Par­ents, staff raise con­cerns over gen­der iden­tity clinic

The Observer - - Front Page - Jamie Doward

Britain’s only NHS gen­der iden­tity ser­vice for chil­dren is re­view­ing its op­er­a­tions amid claims made by a se­nior mem­ber of staff that it is fail­ing to ex­am­ine fully the psy­cho­log­i­cal and so­cial rea­sons be­hind young peo­ple’s de­sire to change gen­der.

The views are shared by a group of par­ents of trans­gen­der chil­dren, who raised con­cerns that the Tav­i­s­tock Cen­tre’s gen­der iden­tity de­vel­op­ment ser­vice (GIDS) in Lon­don is “fast­track­ing” young peo­ple into life-al­ter­ing de­ci­sions with­out fully as­sess­ing their per­sonal his­to­ries.

In a let­ter to the trust’s board, seen by the Ob­server, the par­ents say they fear “the GIDS team is be­ing asked to en­gage with and as­sess com­plex and dif­fi­cult cases within a highly con­strained time frame”.

They con­tinue: “We have spe­cific con­cerns about the sit­u­a­tion of those with gen­der dys­pho­ria in the age group 17 to 25 who are re­ferred to the [adult] GIC [gen­der iden­tity clinic], where they do not re­ceive the com­plex psy­choso­cial as­sess­ment of­fered at GIDS: for these young adults there is lit­tle ex­plo­ration of the fam­ily or cul­tural con­text of their still de­vel­op­ing gen­der iden­tity.”

The Tav­i­s­tock con­firmed that a se­nior mem­ber of staff had sub­mit­ted a re­port to its board, rais­ing is­sues about its ser­vice. The Ob­server be­lieves that the re­port ques­tions

whether the clinic should do more to con­sider young peo­ple’s per­sonal his­to­ries, no­tably by ex­am­in­ing whether they are on the autis­tic spec­trum, have ex­pe­ri­enced trauma or are be­ing in­flu­enced by so­cial pres­sures, be­fore help­ing them on the path to tran­si­tion. As a re­sult, the clinic has be­gun an in­ter­nal re­view.

In a state­ment, the Tav­i­s­tock said: “A doc­u­ment has been pro­duced that makes al­le­ga­tions about the ser­vice. In re­sponse, our med­i­cal di­rec­tor is con­duct­ing a re­view of the is­sues raised. All staff in the ser­vice are aware of the re­view and have been en­cour­aged by both our med­i­cal di­rec­tor and chief ex­ec­u­tive to avail them­selves of this op­por­tu­nity to ex­press their own views about the ser­vice.”

It added: “The trust is con­cerned by the tone and man­ner in which these al­le­ga­tions have been made. They re­veal a neg­a­tive at­ti­tude to gen­der dys­pho­ria and gen­der iden­tity which does not re­flect the views or the ap­proach of the trust.”

The par­ents claim that the huge in­crease in num­bers of chil­dren seek­ing re­fer­rals, which has risen from 97 in 2009 to 2,519 in the year to April, is plac­ing great de­mands on the clinic, with po­ten­tially neg­a­tive con­se­quences for chil­dren.

“Given the pres­sure un­der which GIDS now works, we be­lieve there is a real dan­ger that the co­hort of young peo­ple who en­ter GIDS post-16 may be fast-tracked on to adult ser­vices in an at­tempt to re­duce caseloads,” the par­ents claim. They said they feared the adult ser­vice did not ad­e­quately ex­am­ine psy­choso­cial fac­tors that they claim may in­flu­ence a young per­son’s de­ci­sion to tran­si­tion.

But the Tav­i­s­tock in­sisted that “com­pre­hen­sive psy­choso­cial as­sess­ment pre­cedes any re­fer­ral to the en­docrine clinic for con­sid­er­a­tion of phys­i­cal treat­ment”, and that no one was be­ing fast-tracked.

In a state­ment, it said: “We do not limit or cur­tail as­sess­ments be­cause of pres­sure to move swiftly to med­i­cal in­ter­ven­tions. With com­plex cases, rather than trun­cat­ing as­sess­ments, we will of­ten ex­tend the time given to try­ing to un­der­stand what may be go­ing on. Whilst the na­tional spec­i­fi­ca­tions against which the ser­vice is com­mis­sioned de­scribe an as­sess- ment phase of be­tween four and six meet­ings, one out­come of as­sess­ment may be fur­ther as­sess­ment. Nev­er­the­less, we are al­ways mind­ful that gen­der dys­pho­ria is not in and of it­self a men­tal health di­ag­no­sis.”

The view that psy­choso­cial fac­tors – such as the pop­u­lar­i­sa­tion of trans is­sues on so­cial me­dia, or the role trauma has played in their early life – can help shape some­one’s de­sire to tran­si­tion is re­jected by many trans sup­port groups. They said their ex­pe­ri­ence was that, far from be­ing fast­tracked, ado­les­cents ex­pe­ri­enced a lengthy as­sess­ment process be­fore tran­si­tion­ing could be­gin.

“The re­al­ity we hear from our ser­vice users is quite the op­po­site of the sugges­tion that ser­vices are rushed,” said Lui Asquith of the trans­gen­der sup­port char­ity Mer­maids. “In most cases, af­ter the ini­tial as­sess­ments and be­cause of the rig­or­ous ap­proach to as­sess­ment the Tavi im­ple­ments, there will be a fur­ther long pe­riod of ‘watch­ful wait­ing’, which can lead to chil­dren not get­ting timely sup­port.

“At Mer­maids, we see that a de­lay in nec­es­sary, de­vel­op­men­tally ap­pro­pri­ate or age-spec­i­fied med­i­cal in­ter­ven­tion can have a neg­a­tive ef­fect on the well­be­ing of a trans child – an in­abil­ity to con­cen­trate at school, to en­gage with their peers, to ex­cel in their hob­bies – be­cause they are not get­ting the sup­port they need in time.”

Lui Asquith of the trans­gen­der sup­port char­ity Mer­maid said that ser­vices were far from be­ing rushed.

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