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Monsour of Berkeley's Pacific Center explained it this way: "People don't come for treatment because they are transgender. They come for treatment because of the way other people treat them." She estimated that her agency sees about fifty to sixty transgender individuals a year. "They are losing their jobs. They are not being offered jobs. They are being harassed in the workplace. Their family is kicking them out."
Perhaps not surprisingly, there is a high rate of post-traumatic stress disorder in the transgender community, noted Davis of the Transgender Law Center. "It's real and it takes a toll."
The consequences can be deadly. Just this month, Woods said she received emails from the concerned friends of two transgender women who had posted suicidal messages on social media, one who was hospitalized as a result. Both women, she said, had dealt with various forms of family rejection in their lives. Soon after, Woods also learned of a 25-year-old transgender woman from Concord — identified as Natalie Nereza — who apparently jumped to her death onto Interstate 680 in Walnut Creek on November 6.
Advocates say the mental health challenges for some transgender women stem from, and are greatly exacerbated by, their long and complicated relationships with the criminal justice system. Janetta Johnson, of Transgender Gender Variant Intersex Justice Project, spent three-and-a-half years behind bars in a medium-security federal prison for a drug offense. Johnson transitioned to a woman at the age of seventeen, but because she never had gender reassignment surgery, she was required to serve her time in a men's prison. As a result, she said she was frequently victimized, assaulted, taunted, mistreated, and denied medication, yet she had no safe or reasonable way to speak up, she said. Out of more than 1,300 inmates, Johnson said she was the only transgender woman at her federal correctional institution in Oregon, where she was sent after her arrest and conviction in San Francisco.
"They do everything in their power to make you devalue yourself," she said. "The criminal justice system tries to strip you of your identity. Just because you go to jail, it doesn't mean your transgenderism stops or your transition stops. ... I felt like I had been so stripped of my identity as a trans person."
Johnson said that her cellmates regularly sexually assaulted her. Guards sometimes forced her to strip just because they were curious about her body, she said. Health-care providers interrupted her hormone therapy, for no apparent reason, which exacerbated her depression. She picked her battles.
"The only reason I managed was that I very carefully and selectively and strategically negotiated with people that wanted to take advantage of me sexually," she said. "I felt so humiliated, so degraded."
Inmates are discouraged from reporting rape or assault because they will be placed in solitary confinement or segregated housing allegedly for their own protection, Johnson added. She said she spent about six months in segregated housing — at one point with a cellmate who demanded sexual favors from her on an almost daily basis.
Chris Burke, spokesperson for the Federal Bureau of Prisons, said that segregated housing is used "to keep an inmate safe," but noted that it can also be used for disciplinary reasons. He said that inmates who want to report an assault can go through a grievance process, and that with transgender people, "We do treat gender identity disorder inmates on a case-by-case basis."
Johnson was released from prison on May 12, 2012 and moved into a halfway house in the Tenderloin. Five days later, she suffered a severe panic attack and was hospitalized. Fortunately, Johnson had been in contact with the Transgender Gender Variant Intersex Justice Project while in prison, and eventually got a job with the group. But she said it has been a long road to emotional recovery. Part of her work involves helping transgender clients navigate the process of reentry after incarceration, and she said it can be re-traumatizing for her to even discuss abuse and violence.
"I'm just crying and crying and crying when I'm hearing all this stuff," she said, describing some training sessions she has attended for work. "There are times I just wanted to scream."
Many transgender women reentering society after prison often feel like they have no recourse if they are assaulted or victimized. "Once you become an ex-offender, you can never be a victim," she said, explaining that she would be very reluctant to call police if she faced violence today for fear of being re-victimized or arrested.
In other words, the obstacles transgender people face — lack of job opportunities, housing, and support — are amplified for ex-offenders, Johnson said. "[In prison], the transgender community ... is to be used and not respected. The only thing [others believe] we're really good for is to suck somebody's dick and get fucked in the ass." Once outside of prison, she said, it can be challenging to find any sources of income other than sex work. Finding basic mental health support can also be a struggle.
Johnson grew angry while relaying a story about one of her current clients, who was recently released from a twenty-year prison sentence and was unable to get an initial intake appointment with a mental health professional for more than a month after being released. Inmates, she explained, are essentially on their own in navigating social services, making it very easy to slip through the cracks.
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