2SLGBTQI communities’ connection to healthcare in Canada is a crucial and evolving topic. Despite Canada’s universal healthcare system, 2SLGBTQI individuals encounter significant challenges, particularly in accessing mental health and gender-affirming care. High rates of anxiety and depression are prevalent among 2SLGBTQI individuals, with many delaying their care due to affordability issues, fear of discrimination, fear of being outed, or concerns about being treated disrespectfully. This fear can result in delayed diagnoses, non-compliance with medical recommendations, or neglect of healthcare needs. For racialized 2SLGBTQI individuals, these experiences are compounded by racist assumptions and biases within the healthcare system, leading to further feelings of frustration, lack of safety, and uncertainty.

The pandemic also magnified previously known barriers to mental healthcare access, such as a lack of available and competent providers or de-prioritizing healthcare services such as gender affirming care.  As in many parts of the world, 2SLGBTQI people in Canada face unique healthcare challenges, which are influenced by both systemic issues and specific needs related to their identities. As a result, the mental healthcare system continues to create unsafe and exclusionary spaces for 2SLGBTQI individuals, particularly for trans and nonbinary individuals. 

Trans and gender-diverse individuals face additional challenges, including long wait times, inconsistent coverage, and a lack of knowledgeable providers for gender-affirming care.  The lack of knowledgeable healthcare providers further complicates access to necessary care, often resulting in suboptimal treatment or a lack of understanding regarding their needs. These barriers lead to emotional distress and unmet healthcare needs for 2SLGBTQI individuals.

Access issues are particularly pronounced for rural and older 2SLGBTQI individuals. Those living in rural areas face additional challenges due to travel distances and limited healthcare infrastructure. Older 2SLGBTQI adults often encounter hostile providers and a lack of 2SLGBTQI-friendly healthcare spaces. The need to travel to urban centers for care further limits their ability to access healthcare at the frequency needed. Continue reading to further explore how 2SLGBTQI experiences intersect with healthcare and mental health work in Canada.

How Healthcare in Canada, Explained

Healthcare in Canada operates under a publicly funded, universal system called Medicare (Government of Canada, 2023). Medicare ensures that all Canadian citizens and permanent residents have access to medically necessary services regardless of their income or geography, as outlined in Canada’s Health Act (1984) (Government of Canada, 2023).

Healthcare is primarily the responsibility of provincial and territorial governments, with the federal government providing funding through taxation (Government of Canada, 2023). Services such as doctor visits, hospital stays, surgeries, and diagnostic tests are covered, though some services such as prescription drugs, dental care, and vision care may vary by province and age-demographic. Individuals in Canada typically access healthcare through their family doctor for general health and preventive care, with referrals to specialists as needed. Emergency care is also covered, with some provinces regulating non-emergency services like ambulance costs.

Mental healthcare is severely underfunded and is not engrained in Canada’s universal healthcare system. Unlike other medical services available to citizens and permanent residents free of charge, a significant financial barrier exists for many individuals in Canada to access mental healthcare (Government of Canada, 2024).

The Canadian healthcare system is also reeling from under-funding and strain from the COVID-19 pandemic (Tasker, 2022). Many hospitals across the country are at over-capacity, lack trained personnel, face extreme delays for surgeries and procedures, coupled with an increased need for mental health related services. At this time, the Canadian healthcare system is facing a crisis (Tasker, 2022).

Egale Canada’s Health-Related Research

• Healthcare access experiences and needs among LBQ women, trans, and nonbinary people in Canada: A research report
• Queering Mental Health Supports in Canada: Priorities for Research, Policy & Practice
• Aging with Affirmation: An Exploration of the Healthcare and Social Service Experiences and Needs of Transgender and Gender-Diverse Older Adults in Canada

Quick Facts

• 82% of 2SLGBTQI individuals surveyed frequently feel nervous, on edge, or anxious, while 71% frequently were depressed, felt down, or hopeless (Seida, 2023).
• 61.5% of respondents delayed their mental healthcare due to reasons around affordability (Seida, 2023).
• 50.6% of 2SLGBTQI individuals during the COVID-19 pandemic did not receive the mental health supports that they needed (Seida, 2023).
• 2SLGBTQI individuals may avoid medical visits due to past negative experiences, fears of being outed or misunderstood, discrimination or stigma when accessing care, or concerns that they will be treated disrespectfully (Seida, 2023).
• Long wait times, particularly for trans and nonbinary individuals, causes great emotional distress (Wells et al., 2024).
• Many healthcare providers lack training on 2SLGBTQI health issues, leading to misinformed or inappropriate care (Seida, 2023).
• As healthcare is often provided in urban centres, for older 2SLGBTQI individuals living in rural communities, travelling to an urban centre further limits an individual’s ability to access care or at the frequency needed (Jakubiec et al., 2023; Pang and Maclennan, 2023).
• 29% of sex workers do not have access to the health services they needed. For individuals experiencing sexual or physical violence, 31% of sex workers reported barriers to accessing counselling, which rose to 64% during the COVID-19 pandemic. For trans and nonbinary sex workers, 39% of individuals report being denied healthcare due to their identity, while 20% avoided emergency rooms out of fear of discrimination (Argento et al., 2020).