Case 4 - Ibrahim
Ibrahim is 19 years old and was assigned female at birth. He fled Saudi Arabia, seeking asylum in the UK having started using testosterone on the black market. He has come to see you with feelings of hopelessness, particularly around his gender identity. He feels his mental health worsened since telling his parents back home six months ago that he is a trans man. They believe this is sinful and continue to use feminine pronouns and his previous name. His sleep and appetite are poor, with early morning waking.
He appears tired but well kempt. His eye contact is intermittent, speech a little sluggish and affect flat. Thoughts are negative and fleetingly of suicide, but he is adamant that in his religion this is forbidden, and he has no intention of acting on his thoughts. He is not distracted or agitated, and there is no evidence of psychosis.
He would like your help, and to be referred to a GIC (Gender Identity Clinic) for further support with medical intervention. Do you:
Suggest he stop testosterone and focus on stabilising his mood
Incorrect
Explain that before a GIC referral can be made it is important that his parents are on board with his transition and accepting of his gender identity
Incorrect
He has depression which is likely to be linked to the distress his parents are creating around his gender identity. Suggest a mental health management plan and make a simultaneous referral to the GIC
Correct
Refer him directly to the CMHT for crisis intervention
Incorrect