Policy Changes to Provide Access

Now that the history of our Commissioners Directive 800 policy has been explored in detail, it is necessary to discuss possible alternatives to this discriminating policy. Possible alternatives would include changing the wording of this policy. By simply modifying specific words within the policy you could completely change the implications affecting transgender individuals in the prison system. As we know there are very negative implications for transgender individuals with the current policy in place. Although, through fairly minimal word changes in the policy we could drastically improve incarcerated life for the Trans community.

The goal intended when we speak about alternative policy development is to break down the barriers for Trans individuals, when seeking access to health care within the prison system. First it is crucial for us all to understand what "access" means. "Getting in the door is the first step but access includes more, such as the quality of services, as well as the spirit in which the service is provided. Access is a commitment." http://www.the519.org/. Access for a Trans person in jail is about respect, and allowing the Trans person to have control over decisions regarding their own bodies.

Breaking down barriers to create this aforementioned access is our next step in eliminating discrimination from this prison policy. Barriers include having the jail’s "specialist" be in control of the Trans person, rather than having the Trans person’s doctor have input. Another barrier is the strict one-year requirement regarding the life test. Lastly, the jail’s "specialist’s" need to "recommend" surgery is a final barrier inhibiting Trans individuals from accessing healthcare, as well as having control over their own bodies.

Recommendations would include having incarcerated transgender individuals’ doctors able to have input into the lives of their patients. Doctors that have spent time with these Trans people, while they were in the community, would have a better idea of the "readiness" of their patients. Also, by making the time restrictions on the duration of life tests a bit less rigid, we could improve the quality of life for many incarcerated Trans people. Lastly, we should eliminate the need for the jail doctor to "recommend" surgery, as this is a monumental barrier for many Trans people trying to gain access to their health care needs.

Impacts of Case by Case Policy

It is a human right for transgendered people to be treated fairly and without discrimination, to have equal rights and opportunities and be recognized for their dignity and worth. Yet, all transgender people in prison are handled on a case by case basis where there is likelihood for personal interpretations of the policy to be projected by prison professionals that fluctuate from one case to the next.
Consistency in a structured environment such as prisons helps to create norms within that environment; consistent practices and principles normalize everyday conduct, attitudes and behaviours. Each transgendered person in prison, however, is scrutinized as an individual and treated separately from others often from a transphobic mindset. When each case is managed differently there is a lack of consistency both in the treatment and the outcomes. It causes confusion, perplexities and uncertainties about the norms pertaining to transgendered inmates. The variance in outcomes also makes it hard to distinguish the best way to go about solving the problem.
Prison professionals may use the inconsistencies as an escape route for their decisions and treatment towards a transgender inmate where they blame the system, not themselves for the discrimination. Other inmates may feed into the lack of consistency and see it as a doorway for justifying their transphobic ideals as well. A case by case framework may be detrimental to a transgender inmate in that they may internalize the negative ways in which they are treated, where their self-worth and self-esteem are diminished. They may also generate mistrusts towards prison professionals. Handling these issues case by case may also cause a divide between other transgender inmates whose experiences with the process are drastically dissimilar.
A universal law may not account for all the injustices faced by a transgender inmate, nevertheless, it may be a good place to start in order to establish a standard in which prison staff are held accountable for any mistreatments, and to abolish multiple interpretations of the policy in any given case. Assembling standards may assist in regulating and normalizing more positive perceptions about transgender inmates and help to protect them from harm.
For more information on human rights and sexual orientation, please visit: http://www.ohrc.on.ca/en/issues/sexual_orientation

Subjective Policy

On the surface, it appears as though this policy protects the transgendered inmate; however, when we dig deeper it becomes clear that this policy is very much subjective and open to interpretation. The policy is not uniform, and for that reason, allegations exclusive to transgender individuals are dealt with on a case by case basis. Furthermore, even if laws were uniform, transgender inmates face differential treatment which is associated with staff ideology.
Before 1918, the laws between provinces were dissimilar and in some cases, contrasting. This problem called for a conference with the intention of harmonizing the laws of the provinces and territories of Canada in 1918. This conference is now held annually in order to identify deficiencies, defects and gaps in existing law. The civil system which constitutes of lawyers, judges, analysts and law reformers meet to discuss possible areas in which provincial and territorial laws would benefit from harmonization. Uniform statutes are drafted by legislative counsel and effective immediately.
Critically speaking, the answer may not lie in trying to create a rigid, obstinate and objective legal system because human beings are multifaceted and complex. We are by nature subjective beings, and according to Niklas Luhmann, this awareness has allowed for the “personalization” of law to occur over time. This process takes into account environmental and individual factors and sees a need to move beyond this concept of a universal and uniform law. Niklas Luhmann’s concept is particularly useful to keep in mind as we enter a time when law and policy is being required to evolve to accommodate for lesbian, gay, bi-sexual and transgender individuals. The assimilation of transgender inmate’s into a prison setting which strictly accommodates toward heterosexual inmates and their values is no longer acceptable. What is needed is recognition of the diversity within institutions and the creation of policy with difference in mind.
Everything considered, it becomes open to discussion whether uniform law and policy are realities, as much as they may be aspirations.

For more information on the Uniform Law Conference of Canada, please visit their website at http://www.ulcc.ca/en/home/

The "Specialist's" Impacts

Commissioner’s Directive 800 number 36 has been established as a very discriminatory policy. There are a plethora of ways that this policy impacts individuals, and it is crucial to pinpoint these impacts in order to understand the ways in which this policy is oppressive. One way that this policy affects the incarcerated transgender person is the requirement that one person, a psychologist, decides the fate of the individual. I intend to show that putting the outcome of someone’s life in the hands of another person, who could undoubtedly be transphobic, is very risky, and ultimately discriminating.
As transgender individuals are one of the most stigmatized and oppressed groups it is crucial that as a society we ensure that the medical treatment received by transgender individuals is not lined with discrimination. Although, health care providers, being human, often carry the same bigoted viewpoints that the rest of society does. One story that made headlines was when a Catholic hospital refused breast implants to a transgender woman. (http://www.catholicnewsagency.com/new.php?n=11383). The surgical coordinator was quoted as saying, "it is against god’s will". This type of discrimination is faced daily by people not within the jail system; I can only imagine the type of oppression that is occurring within the jail walls.
Transgender individuals have to go through multiple levels of personal contact before receiving actual sex-reassignment surgery. If these transgender individuals are subject to one transphobic individual throughout the process, there is a distinct possibility that they will not be able to receive proper treatment. There are many debates over the ethical nature of the Harry Benjamin standard of care we previously discussed. "Some members of the transgender community are very critical . . . of the Standards of Care and take issue with the perceived need for someone other than themselves to decide whether they are eligible for sex reassignment (Bockting, 2004).
By picking through the many aspects of the Commissioner’s Directive 800 we have noted that there are many areas of the policy that need improvement, as this policy has a direct impact on the life of all incarcerated transgender individuals. The very fact that someone other than the transgender individual has control over the life choices of the individuals marks the policy as problematic. Due to the fact that we live in a world that discriminates against the transgender community we must ensure that the transgender community, as well as the incarcerated transgender community, can access proper health care without facing barriers at every step of the process.

References
BOCKTING, W. (., ROBINSON, B. (., BENNER, A. (., & SCHELTEMA, K. (. (2004). Patient satisfaction with transgender health services. Journal of Sex & Marital Therapy, 30(4), 277.

What Makes a Specialist?

In the Commissioner’s Directive 800 policy number 36 it states that a recognized gender identity specialist has to confirm that the offender has satisfied the real life test for a minimum of one year prior to incarceration. It also states that the recognized gender identity specialist then has to recommend surgery happen during incarceration. When looking at this our questions are what qualification do you need to be recognized as a gender identity specialist? And who decides within the prison system which specialist to use with transgendered inmates?

In order to get a favourable recommendation for SRS two different specialists have to agree. One of the specialists must possess a Masters Degree in a clinical behavioural science. The other must hold a doctoral degree (e.g., Ph.D., Ed.D., D.Sc., D.S.W., Psy.D., or M.D.). The specialists should also demonstrate competence in psychotherapy, sex theory and therapy. If you look closely at the requirements as to what defines a specialist, it uses the words should and competence, this leaves a lot of room for recommendations being made by health professionals who are not necessarily proficient in transgendered issues and who are not experts on SRS surgery. Also leaving people’s fate in the hands of someone who is competent and not an expert doesn’t not sound promising. A lot of room is also left for discrimination, since being aware and up to date on transgender matters is only a recommendation and not a requirement.

The potential for discrimination is even higher when we are talking about a transgendered inmate for three main reasons. First of all, the prison is most likely not going to use the same specialist that has been treating the person during their RLE. This means that whoever is making the recommendation will not have been through the transition with the individual and will not be able to truly judge their motivation or success. Second of all since the prison is the one hiring the specialist and it is not required that the specialists are experts in the field of SRS, they are more likely to hire who is available and who will compile with their value system instead of the specialist would have the best interest of the prisoner in mind. This could very easily lead to a transgender inmate being stuck with a transphobic doctor deciding their fate. Thirdly since again the specialist is being hired by the correctional system, they very well may be being paid for their unfavourable recommendation, since it is much cheaper for prisons to pay a “specialist” than to pay for the expenses related to surgery, i.e. transportation and medical attention during recovery.

Therefore the fate of transgendered inmates is placed in the hands of whomever the prison sees fit: qualified or not, bought or not, open minded or not.....
http://www.genderpsychology.org/transsexual/hbsoc_1990.html

Discriminatory and Unfair Influence of Policy

As evidenced in the previous blog, the policies that are designed to protect the transgendered inmate are flawed, and this gravely influences and shapes the transgender inmate experience in the institution.

The policy we have chosen questions what it means to have equal access to emergency health care in Canada. More specifically, minorities receive poorer health care and as a result, have poorer health outcomes. This is certainly true for the transgender inmate as they are less likely to receive certain surgical procedures. The question is not do disparities in health care exist for the transgender inmate but the challenge is in developing and implementing certain strategies to eliminate them. This needs to happen from the bottom up, as it is evident in the prison system that these discriminatory policies could be said to encourage and maintain indifference.

The psychological state of the transgender individual is in constant turmoil. Often, the transgendered individual is at a point where they are trying to establish a personal sense of identity. This is extremely difficult to accomplish in an institutional setting because you’re working with a system that fails to recognize you as an individual. This is evident as transgender inmates are prohibited from receiving their surgery and from obtaining necessary hormones to maintain their transition. They may experience permanent side effects from being unable to transition such as anxiety and suicidal tendencies. Depression is the leading mental health concern among the transgendered population. For more information on how depression specifically affects the transgendered person, visit: http://www.firelily.com/gender/gianna/depression.html
As we can see, it appears that the very notion of transgender is a psychological and medication problem. As a result, health care providers initially pathologize the transgender condition and in doing so place their mental illness as a secondary concern.

When transgender inmate is living with individuals they do not identify with, this creates an uncomfortable and dangerous situation. These inmates are neither sympathetic, now sensitive to their situation and may not agree to how they have chosen to live their life. Experiences often include sexual assault, brutality, threats and harassments. This may not only be coming from fellow inmates, but staff working in the institution also.

Transgender Policy: Discriminatory and Unfair

The laws which are created with the intention of “protecting” the transgender inmate are discriminatory, biased and unfair. Policy makers have inadvertently created a system which results in the production, maintenance and preservation of the ill treatment of the transgender individual. Moreover, it does this to such a large extent that it questions the intentions of policy makers to create a fair system to begin with. It is my intention to critically examine this law, in order to identify the various inadequacies that support its framework.
What I found to be chief contradictions and areas of discrimination were within the institutions obligation to deliver suitable health care to the transgender inmate. This policy specifically claims that all inmates have the right to health care and that staff members have an obligation to bring attention those inmates who appear to be ill in any way. Furthermore, emergency health care is a priority. In reality, we generally see this as applying to acute problems only. The distress transgender inmate’s faces are long lasting and constant. Inmate health care is flawed and will not support the transition of the transgender inmate regardless of the severity of distress. Inmates are unable to receive sex reassignment surgery and they are only granted hormone treatments if they request it, and make arrangements for the hormone to be sent to the hospital via a third party.
In some cases, the transgendered individual has lengthy sentences and although an inmate’s health care is subject to these considerations we do not see the process of transitioning as being a top priority. As a result, the denial or cession of a progressing transition causes exceptionally harmful psychological states.

Moreover, the transgender inmate faces further barriers when it comes to living arrangements. They are required to be placed in the institution based on their biological genitalia. This is unfair as you cannot create a uniform policy because the transgendered individual can be at a range of places on the transitioning continuum. For example, if they have partly transitioned, they may still have their biological gender; however, may look, speak and resemble the opposite gender due to extensive hormone use. It is dangerous to place these individuals with fellow inmates with whom they do not identify or classify as there same gender. To comprehend the unique problems faced by a transgender individual when entering this environment, please read the story of Kalani Key, a women’s story of survival in a male prison.
http://www.alternet.org/rights/69173/