Trans Lifeline: Naming Trans-Specific Harm in Mental Health

Interim Hotline Manager Jahmil Roberts and Advocacy Director Yana Calou from the Trans Lifeline work towards connecting trans people to the community support and resources they need to survive and thrive. Trans Lifeline is a grassroots hotline and microgrants 501(c)(3) non-profit organization offering direct emotional and financial support to trans people in crisis – for the trans community, by the trans community. Their hotline is a peer support phone service run by trans people for trans and questioning peers and does not contact police without consent. The Cops out of Crisis initiative, which you can learn more about here, does advocacy work based on the negative impact of non-consensual law enforcement intervention and forced hospitalization on those in marginalized populations. The Trans Lifeline envisions a world where trans people have the connection, economic security, and care everyone needs and deserves – free of prisons and police.

This is the third and final interview in a series of conversations being conducted around the issue of hotline tracing and intervention. The first interview was with Vanessa Green, founder of Call BlackLine and the second was with Sera Davidow from The Wildflower Peer Support Line. It is part of Mad in America’s Suicide Hotline Transparency Project, which was born out of the belief that creating transparency and public access around suicide hotline intervention and call-tracing policies should be a priority. This project includes a directory of lines that do not trace or intervene without consent, a public poll, survivor interviews, and an open call for art. Please visit the project page to find out how you can participate.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Karin Jervert: I’m excited to be interviewing Yana Calou and Jahmil Roberts from the Trans Lifeline. How about you both introduce yourselves?

Jahmil Roberts: My name is Jahmil Roberts. I don’t use any pronouns, and I’m a Black queer person. I am existing on the gender spectrum. I’m currently serving as the interim hotline manager at Trans Lifeline, and my work is to build practices of connection. My goal is to shift the ways that we approach peer support by centering the relationships that we build through the services that we provide. Through this lens we’re able to focus on how people relate to one another, and gather for work and sharing purpose, and by encouraging analysis and curiosity while building trust. We encourage one another to create language and to name and address the impacts of systemic harm and to nurture individual and collective growth and healing.

Karin Jervert: Thank you for being here with us today. Yana, can you introduce yourself?

Yana Calou: Karin, thank you so much for having us and for this important work. My name is Yana Calou and I use they/them pronouns. I’m an organizer and storyteller. I’m currently launching a campaign to get Cops Out Of Crisis Calls as the Director of Advocacy at Trans Lifeline. I identify as a non-binary Brazilian-American person. My work right now is really focused on centering lived experiences and survivors in abolitionist organizing, healing, and peer support.

In terms of my background, I just want to say that I’m really grateful for the mentorship and learning that I’ve received in queer studies and labor and economic racial justice movements, in media justice movements, and [the ability] to bring those perspectives to my work as well as outside of work. Another piece of what I do is I co-facilitate a psychedelic peer support integration circle for trans and non-binary people.

Jervert: I am excited to have you two because this work is justice work. Tell us a bit about how you arrived at the work you’re doing in the community and how you came to be leaders in this kind of peer support.

Roberts:  For me, this work is very personal. At the beginning, but even throughout my journey, it was a process of shifting my relationship to what I defined as work. Sometimes experiencing the world as a black and queer, a visibly queer person, sometimes it can feel like a punishment. In some ways, the work that I was accessing was aligned with the access blocks that I felt like I was experiencing.

A lot of what shifted was my relationships to work and querying my definition of what was valid work to me – what was labor. I began to look into what care work is, what is the labor [of that]. A lot of the care work that is happening, and the necessity of it, doesn’t get honored.

Aside from that, I was able to access my own [definition of work], and I would say [I was able] to support people through really holding a conversation with them. Through that moment, for myself, I found Trans Lifeline and it was a super aligned moment for me. I applied to this organization on my birthday, actually. I applied as an operator and navigated through a lot of  the space within the organization.

What we do honors the gifts that I can bring into the work and I am really able to offer the care that I have because of the way we treat the work that we do and the impact that it has on the people that we touch. It’s been a process of constantly honoring that, and now I find myself here and talking to you about it.

Jervert: That’s wonderful. You started out as a hotline operator for the Trans Lifeline?

Roberts: I did. It was back in 2020. That was mid-pandemic and I saw the need and I responded to it. I also met it with my own need for something that was more fulfilling. That was also a thing that I wanted to do, to have work that felt good to me, with people that I cared about, and doing something that I cared about. That was something that I really personally needed because I was really losing my grasp on what it meant to work without the care aspect of it.

I have a hard time holding things that don’t make sense to me anymore. Mid-pandemic, I really needed to work in some way that wasn’t going to create a harder time for myself and I faced some of the hard times that we were having with a lot of space to navigate through them, through this work with people.

Jervert: Yana, how about you? How did you come to being a leader in this area and in peer support?

Calou: Thanks. Jahmil, it was so nice to hear about your story coming in [to Trans Lifeline] that I hadn’t heard before. For me, I joined Trans Lifeline as the Communications Director after  having a pretty accidental career of being a Communications Director for about 10 years. I came to that work in gender and queer justice movements in the early 2000s when the country was passing a lot of anti-gay [bills] and not even including trans folks, marriage amendments, and  I had just come through being a student in gender studies and really learning about how the structures of marriage were really harmful to queer folks, trans folks, folks of color, women.  Then I was put into this movement where it was actually just focused on that and having some real conflict about what I was actually fighting for, for my people.

I was really fortunate to have a lot of mentorship around teaching organizers and activists. Learning myself and then teaching other folks about how to share their stories. Having trans stories told by trans people was a really important part of that communications work. But a lot of my work in those early days was really about sanitizing movement language and saying, “Oh, we’re saying marriage for loving and committed couples, not gay marriage.” Because that grosses people out. It was really about being really respectable in terms of the ways we talked about this. So some of my first work in this area was really not aligned with the ways that I think about what we want and our whole lives. Coming to Trans Lifeline 20 years later was really important to me to be in an organization that is really critical of the structures and systems for structural and economic support for our community.

In my personal life, having gone through a lot of the crises and challenges that a lot of our callers go through, knowing the importance of support outside of the systems that really harm people is really important. This is what brought me to my work that is abolitionist in terms of police and prisons, and also for psychiatric treatment.

Having the experience of using 911 and police when my father was unwell and being personally responsible for him being involuntarily held and committed in a psychiatric hospital, really let me understand the ways that the systems we have for support in those times are hurting people.  They’re not helping people and being really angry –that is all we had. That wasn’t helpful. That’s what makes the work that I’m currently doing feel really important and touches on my life.

Jervert: You had mentioned before about the Trans Lifeline Cops Out Of Crisis project. You are heading up this advocacy project. Can you to talk a bit about this experience that people have of calling these hotlines and the interventions that happen, this non- consensual psychiatry that often ends up being the case for so many.

Calou: The Cops Out Of Crisis Calls Campaign came from the years of providing community based crisis support, as Jahmil does, without police or involuntary hospitalization. When we say we don’t use 911 or police on our line, it’s not just because we understand the way police violence and criminalization hurt people. They do, that’s true. But we’re also not saying that we think a medical model is necessarily what folks need either. Or that involuntary hospitalization is the answer to no cops. It’s actually being critical of both of those systems.

The need for this campaign arose from needing to have more dialogue amongst our peers, other hotlines, about the harm that is caused to people in crises. Particularly the harm that is faced in having police intervention and forced hospitalization for those who are trans, those who are under 18, those who are neuroatypical or living with disabilities, and those who are black and indigenous and folks of color.

We also know that those kinds of interventions don’t get to the cause of these crises, and they often exacerbate them. We are launching this at a time when crisis hotlines are touted as alternatives to calling police and there is more public awareness, because of the work of black organizers, of the harm that police cause to communities. Crisis lines are often shown as alternatives to calling police. But what many people don’t know is that most national hotlines and technology services use geo-locating surveillance to engage local police often without caller’s knowledge or consent, and police or emergency medical teams are going to arrive at their school or at their jobs or their homes. This results in hundreds of thousands of police interactions and involuntary hospitalizations of people in crises each year. Unfortunately, particularly with involuntary hospitalization, emergency room visits, psychiatric holds, we’ve seen that our suicide rate in this country keeps growing as we increase these kinds of interventions. Most people don’t know that suicide attempts increase after having forced treatment.

The systems that we have in place to support people are not helping people. One of the things that our campaign is trying to do, aside from educating other crisis services and hotlines about the necessity of community-based alternatives to police and hospitals, and advocating for real upfront transparency on hotlines so callers know what to expect, is we want to reduce the harm of that. Trans Lifeline is one of several kinds of alternative systems of providing peer support and crisis care to people that doesn’t engage these more harmful systems.

Jervert: People just don’t seem to understand the scope of this and the kind of harm that’s being done. Jahmil, any additional thoughts about the Cops Out Of Crisis program?

Roberts: I don’t think I necessarily have anything to add, it’s perfect timing, especially to focus on what it means to support someone? It draws some attention to how non-consensual interactions with these systems can [be harmful] and can give us a lot more information to move with so that we as a collective can start to choose options for ourselves that honor our own agency.

Jervert: Can you speak a bit more about the services of the Trans Lifeline?

Calou: We are best known for our peer support hotline that is created by, run by, and for trans people without the non-consensual police intervention that we’ve spoken about. We also offer many other programs. One thing that is unique about our Lifeline is that when you call Trans Lifeline you will always be speaking with another person who identifies as trans and non-binary. For many people calling us, this can be the first other trans person they’ve ever spoken with, so that peer aspect of being able to connect with someone who’s trans life is possible can be really, really helpful, and prevent crises from happening in the first place.

We offer our hotline in English, also in Spanish for monolingual Spanish speakers, and we also offer a family and friends service for folks who are supporting a trans person in crisis as well.

The other big pillar of our work comes from our micro-grants department, which recognizes that sometimes the best crisis support you can receive is economic support. This program is based in mutual aid and puts money directly in the hands of trans people for several needs, like folks who need to change their name and gender marker legally on their identifying documents.

We also provide commissary grants, and post-release micro-grants for trans people who have been incarcerated or detained. That’s some of the economic redistribution work that we do in the micro-grants program. Then certainly, the Cops Out Of Crisis campaign and our advocacy department is our first foray out of just providing those services, and into the advocacy space that extends beyond just trans folks. We believe the self-determination and agency that Jahmil was talking about is important for all people in crisis.

Jervert: Jahmil, how about your personal philosophy around caring for community members who are experiencing crisis?

Roberts: I am centered around empathy as a practice. I want to contextualize that by saying that I read a book about empathy that went through an etymological history of that word. The middle section focused on how empathy was used in psychology and psychotherapy. There was, at first some, some crude test that was used for diagnosis based on a scale of empathy. It was a measure of how much a practitioner could empathize with a client. The more that you could empathize with a person, in this particular context empathize meaning understand what they were going through, the more saint[ly] that they were.

But then that’s also where a lot of social implications come into play. A lot of these practitioners were cisgendered, heterosexual, white men, especially during the time which was post World War I and before World War II, during the time when a lot of morality that gets conflated into [these] identity markers. When I say the test was crude it’s really an understatement.

But there’s a part that goes beyond that in this book. There’s a woman researcher that says maybe we could look at this differently. She works with children specifically who are known to be unruly or have unruly behavior. Her method is to empathize with them by giving them the space to experience their experience, and to be the leader of gathering this information for themselves, to see what it means to access someone’s agency and then empower them to start to name their reality and navigate through it in a more competent way, in a more agent way.

That’s what we try to access in the work that we do. It is to allow people who are in crisis or who appear rather to be in crisis, the opportunity to access their own agency and decide where to go next for themselves in a way that they think would be best.

Jervert: So little of psychiatry is organized around anything close to this kind of care, empathy, and empowerment. It’s the opposite, in so many ways. The next question I have for you both is what are the challenges of your work? What stops you from doing this work?

Roberts: That’s a really lovely question. The challenges that can be named inside of the work, in larger picture ways, is the general undervaluing of care work and what it means to do care work,  what the cost is, what the labor of care work is. Some of what can make it difficult is experiencing some of that devaluing, and still offering this to the community and that contributing to how we experience our own capacities as people who do this work.  Also experiencing our own lives while doing this work. I got hired through the pandemic, and we’ve been doing this work throughout the pandemic.

There’s not been a moment that we have taken a set amount of time away from it at all. It’s   being inside of ongoing and continuous work. In some ways, constantly gathering the capacity to continue to do the work can be a real balancing act. Then there can be some perspective shifts that happen inside of supporting people where it’s important to hold boundaries and sometimes to humanize yourself as not just a fixture of peer support or a person who’s holding this experience in order to support someone else who’s holding their experience.

What does it mean to not just be a vessel of support, but to embody connecting with someone in a supportive way? That is not so much an exchange, but it is a collective and collaborative effort, and those are the things that are sometimes hard to grasp instead of a lot of other ways that we as a collective, as a society, think about or approach asking for support or offering support.

Jervert: Yana, how can listeners support your work, specifically the Trans Lifeline, but also the Cops Out Of Crisis?

Calou: First, you can donate to our work. When we talk about defunding police as crisis responders, we are talking about funding alternatives like a hotline and Jahmil’s work, so donating to Trans Lifeline is a way that you can support people being able to access this care.

You can join our campaign email lists. If you identify as trans or non-binary person, you can apply to volunteer as an operator with our line and provide that care and learn how to do community-based care without police or involuntary hospitalization.

Jervert: Jahmil, any additions to that?

Roberts: If you are a person who can provide peer support to people within community, definitely sign up to be a volunteer when those applications open. That would definitely be lovely.

Jervert: We’ve been talking about the impact of oppression, bigotry, bias, and stigma on people in suicidal distress. How it can be ignored or denied by the framework of psychiatry that is powerful now. And how lines like the Trans Lifeline are working so hard towards interrupting the cycle of abusive care towards trans people, Black people, Indigenous people, and people of color. All sorts of people are experiencing that abusive care and your line acts as a way of stopping that cycle from being activated, which can save lives.

Calou: One, it’s just important to name the history of psychiatry and psychology and pathologizing queer and trans people, black people, women, poor people, and the role of  individual responsibility that those kinds of systems create. The dialogue that’s happening now around breaking down the stigma of mental health that hides the root causes of crises, that are crises caused by colonization, racism, and capitalism. These are actually the crises that we’re dealing with. Just having more of same day-next day outpatient slots and having more beds open isn’t going to support somebody who doesn’t have a safe home to sleep in, or a school where they can even go to the bathroom .

I want to name the underlying piece that we haven’t directly gotten to. I would like to share the ways that behavioral health models of care maintain who is considered in the norm and then causing harm for those forced to the margins. Part of this is explaining what are the trans-specific impacts of these kinds of things.

Sometimes when these interventions happen in forced ways it can out trans youth to unsupportive parents. Trans folks are less likely to have health insurance because of the ways that we are discriminated against in employment and our unemployment rates are very high because of this. Having huge ambulance and hospital bills when we know that financial instability is a top suicide indicator is harmful to our community. We know that for trans people that involuntary psychiatric holds have been used to deny informed consent for life saving trans care like hormone replacement therapy, or gender confirming surgeries.

We know that trans folks are misdiagnosed and mis-medicated when the issue is gender dysphoria and the oppression that comes along with being trans. And we can be forcibly medicated while actually denied trans-specific medications at the same time, or put in the wrong gender units in psych facilities, in jails, in prisons were we are more likely to be sexually and physically assaulted. We’re also not allowed access to trans healthcare while incarcerated, not just in hospitals.

Undocumented trans people can be sent to detention centers indefinitely when they’re coming to the US for asylum due to threats on their lives because they are trans. In the US this is what we’re doing. Certainly, we see the criminalization of sex work and substance use in our community because of transphobia, and a lack of access to traditional employment. There’s a long history of a lack of trans competency in mental health, in domestic violence services and in medical services. So we see people who are trans being put in involuntary holds across all kinds of detention, psychiatric and carceral detention systems – they’re all carceral. So, people are being put in solitary for their own  “protection” just because they’re trans.

It’s important that people know some of the trans-specific harms that happen. What we really need is [to be able to] trust that when we’re calling for help, that the help we get isn’t going to make our crises worse. We need to recognize that the crises we’re experiencing are racism and capitalism and colonialism. We need to realize that economic redistribution will actually prevent so many crises that one therapy appointment isn’t going to help you get the financial stability that you need. We need to really think about how we can fund and proliferate peer support systems of care and keep funding and exploring these alternatives outside of state systems and behavioral health interventions.

For me, a huge part of my work is helping make folks aware that forced medicalization doesn’t actually keep people safe or saves lives as the suicide prevention language would have us think.

Roberts: Because of what Yana was saying, we don’t get the opportunity to get to the root of the issue the person is experiencing.  When we do peer support work, our first goal is to listen to the caller, and let them be the leader and to tell us what they need, and then make a plan with them so those needs are met, and not just so they feel better with these unmet needs.

A part of this is allowing people to access their own power. Through agency and embodying  what it means to experience consent as others [marginalized people]. What does it mean to offer that to someone? Also what does it mean to exist in a caring way with someone that you don’t know personally? That is also what our work tends to be. It is not just caring for people we know, but also inside the anonymity of it.

We offer harm reduction strategies, so that is specific to certain experiences, but we can approach it and work backwards from where you’re at, listen to you and ground together so  we’re not adding to the harm that people are experiencing.

We take that analysis and then the question is how can we lessen what’s going on? It’s just being inside of it with the person in a way that is, of course, boundaried, but in a way that creates more space and more safety so we can navigate with more clarity as people who are receiving this type of support. I think that’s so important.

Jervert: The experience of care in a modern psychiatry paradigm is always ignoring oppression. And to the point of saying “let’s just get back to you being okay with this oppression.” It’s impossible to wrap my head around how we’ve decided that this is what works, when it is absolutely not what works. Like Yana was saying, it causes this enormous amount of harm, and increases so much pain and suffering among all people.

Roberts: I really agree with that, thank you for bringing that into this space. I was going to add, a lot of what you’re naming is why it’s important to also see this work as justice work.

Jervert: Last question. What would you want listeners to know about providing community support on your hotline?

Roberts: On an individual basis, when we’re supporting people, we access their individual lives and those individual needs, and we create those individual plans with them. That is the connection part that comes with caring for another person. In this moment, can we exist inside of this time and this space with another person to amplify their access to resources?

It can be iterated differently in the work that Yana is doing, where the question is “how can we exist with these people to amplify their access to awareness?” How many people are aware of this thing? How do we access our own power and add it to somebody else’s?

Jervert: Thank you both  for being here with me today. This was a great conversation, and our listeners are going to learn a lot. Good luck with this work and I hope you get all the support that you need.