In the last year, there has been an unfortunate tide of transgender individuals taking their lives, some of these individuals have been quiet members of our communities and others have been visible prominent activists. Suicide and the emptiness it leaves behind for any community is hard to grapple with and often leaves more questions than answers. Transgender youth and adults experiencing discrimination and prejudice when seeking employment, adequate housing, education, proper medical care, or just simply, affirmation is not easy for anyone who is isolated or may feel alone. For transgender youth and adults these experiences are often compounded by the fact that they are misunderstood by society and misguided through a healthcare system riddled with stigma and anti-transgender biases. Sadly, given this reality, some transgender youth and adults have either attempted or completed suicide as a means to quell whatever pain, affliction, or guilt they might feel.
 
Recent health reports from the American Association of Suicidology indicate that just about 1.6% of the general population have attempted suicide in their lifetime. The National Center for Transgender Equality, along with the National Gay and Lesbian Task Force, surveyed 6,456 transgender and gender nonconforming people and found 41% of the participants reported attempting suicide. Also, rates increased if the individual experienced a job loss due to bias, harassment or bullying in school, lower socioeconomic statuses, and sexual or physical assault. These findings reveal evidence that suicidal ideation and suicide attempts among transgender individuals across the nation are considerably higher than those of the non-transgender population.

Transgender suicidality is a major public health concern, yet is often invisible. Though the research is scant, existing studies continue to report poorer health outcomes for transgender people, including higher rates of HIV infection, rejection from family members, substance use, and denial of medical and mental health services. Policy makers, community activists, legal advocates, and healthcare providers should consider working to enhance existing resources by increasing public awareness of transgender issues and modeling a culture of acceptance, support, and affirmation of transgender youth, adults, and their families. Additionally, transgender suicide prevention must become a key component of the transgender healthcare agenda.
 
In 2008, the Massachusetts Transgender Suicide Prevention Working Group (MTSPW) was formed to promote safer and inclusive communities for transgender people by bringing awareness and education to the issue of suicide among the transgender population. MTSPW is a collaboration of the MA Department of Public Health Suicide Prevention Program, the Massachusetts Transgender Political Coalition, Fenway Health, Samaritans, Inc., and the Justice Resource Institute's Health Division. Past projects include developing suicide prevention education brochures and video vignettes for providers and the community, adapting transgender-specific suicide prevention training curriculum, and training for providers and the community on how to create safe and welcoming spaces for transgender people.

 In acknowledging World Suicide Prevention Day, held on September 10th this year, MTSPW will focus their efforts this year on bring visibility to the issue of suicide in transgender communities and particularly suicide prevention and intervention among transgender community leaders and activists, as well transgender youth and resources critical to their needs.
 
Coping with discrimination, bias, exclusion, and isolation seem all too relevant for transgender youth and adults, especially for transgender people of color. There is an epidemic of anti-transgender violence and victimization due to societal bias and exclusion, which may perpetuate feelings of isolation and possibly increase suicidal ideation. Public health efforts should remain vigilant in supporting increased awareness and affirmative care for the transgender community, ensuring those affected receive timely access to care and much needed interventions.

For more information about MTSPW email alison.brill@state.ma.us, for suicide prevention resources please visit www.masstpc.org/suicideprevention and for immediate support contact Samaritan's State Wide Toll-Free: 877-870-HOPE or The Trevor Youth Lifeline at 1-866-488-7386.