Warning: This article is about suicide and may be distressing for some readers.
Pretending to be someone you're not or facing exile from society can drive those with fluid sexuality and gender to breaking point.
Jay, a genderqueer Wellingtonian, described it as playing a character you don't want to be. The situation drove the 25-year-old to contemplate taking their life two years ago.
Jay doesn't identify with being male or female and uses they/them/their pronouns.
They are speaking out for the Herald's Break the Silence series in the hope of lowering the high suicide rate among the lesbian, gay, bisexual, transgender and gender & sexual minorities (LGBT+) community.
WATCH
• Local Focus: It's not about wanting to die
• Local Focus: How Maddy stopped self-harming
READ MORE
• Read the full Break the Silence series here
• Investigation: The untold story of teen suicide in the North
According to Youth 2012, a major national survey of the health and well-being of secondary school students carried out by the University of Auckland in 2012, almost half of queer youth had seriously thought about taking their own life in the previous year.
One in five had attempted suicide, compared with one in 20 of their non-queer peers. Queer youth were three times more likely to be bullied every week than their heterosexual peers and almost half had been hit or hurt at school in the previous year.
Jay knew they were different aged 13 but it wasn't until they were 23 and supported a friend through their own transition that Jay realised they were genderqueer.
With that realisation came a dark year of depression as Jay wrestled with their socially marginalised identity. Jay contemplated taking their life many times.
"You can't see how you're going to get through that sort of thing," they told the Herald.
"Do I live a life that I'm not, or be me but never accepted? Things just seem very bleak.
"It feels like you're cast in a role. But you can't relate to the character you're playing and you don't want to be that character."
Jay's story is not unusual. They believed all their close friends in the rainbow community had contemplated suicide at one point.
It was only by meeting other trans and nonbinary people through the "lifesaving" sexuality support service Evolve Youth that Jay managed to drag themselves out of depression.
"I was able to ride it out and find a sense of connection through being involved in the rainbow community.
"They [support services] are basically the only people you've got."
The Youth 2012 survey, which polled 8500 young people, found almost 15 per cent were trans, gay, or were unsure.
Around 20 organisations including Rainbow Youth and the Mental Health Foundation penned a submission on The Government's draft strategy to prevent suicide.
They were disappointed the LGBT+ group was ignored bar one mention that more research was needed.
Youth 2012 is the most recent in a series of similar surveys. Researchers want to do another one next year but the Government has yet to guarantee funding.
A Ministry of Social Development spokesman said the ministry was considering options but no decisions had been made.
Requesting more research but refusing to fund it was a massive contradiction, InsideOUT national co-ordinator Tabby Besley said. University of Auckland surveys provided the only data rainbow services had to prove their particular challenges exist.
"Every funding application asks you to prove the need for your service - how are we meant to do that if we don't have data that acknowledges our community?"
Rainbow Youth support manager Morgan Butler said that when a youth's support system like their family, church, school or community rejects them, it can really sting. So feeling isolated is a key factor for suicidal thoughts.
"The silence and prejudice or lack of education in these natural support systems means that queer and gender-diverse young people fall through the cracks."
Mental Health Foundation spokeswoman Moira Clunie believed it was time for proactive measures.
"This risk comes from their experiences of hatred, discrimination and exclusion. Rainbow mental health needs are not currently recognised in policy at a national level."
Ministry of Health deputy director of mental health Ian Soosay acknowledged more needed to be done and public feedback was being analysed.
"Since 2008/09 mental health expenditure by the country's 20 district health boards has increased by over $300 million from $1.1 billion to $1.4 billion.
"Budget 2017 included an extra $224 million over four years in mental health services including $124 million in new innovative approaches."
While some change is under way, Besley believed the Government's slowness was causing an unnecessary loss of life.
"Our people are dying and the Government aren't taking serious measures to prevent it. They aren't funding the organisations that are doing the work to support them, they aren't providing life-saving health care for trans people.
"It often feels like nobody else cares so we have to get in there and try to help each other."
A 76-year-old transwoman believes a 50-year wait for gender confirmation surgery is partially to blame for transpeople's high suicide rate.
Diane Sparkes is urging the Government to fund more surgeries. She said the gender confirmation surgery is crucial to transpeople's mental well-being as it enables them to be their "authentic self". Sparkes paid $18,000 for her surgery in Thailand.
"For me I could no longer live if I could not have the body my mind had told me I should have - having surgery at 67 in a foreign country on my own was no longer important if I could not be my authentic self.
"This decision truly saved my life."
Sparkes believed a spike in suicides in the 40s age bracket could be attributed to "invisible transgender people" coming to terms with their gender later in life.
Almost 100 people are on the Ministry of Health waitlist which will take 50 years to get through. One female-to-male and three male-to-female surgeries are funded every two years.
Currently 72 people are waiting for male-to-female gender confirmation surgeries, which cost between $16,000 and $40,000, and 21 waiting for female-to-male surgeries which can cost up to $180,000.
The Herald estimated it would cost around $5m to clear the waitlist.
• Support OUTLine by donating here.
• Support InsideOut by donating here.
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234
There are lots of places to get support. For others, click here.
Western Bay of Plenty District could have fewer councillors to vote for next election.