In this chapter we focus on the cultural diversity of genders and sexualities, and the effects of marginalisation, interpersonal and intimate partner violence and abuse on people's mental health (Afifi, 2007; Seedat et al., 2009). We describe the ways in which mental health practitioners are able to practise empathically and effectively in gender, diversity and trauma-informed care. Throughout the first part of the chapter we will be reading Riley's story to help us understand how mental health services can be more supportive and accepting of gender and sexual diversity.
Continua of sexuality and gender
The Australian (2011) and New Zealand Human Rights Commissions (2008) refer to a broad and diverse range of sexual orientations and gender identities. Many people are familiar with the idea that there exists a range of sexual orientations. One way to conceptualise gender as more than a binary of male and female is to imagine a continuum of gender identity (United Nations High Commissioner for Human Rights, 2012), with heterosexual or straight at one end and lesbian or gay at the other. Many people position themselves at either end, while others place themselves at a myriad places in between. Some people move along the continuum over the course of their lifetime. It is less commonly acknowledged that there is also a wide range of gender identities. Some terms that people might use include transgender, transsexual, intersex, gender-queer, woman or man.
‘Transgender’ is a term that encompasses a range of identities for people who do not identify with the sex they were assigned at birth. Some of these people identify as transmen (assigned female at birth, identify as male) or as transwomen (assigned male at birth, identify as female). Some people do not identify with the binary concept of male or female, and may use terms like gender-queer. Gender-queer people identify as both male and female, or as neither. This is different to intersex, which is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that does not fit the typical biological definitions of female or male.