From crisis to silence: systemic failures in mental healthcare for transgender and gender diverse people in Ontario

Transgender and gender diverse individuals face significant institutional harms in in-patient psychiatric care, leading to high rates of care avoidance and poor post-discharge follow-up. Our mixed methods study found that experiences of misgendering, lack of affirming resources and structural marginalization contribute to disengagement from mental health supports after hospitalization. Integrating qualitative insights with population-based data revealed that current practices fall short of Ontario’s own gender-affirming care standards. Policy efforts must move beyond broad principles to mandate concrete, measurable actions that ensure continuity, safety and affirmation across the full spectrum of mental healthcare.