The call came too late.
About 15 hours earlier, Bridget Flack’s family had launched a frantic search to find the 28-year-old transgender woman, who had gone missing.
The person at the other end of the phone told Flack’s sister, Angela Pucci Love, that there was an inpatient bed available at a private mental health clinic, which had been sought for weeks.
Pucci Love wishes that call had come in sooner.
“[Bridget] could have been taken care of, she would have got the help she knew she needed and wanted,” Pucci Love says.
Three years after Flack’s death, an inquest at the Melbourne coroner’s court this week examined her suspected suicide and those of four other transgender women who died between 2020 and 2021. Some – but not all – of those women, aged between 18 and 33, knew each other.
The three-day inquest focused on the challenges in accessing already stretched mental health services as a transgender or gender diverse person who belongs to a cohort who experience higher risks of mental health issues, suicide and self-harm.
Each of the women had a history of mental health issues and at least one current mental health diagnosis.
In Flack’s case, she spent the weeks before her death calling private hospitals seeking a mental health admission after receiving a GP referral.
The struggle to access support
Pucci Love told the inquest that Flack – who first told her she was affirming her gender as female in 2019 – seemed “happier in herself as Bridget.”
But as Melbourne spent swathes of 2020 in Covid lockdowns, Flack struggled with her mental health and the loss of her rich extracurricular life. She couldn’t DJ at events. She couldn’t attend union protests. Gone was her involvement with community support groups.
So Flack, who previously had a negative experience during a stint in the public mental health system, reached out to friends, online forums and other LGBTIQ+ people to seek recommendations to inpatient providers, the inquest heard.
“She had felt incredibly unsafe in those [public hospitals] as a transgender woman,” Pucci Love says.
She told the inquest Flack came across as “very articulate” when she reached out to private providers, which may have affected how they assessed her level of risk.
On 30 November 2020 Flack told a friend she was going to take a walk. She never returned home.
The Victorian government has noted increased demand on mental health services since 2020, with months-long waiting lists just for an appointment with a psychiatrist.
But experts say the issue is more acute for transgender and gender diverse people, the inquest heard.
A panel of health experts and representatives from LGBTIQ+ organisations told coroner Ingrid Giles that mainstream mental health services do not understand the heightened suicide risk that transgender and gender diverse people face due to discrimination.
They also flagged a period of vulnerability, between the point of deciding to affirm their gender and receiving this care, due to long waitlists. Some experts, including Vic Harden, the transgender and gender diverse health lead at Thorne Harbour Health, told the inquest they want more GPs providing gender-affirmation care, such as hormone therapy.
GPs currently can prescribe hormones, with 152 receiving training on “affirming care” by one community health service since 2019.
Dr Tram Nguyen, a psychiatrist at the Royal Children’s Hospital’s gender service, told the inquest about barriers for some GPs, including that one of Australia’s largest medical insurers this year ceased coverage to private practitioners prescribing this treatment for adolescents.
No clinician who treated the five women gave evidence during this week’s hearings.
But Prof Jeffrey Zajac, who leads Austin Health’s endocrinology clinic, told the inquest that some endocrinologists did not feel they had enough training to treat transgender people.
The inquest heard of a proposal to co-design mental health services with the transgender community, and to provide adequate government funding to fund them.
Harden told the inquest that training could be improved within mainstream mental health providers about discrimination and stigma faced by transgender and gender diverse people, along with better data collection about the LGBTIQ+ community to determine policy needs.
Carolyn Gillepsie, the director of services at Thorne Harbour Health that specifically serves the LGBTIQ+ community, told the inquest about how it was forced to close its doors temporarily in April 2022 due to its waitlist. She said, at any one time, it had 175 people on the waitlist, leading to a two-year wait to receive care.
Gillespie pushed back at a suggestion for a centralised intake point to triage people. She told the inquest that the ultimate goal is for a transgender and gender diverse person to receive good healthcare “wherever they are”.
Even when a transgender person gets access to mental health services, they can still face issues, the inquest heard.
Among the five deaths examined was that of Natalie Wilson, a 33-year-old woman who died on 2 September 2020. The inquest heard that, as a teenager, she had developed a mistrust of hospitals and psychiatric intervention after she felt she was forced to deny her female identity during an admission.
The inquest heard that, on the night of her death, she was accepted for voluntary admission at a hospital – only for it to be discovered that no beds were actually available. She was advised to wait for a bed to become available but, due to her social anxiety, she declined.
The inquest also examined the 11 May 2021 death of Heather Pierard, 20.
The inquest heard Pierard was deeply affected by another death that was examined by the coroner this week – that of Matt Byrne, 25, who died in March 2021. Byrne had also sought out mental health support through providers but, due to the long waiting lists or being engaged with the wrong services, she struggled to access support, the inquest heard.
Heather’s mother, Kedra Pierard, told the inquest of how her daughter’s transgender journey had “made her happier” but that she struggled after the loss of Byrne and the death of another person, identified only by the pseudonym AS, whose death was also examined by the coroner this week.
A ‘medium’ risk
For Pucci Love, it is not just the mental health system that needs to change. Immediately after Flack disappeared, she says Victoria police failed to understand “the level of risk” that her sister faced.
A few days into the search an officer told Pucci Love that “nothing else could be done”, the inquest heard.
The coroner heard Victoria police’s internal assessment had deemed Flack a “medium” risk, despite a close friend warning them about fears of self-harm and suicide.
Joe Ball, the chief executive of LGBTIQ+ non-profit Switchboard Victoria, labelled the police’s actions during the search a “miscarriage of justice.”
He told the inquest that the impact of Flack’s death and her body being found by two members of Victoria’s LGBTIQ community was still being felt, saying there was “deep grief” for every person Flack represented.
Assistant commissioner Neil Paterson acknowledged to the inquest that the search could have been better, to ensure members of the LGBTQ+ community did not find Flack deceased.
But, most of all, Pucci Love hopes the inquest can lead to improved care and support for the transgender and gender diverse community.
“I would have liked her to feel cared for and looked after and heard when she said she needed help,” she says.
Giles will consider the evidence and hand down her findings in the coming months.