When Keisha Lewis comes into contact with a police officer, one of the first emotions she feels is fear. Lewis, a 35-year-old Black transgender woman and office manager at the Morris Home, a residential recovery program for the transgender community in Southwest Philadelphia, can’t be sure of the reception she will get.

“It’s like, ‘Is this person going to be mean to me?’” Lewis said. “It plays on your psyche and messes with you very badly. I’m a human, too, and I deserve protection, and I deserve to be taken care of like everyone else.”

After the June murder of Dominique “Rem’mie” Fells, a Black transgender woman in Philadelphia, the outcry to address violence against transgender people is louder than ever. The problem is not unique to Philadelphia. In 2019, at least 26 transgender or gender-nonconforming people were killed in the U.S. — 91% of them Black women — according to the Human Rights Campaign.

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Black transgender people often already are at higher risk for mental-health issues. Their problems are only made worse by the violence that they experience, a lack of acceptance within their families and communities, and a shortage of mental-health care specific to their needs.

Lewis, who has experienced the pain of rejection and the fear of gendered violence, said she struggles with mental-health issues because of it.

“The proximity to trauma for Black trans women is very real,” said Shana Williams, clinical director at the Attic Youth Center, which serves LGBTQ youth in the Philadelphia area. Williams is also a therapist with the Morris Home and identifies as a Black queer woman. “The average lifespan of a Black trans woman is 35 years old, and if you constantly see that around you, you cannot help but to mentally accept and be prepared for death as a Black trans woman navigating society.”

‘A lot of us are ostracized’

The 2015 U.S. Transgender Survey (USTS) found that 81.7% of the 27,715 respondents had seriously considered suicide; 40.4% had actually attempted it.

For Black transgender people, the mental health impact is likely even worse — a 2013 study found that experiencing transphobic and racist events increased depressive symptoms for transgender women of color.

But “the idea that being transgender is the mental-health problem” is incorrect, Williams said. The trouble is with “the world functioning as a gatekeeper,” rejecting anyone who doesn’t meet certain norms.

“It’s really about society and family rejection,” Williams said. “Being a Black person who already has to navigate oppressive systems, with the added layer of being trans, leads to another way to be discarded, shunned, and not supported.”

Lewis said that many people in her community have abandonment issues that stem from the rejection they experienced after coming out to their families.

“A lot of us are ostracized by our community, our family, the people who are supposed to love you, when we come out,” she said. “But it’s like they throw you away and discard you like trash. When you’re young, you don’t know what you’re supposed to do then. You’re lacking love, and no one has provided you with any type of tools to move forward with, and over time, that begins messing with your mind.”

Lewis said suicidal thoughts may begin taking hold when it feels as if people have lost their family’s love through no fault of their own.

“They think that they don’t want to be here if they can’t have their family,” she said. “This is just who they are, and the people who are supposed to love them unconditionally don’t want them around.”

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Needed: More Black LGBTQ therapists

Okichie Davis, a Philadelphia therapist who works with queer people of color through their private practice, Endeavoring Wellness, has found that Black transgender people experience all of the same mental-health challenges that the general population faces. But “the difference is that [Black LGBTQ+ folks] are marginalized for our gender identity and sexuality, which makes it difficult for us to manage those challenges,” said Davis, who identifies as a queer Black woman.

Transgender people deal with higher levels of housing and food insecurity, violence, difficulties accessing affordable, affirming health care, Davis noted. “All of these barriers serve to exacerbate any symptoms that already exist, and compounds the severity of the mental-health challenges that folks deal with. When people are making the choice between paying for food, medicine, or keeping the lights on, therapy gets bumped,” Davis said.

That’s why it’s so important to have more therapists from the Black LGBTQ community who understand those challenges, Davis said. Many of Davis’ clients search for months before making an appointment.

“When you work with clinician not from your racial background or sexual identity, sometimes you encounter racism, transphobia, homophobia, or the pathologizing of Black and LGBTQ people,” Davis said. “That drives people away.”

Williams also stressed the importance of exploring implicit biases around gender and identity as clinicians. She said she still hears about clinicians who insist on using their clients’ legal names instead of their preferred names and fail to ask which pronouns they use.

“Any clinician in 2020 has to do the work to educate themselves on how to be open and affirming,” she said. “Being trans is who someone is, and we should feel able to support that.”

Lewis knows Black transgender people who will not see a therapist because “there’s nobody that looks like [them].” She said they are afraid of being judged by someone who can’t relate to them.

“I remember years ago when I wanted to see a therapist, I couldn’t find an African American or a trans therapist,” Lewis said. “I just want to tell all the Black professionals out there who are becoming therapists — we need you, keep doing what you’re doing, we want to see more of your faces out here, doing the work.”