Time for honest reflection, not defence
14 signatories call for ‘recovery and redemption’ around the announcement of a new model and Early Adopter services by NHS England following recommendation from the Cass Review.
03 August 2022
Closure resulted from the Cass Review of children and young people’s gender services in England. The interim report recommended a new service model which acknowledges multiple routes in and out of gender dysphoria. Elevated rates of same-sex attraction, autism spectrum disorders, mental health issues, and looked after children were noted amongst the – now majority female and hugely increased – GIDS cohort. Dr Cass reported that ‘diagnostic overshadowing’, using gender as the primary clinical lens, had led to such wider issues being relatively neglected. Inadequate records and data were highlighted, particularly regarding puberty blocker outcomes. The new model intends to re-centre the young person’s needs, taking a holistic view of their difficulties.
These constitute serious criticisms of a flagship psychology-led service, resulting in its closure to protect patient safety. In this context, the statement issued by the BPS is profoundly inadequate. It offers no acknowledgement of the severity and range of these problems, or of the harm done to some children and young people. There is no reflection on mistakes made or lessons to be learnt.
Defence, not reflection, has been a theme throughout the story of GIDS. Many clinicians, parents and patients have raised repeated concerns about the practice model. Ex-patients have discussed feeling rushed into body-altering interventions which some have come to regret. Criticism has grown louder recently, following a 2018 internal report, a judicial review in 2020, damages awarded to the Trust safeguarding lead and an ‘inadequate’ CQC report in 2021, plus increasing media coverage. Concerns that GIDS was operating outside usual clinical practice were first raised, however, in 2004. Critics have consistently been labelled bigots or transphobes and ostracised.
This is a sobering moment for psychology. We need to take seriously that damaging practice was enabled for so long. Hundreds of psychologists worked at GIDS – highly trained scientist-practitioners skilled in reflective practice. Hundreds more have watched this unfold from the outside. Why did it take an external review to address the widely aired problems? Why was the service not able to reflect and change itself, instead vilifying critical voices? These are questions that psychologists should be well placed to answer, as experts in human meaning-making, embodied distress and group processes. We know that as a profession we are fallible, because we know that mistakes are made by all humans and all groups – yes, even by ‘me’.
We also know about recovery and redemption. Difficult things can be tolerated, made sense of and moved beyond. First, we need to acknowledge what has happened and the risks that have been taken with young lives. Some children have been badly let down and may not be forgiving. Nor should they have to be. Trust in psychology has been damaged by this episode and our collective failure to address the emerging scandal. Rebuilding trust requires accountability, honesty and reflection. We must not retreat into the comfort of defensive denial at this crucial moment.
- Dr Laura McGrath, Lecturer in Psychosocial Mental Health
- Dr Anna Hutchinson, Clinical Psychologist
- Dr Sallie Baxendale, Consultant Neuropsychologist
- Dr Libby Nugent, Clinical Psychologist and group work practitioner of group analysis
- Dr Kirsty Entwhistle, Clinical Psychologist
- Amanda Perl, Existential Psychotherapist, former Lecturer in Forensic Psychology and Counselling
- Dr Jenny Paton, Consultant Clinical Psychologist
- Dr Celia Sadie, Consultant Clinical Psychologist
- Dr Lauren Quigley, Clinical Psychologist
- Dr Russel Ayling, Clinical Psychologist, Psychoanalytic Psychotherapist
- Dimitri Spiliotis, Counselling Psychologist
- Anastassis Spiliadis, Systemic & Family Psychotherapist, MSc Psychology
- Dr Jenny McGillion, Clinical Psychologist
- Dr John Higgon, Clinical Neuropsychologist
I agree that this is a moment for ‘sobering’ ‘reflection’. I note that the BPS statement said ‘We will carefully review the new proposals as more detail becomes available and will respond to the planned consultation on the new service.’ It’s also interesting to see the Tavistock and Portman NHS Foundation Trust statement, with its admission that the ‘level of need cannot and should not be met by a single highly specialist national service’.
In terms of our own coverage, we are a forum for discussion and debate and we are keen to hear from a range of voices, including trans people and those psychologists who work directly with them. Please reach out on [email protected].
We will begin to publish a selection of responses here:
Why did this 'scandal' happen in the first place?
As a trans person waiting to be seen by the UK adult services, and as someone who has watched the media-led moral panic about trans people (and trans young people in particular) unfold over the last five years, I read the letter ‘Time for honest reflection, not defence’ with both interest and some trepidation. As expected, the trepidation was well-founded.
The letter talks at length about trust and failure, and the need for honesty, but it falls at the first hurdle. The authors themselves point out that critics of GIDS have consistently been labelled bigots or transphobes. However, I would encourage readers to seek out their public and social media statements on trans issues, and those of groups and individuals that they follow, to assess whether they are inclusive of trans voices and experiences, and subsequently whether their views here represent anything more than a veneer of faux concern.
The letter itself is replete with distortions and misinformation, linking trans-hostile articles, actors and activists throughout, as well as propagating well-known trans-hostile talking points, pushing the current moral panic narrative prevalent in the media, and it even misrepresents the closure of GIDS, failing to even mention that the service is being replaced by regional and local services with the intent of improving accessibility and treatment.
It does little more than present a single side of a highly complex area of psychology as the only 'correct' view, ignoring the lived experiences of tens of thousands of trans people who lead much happier lives because of the treatment they fought to access.
But why did this ‘scandal’ happen in the first place?
Parents, service users and trans people have been raising the alarm on this for more years than the trans hostile activists who are touting this as some sort of victory, but as usual, trans people are ignored.
We are ignored because GIDS, the wider NHS Mental Health Services, and frankly the so-called professional bodies who monitor practitioners, all refused, and continue to refuse, to listen to us. Gender services are no exception in this regard. It's a problem prevalent across the entire scope of the relevant professions, where clinicians’ personal biases and opinions ride roughshod over trans people’s lives.
I speak from personal experience. In trying to access a diagnosis for ADHD as an adult I was repeatedly told by ‘professionals’ that my experiences were due to ‘being trans’ – despite said professionals also stating they knew nothing about ‘being trans’. Unsurprisingly after a two year fight, I was diagnosed with ADHD. A small example of the issues trans people face: one that’s emblematic and repeated ad infinitum across services.
Mental Health practitioners have a major problem when it comes to being trusted by trans people, and this letter is a prime example of why that lack of trust will remain until the professional bodies clean their house of known conversion abuse practitioners and those practicing in this field who are oppositional to trans people. Until that happens, and until the professionals overcome their 'we know you better than you do' attitudes, this lack of credibility and trust will remain unresolved.
The World Health Organisation removed Gender Incongruence from the mental health category of the International Classification of Diseases in 2019. In the 1950's transgender people were treated successfully under the auspices of endocrinology, but that changed in the 1960's when those fledgling services were taken over by mental health 'professionals', ushering in an era of conversion abuse that continues in various forms today.
While UK mental health practitioners can be vital in a supportive role in dealing with issues unrelated to gender incongruence, it’s high time they were removed from gatekeeping access to treatment in the UK, because you cannot 'diagnose' a person’s identity and not have a detrimental impact on trans lives.
Claire's Transgender Talks: www.clairestranstalks.co.uk
‘Those of us still trying to find our way through…'
So, child GIDS is to be closed. The reactions are, perhaps predictably, polarised. From “damning indictment” to the brave face of “simply a regional relocation”. The Cass report is, to my eye, far more nuanced than these verdicts (though the criticism is inescapable). It’s an emotional moment personally.
There was a time when I was a significant supporter and felt it offered what young people needed. But much has changed and it’s been a long time since I felt that. I can’t quite pinpoint when things started to shift, but being the parent of a trans child (and a family member of a GIDS service user) is undeniably part of it.
Approaching the Tavi (as everyone calls it and I will here) I think I held an expectation that they would offer an approach that engaged with the complexity of my own feelings. This was a big thing we were talking about: not just a change or role but life-changing and irreversible physical treatments. It would surely be, in their own words, “thoughtful’. And I suppose it was, to a degree. But maybe not quite as much so as I expected.
Or perhaps as much as I wanted. To be fair, I also wondered how much room the staff had to be searching. Could they hold the gates to physical treatment shut? After all, by the time kids arrived in Belsize Park many, it seemed, had just one intention: to get to the meds. The possibility of alternatives, questions or challenges all felt a long time ago.
Above all there was little chance to think about the social pressure (not coming from the Tavi I hasten to add), “your kid will kill themselves if you don’t get on board”. Those of us who resisted hormone blockers felt we were walking a lonely, and risky, path. I was lucky, I think. I have a child who didn’t push this choice too hard.
I know others for whom the pressure has been almost unbearable. The difficult thing for many parents was that the Tavi, whatever we hoped, was never designed for us to be the primary focus. They did try. There were parental support groups and regional outreach. But the GIDs clinic has been resourced with the aim of supporting young people. Obviously there are different views on how that responsibility was held.
One thing that strikes me again and again is how, in our gender-fluid world, parents and loved ones are either simplistic stereotypes, or just invisible. Parents especially, are usually portrayed as either angry-rejecting or warm-supportive. More pejoratively, warm-supportive has been characterised as in cahoots with charities to pressure services into doling out the drugs.
And for yet so many parents (and others) I’ve encountered on this journey, the experience is so much more complicated and painful. They’re not kicking their child out or seeking a divorce. They’re trying hard to be on board with something that, in the privacy of their hearts, they feel is not quite real.
Trying to support bodily changes that break their hearts. You can’t say it of course. Feeling that way means you’re a transphobe. And so, invisible we remain. So many are still really trying though. You can’t, we are told, have LGB without the T. All progressives should get on board. But this feels so fundamentally different from coming out as lesbian or gay. In almost every way I can imagine.
In the end the Tavi was never, perhaps could never, be something that was truly able to support families experiencing these kinds of pressures. The Cass Report at least has aspirations to address this. The focus is, perhaps rightly, still mainly on young people though. But I hope services and psychologists can still do something for those of us still trying to find our way through. For that I have a suggestion. It’s simply this. Don’t forget we are there too.
There is more than one group of people who need to be helped and included. When you’re making sure you have your pronouns declarations right, and an apology for accidental misgendering ready to go, think about it for a minute. How might your keen support go down with someone who may feel like they have lost a daughter, or a son, or a father, or a wife. The Tavi couldn't be there with us. With a little care you can be.