A ground-breaking report just released by Waikato University shows that transgender and non-binary people in New Zealand experience alarmingly high levels of psychological distress, suicidal thoughts and suicide attempts.
They also face high levels of discrimination and violence, as well as significant barriers when trying to access health services.
The Counting Ourselves report is an in-depth survey of 1178 trans and non-binary people aged from 14 to 83.
The report's principal investigator Dr Jaimie Veale and research officer Jack Byrne told TVNZ1’s Breakfast that high levels of discrimination cause extreme disadvantage.
"It's mental health awareness week and so the timing is so important - this is such an important issue for our communities," said Ms Veale.
Mr Byrne said trans and non-binary people also experienced very high rates of cyber bullying.
"In every part of a person's life, it's not being recognised for who you are, people mocking who you are, people not giving you a job."
He said in the transgender community there are high levels of low-income and unemployment.
"More than half of our participants hadn't told anybody in their workplace that they are trans or non-binary so that just reflects that so many of us are just not feeling comfortable, for whatever reason, to actually be who we are," Ms Veale says.
Participants were asked about their school, family and work life, physical and mental health including access to gender-affirming healthcare, experiences of discrimination and violence, and the support they received in their life.
Almost a third of participants reported that someone had sex with them against their will since they were 13. This is more than four times the rate of this sexual violence in the general population.
In the last 12 months, participants were more than twice as likely to have experienced discrimination than the general population.
Discrimination and violence are known to cause chronically high levels of mental health problems amongst marginalised groups.
In the last 12 months, more than half of the participants had seriously thought about attempting suicide, and 12 per cent had made a suicide attempt.
Trans and non-binary people across the country also struggle to access healthcare.
The study found high levels of unmet need for all forms of gender-affirming care, such as hormones, counselling or surgeries.
The report calls for measures to improve the wellbeing of transgender and non-binary people, such as creating better laws, policies and training to protect them from discrimination and violence; providing clear pathways for gender-affirming healthcare in each District Health Board; naming trans and non-binary people as a priority in mental health policies; and supporting schools to be safe and inclusive for trans and non-binary students.