On 19 June 2018, the World Health Organisation (WHO) released the eleventh revision of the International Classification of Diseases (ICD-11) which includes the long overdue removal of all trans-related diagnoses from the mental disorders chapter. This is a historic milestone towards depathologisation or the declassification of trans identities as a medical condition and eliminating stigma, discrimination and barriers to fundamental human rights, including rights to self-determination and right to health.
Gender incongruence, which is “characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex,” is now reclassified under sexual health conditions in the ICD-11.
The classification of trans identities as a mental health disorder have not only adversely contributed to an inaccurate and discriminatory perception of trans people, but also multiple forms of violence, humiliating and dehumanizing experiences, denial of rights, and efforts to ‘correct’ trans people. In Malaysia, for example, multiple state-funded efforts that aim to correct and rehabilitate transgender persons and school children based on gender expressions have been introduced since 2010. Additionally, the return to the right path or ‘balik ke pangkal jalan’ rhetoric adds multiple forms of pressure and burden on trans persons to ‘change’, which causes psychological and emotional harm, among others.
This significant revision provides further evidence that trans identities are not a form of mental disorder, and should signal the revision of harmful and non-evidence based policies and laws that criminalize transgender persons, as well as the reversal of discriminatory practices.
The classification of trans-related diagnosis as a sexual health condition implies that all treatment of trans-related conditions must be treated with evidence based medical approaches. We urge the Ministry of Health and other relevant government agencies to study the ICD-11 in order to ensure that state policies, especially public health policies are in accordance with current medical and scientific understanding, standards and ethics of good medical practice as well as standards of human rights.
We also urge the newly instated Malaysian government to engage transgender persons and human rights groups to address the discrimination and marginalisation faced by transgender persons. Consistent with the objectives of the ICD-11 to eliminate barriers and meet the healthcare needs of transgender persons, we also urge the Ministry of Health to introduce trans-specific healthcare services as well as improve overall access to healthcare for trans people. This necessitates the removal of barriers that trans people face in accessing healthcare, including stigma and discrimination in healthcare settings, the inaccessibility of legal gender recognition and the lack of expertise of healthcare workers.