This chapter examines chart documentation regarding 16 trans and non-binary patients on inpatient units in a psychiatric hospital in Ontario. An analysis of these charts shows that cisnormativity governed institutional means of collecting data regarding patient demographics, such as the inconsistent use of correct pronouns, names, and gender identities, which in turn facilitated basic problems in recognizing the humanity of trans and non-binary people. Practitioners employed a cisnormative, transmisogynist lens in their descriptions of patients’ appearance and mannerisms, resulting in the pathologizing of trans and non-binary gender expression, especially trans femininities. Practitioners also displayed a significant lack of knowledge about trans and non-binary life, which resulted in the individualizing of structural inequities and the pathologizing of trans and non-binary experiences of marginalization and violence. This chapter further demonstrates that advocating for more access to mental health treatment will not serve emancipatory aims when treatment continues to reinforce cisnormative, damaging assumptions about trans and non-binary life, identities, and ways of being.