader jer dette på skrift, for at informere jer om vores skuffelse og vrede over behandlingen af jeres klienter.

Vi repræsenterer den mængde af transpersoner, som har oplevet stor belastning på grund af den behandling, som de har modtaget af jeres personale.

Selv om vi forstår, at I måske ikke ønsker at tro, at jeres behandling har været utilstrækkelig, har vi samlet beretninger fra mange, som har brugt energi og overskud på at dele deres tanker og oplevelser med os. I er blevet ved med at diktere, hvordan vores kroppe, liv og identiteter skal behandles. I er blevet ved med at gatekeepe den behandling, I skulle have givet til mange trans/non-binære og andre kønsminoriteter, fordi de ikke passer ind i jeres snævre forestillinger omkring køn. I har været brutale i jeres udspørgen. I har spurgt om vores sexliv, seksualitet, kønsudtryk og andre personlige anliggender. Hvis I er de eksperter, som I bifalder jer selv til at være, skulle I ikke have nogen interesse i at spørge ind til dette. Vi har kendskab til andre teknikker/rammer, herudaf mange som er forældede, ufølsomme, sygeliggørende og diskriminerende, som stadig bliver brugt af jeres personale til at bestemme, om vi er trans eller ej i jeres øjne. Vi ved, at I har fejldiagnosticeret klienter med psykiske lidelser, som har påvirket dem. I har fået klienter til at vente måneder, nogle gange årevis, på at blive godkendt til hormonbehandling, selv om I ved, at mange af os er afhængige af hormonerne for at være i stand til at overleve og leve et tilfredsstillende liv. I har ikke gjort noget forsøg på at hjælpe os i kampen mod transfobi, tokønsnormer, racisme, aldersdiskrimination, funktionsnormer, diskrimination på baggrund af klasseforhold og tykfobi inden for det transspecifikke sundhedssystem. Vi ønsker et transspecifikt sundhedssystem, som står med os i kampen for social retfærdighed. Indtil videre har I kun skuffet os.

Det kan godt være, at CKI kun er et job for jer, men det er vores liv det handler om!

Vi vil have, at I tager imod denne feedback og anerkender behovet for markante forbedringer fra jeres side. Vi efterlader jer i dag 10 krav, som vi ved er ufravigelige, når vi skal sikre, at transpersoner, non-binære og andre kønsminoriteter på tværs af Danmark får den behandling, vi fortjener og er berettigede til.

Vi kræver:

1. Vi kræver, at I arbejder med os for at presse regeringen til at igangsætte en ændring af behandlingsvejledning, så transspecifik behandling baseres på modellen for informeret samtykke.

2. Vi kræver, at der åbnes flere centre og steder med adgang til transspecifik behandling.

3. Vi kræver, at transpersoner ansættes som ‘experts by experience’, så vi blandt andet kan bedømme den uddannelse personalet i centret gennemgår.

4. Vi kræver, at intet af personalet fra Sexologisk Klinik bliver ansat hos CKI.

5. Vi kræver, at det transspecifikke sundhedssystem ikke er indrettet efter en bioessentialistisk anskuelse af verden gennem den binære konstruktion af køn, som er forankret i en kolonial, eurocentrisk verdensopfattelse, og at systemet konstant er investeret i at udvikle dets forståelser af køn, når det bliver kaldt ind/ud og kritiseret af transmiljøerne.

6. Vi kræver, at vores forhold til vores krop ikke bliver brugt som ramme for at bestemme, om vi skal have adgang til transspecifik behandling.

7. Vi kræver, at det transspecifikke sundhedssystem ikke har psykiatere og psykologer ansat, og at man ikke skal igennem en psykiatrisk/psykologisk vurdering for at få adgang til køns- og kropsbekræftende behandling. Vi kræver i stedet adgang til gratis terapi, som er fuldstændig afkoblet fra den transspecifikke sundhed, og som varetages af terapeuter med en transspecifik uddannelse (og skal blive ved med at gennemgå videreuddannelse).

8. Vi kræver, at CKI bliver holdt ansvarlig i forhold til ventetider til konsultationer på centeret, og at alle rammer for forløbet, som bliver brugt af personalet, bliver offentliggjort, så rammerne til stadighed kan blive bedømt. (Det inkluderer rammerne for nye klienter, klienter der kommer tilbage til Danmark, og klienter der kommer til Danmark udefra – inklusive de, hvis behandling allerede er igangsat.)

9. Vi kræver åbne dialogmøder med CKI månedligt i stedet for 1-2 gange om året (se ‘Dialogmøder’ på hjemmesiden). Vi forventer, at disse møder vil give reelle mulighed for indflydelse og forandringer. Vi kræver ligeledes en åben platform, hvorpå vi kan se og dele klager for at sikre, at personalet anerkender vores behov/retter sig efter dem.

10. Vi kræver nemt tilgængelige statistikker på, hvor mange personer, der bliver godkendt til køns- og kropsbekræftende behandling, og hvor mange, der bliver afvist, samt at centret er investeret i at dele viden/forskning, som er blevet udarbejdet uden for centeret.