“Gripping onto the last threads of sanity”: transgender and non-binary prisoners’ mental health challenges during the covid-19 pandemic

Abstract Background Covid-19 has had an especially detrimental impact on mental health of people with intersectional marginalized identities. Yet, research evidence on this impact is lacking, with efforts to generate it stymied by pandemic restrictions. Aims To explore how a socially excluded gender minority group—transgender and non-binary (TGNB) prisoners—experienced, and coped with, the pandemic stressors. Methods The data were collected via correspondence with 15 TGNB prisoners in England and Wales in April-October 2020 using an exploratory person-centred qualitative longitudinal approach and examined using reflexive organic thematic analysis. Results The pandemic and its restrictions to support structures and health care detrimentally impacted TGNB prisoners’ mental health and wellbeing. TGNB prisoners experienced added stressors associated with their intersecting incarceration and gender minority positions, including prolonged solitary confinement and reduced access to gender-affirming health care. Environmental resources for problem-focused, emotion-focused, socially supportive and disengagement coping were reduced by the prison pandemic regime, with adaptive coping through positive distraction and engagement with TGNB/LGBTQ community particularly affected. Conclusions During a pandemic and beyond, greater support and innovative practices are needed to improve the TGNB prisoners’ access to gender-affirming care and to TGNB/LGBTQ community, to protect their mental health and wellbeing.