South African mental health workers’ knowledge and attitudes to trans and gender-diverse people

Abstract

Background: Transgender and gender-diverse (TGD) individuals experience higher rates of mental illness compared to cisgender populations. Accessing appropriate care remains challenging because of discrimination and a lack of provider knowledge. There is limited evidence exploring mental health worker views in a local setting.
Aim: This study aimed to explore knowledge and attitudes of South African mental health workers in specialised psychiatric settings towards TGD people.
Setting: This study was conducted at two specialist tertiary psychiatric hospitals in Johannesburg.
Methods: A cross-sectional descriptive study utilising the Transgender Knowledge, Attitudes, and Beliefs (T-KAB) scale was conducted among 150 mental health workers. Information on socio-demographic features, professional characteristics, and work experience was collected and analysed in relation to T-KAB scores.
Results: Participants demonstrated moderately favourable attitudes with a mean T-KAB score of 2.81/4.00. Professional category significantly influenced attitudes, with psychologists followed by medical doctors scoring the highest, and nurses and social workers scoring lowest. Age, sexual orientation, and religious affiliation were significantly associated with T-KAB scores, while years of practice, previous training in TGD-related care, and prior exposure to TGD patients showed no associations.
Conclusion: Mental health professionals in South African psychiatric hospitals hold moderately positive attitudes towards TGD individuals, with significant variations across professional categories. Prior training and clinical exposure were not associated with attitudes.
Contribution: This study provides one of the first assessments of mental health worker attitudes towards TGD individuals in an African setting. Nurses constitute the majority of the workforce and demonstrate less favourable attitudes, which has implications for approaches to improve transgender-affirming mental healthcare in this setting.