Why are increasing numbers of children designated as transgender? Are the resulting medical interventions safe and justified and in the best long-term interests of those children?
These are questions of public interest. Some of the answers being offered are troubling, to say the least. One such answer came this week, and deserves attention from politicians and journalists.
It’s an open letter from Dr Kirsty Entwistle, formerly a clinical psychologist at the Gender Identity Development Service, the main NHS service for children who might be transgender. It’s a long piece and should be read in full.
But here are a few key extracts:
“I think it is a problem that GIDS clinicians are making decisions that will have a major impact on children and young people’s bodies and on their lives, potentially the rest of their lives, without a robust evidence base. GIDS clinicians tell children and families that puberty blockers/hormone blocks are “fully reversible” but the reality is no one knows what the impacts are on children’s brains, so how is it possible to make this claim?”
“There are children who have had very traumatic early experiences and early losses who are being put on the medical pathway without having explored or addressed their early adverse experiences. At GIDS no one directly tells you that you’re not allowed to suggest that perhaps these early experiences might be connected to a child’s wish to transition but if you make the mistake of suggesting this in a team meeting you run the risk of being called transphobic”.
“I am also concerned to see that Mermaids continues to receive financial support and endorsements from high profile people whilst not being subjected to any proper scrutiny of its practice. I believe that it is the duty of GIDS to disclose their concerns about Mermaids as GIDS is one, if not the only place, where information about what goes on at Mermaids is known via parent reports”.
“I also strongly believe that it is GIDS' duty to make it known that it is highly unlikely that any child presenting there will be told that they are not transgender. One of my biggest ethical dilemmas whilst working at GIDS was that there were parents who brought their child to GIDS anticipating that we would confirm that the child was not transgender but we are not able to tell parents that actually there is some unspoken rule that means GIDS clinicians do not tell families, “your child is not transgender”.
“I also believe that there are clinicians at GIDS who are putting vulnerable children on the medical pathway when they are not receiving proper input from [Child and Adolescent Mental Health Services] and Social Care with regards to mental health problems and complex family and housing difficulties.”
In short, a professional clinician who worked at the NHS centre for transgender children has painted a picture of a service where vulnerable young people are potentially being pushed into serious, life-altering medical and social choices on the basis of dubious evidence, by staff either unwilling or unable to act with caution and care.
In isolation that would be serious enough. But Entwistle is not the first to raise such concerns. In April, the Times reported five former GIDS staff had quit over worries about standards of evidence and care.
Earlier this year, Marcus Evans, a psychoanalyst and one of the governors of the Tavistock and Portman NHS Foundation Trust that runs the GIDS resigned over the management of the service.
The Tavistock trust has responded to some of this, in part by commissioning its own medical director to carry out a review of the GIDS. Is that enough? Is it acceptable for the trust to mark its own homework?
Dr Entwistle doesn’t appear to think so. She still thinks that “a proper investigation of the concerns by current and former GIDS staff is required.”
The Trust has been contacted for comment. Previously when such concerns have been raised, the trust has issued statements such as this one, robustly defending the GIDS.
I don’t know if the GIDS is doing a good job or a bad one. I don’t know if the concerns raised by professionals such as Kirsty Entwistle are justified. I do know that this matters, that this is about the welfare of children who deserve the best possible support and care.
And I know that when NHS staff feel they have to take their worries about the care of children to journalists and publish them in open letters online, alarm-bells should start ringing in Whitehall and Westminster.
Questions about the GIDS and the treatment of children over gender issues are serious, persistent and growing. The people who should be seeking answers to those questions are the people we employ to represent and reconcile the nation’s diverse interests and opinions, to ensure policy is made and that implemented on the basis of evidence, and to provide the final protection of the vulnerable against administrative failure and misjudgment. It is long past time for MPs to do their jobs and get some answers about children and transgenderism.
Update: The Gender Identity Development Service gave The Spectator the following statement:
The Gender Identity Development Service operates in a contentious field and appreciates and holds in mind the concerns raised by staff about the complexity and background of many of the referrals we see. There have always been many spaces for staff to share their concerns about the work in general and specific cases they are involved with. These include weekly team meetings, a fortnightly case discussion group, a monthly psychoanalytic group, monthly CPD meetings, a monthly reflective group and a monthly research meeting. In addition, all staff have regular supervision and line management. Senior members of the team are regularly meeting with clinicians to consider more complex issues as the need arises. GIDS, and the Tavistock more widely, is a thoughtful, reflective place to work. Our assessments are co-worked so there is space for discussion between colleagues who were both present with a young person. We also run two service-wide away days per year to discuss developments in the field and in our practice as well as encouraging staff to attend national and international conferences. The service organises regular CPD events which cover topics raised by members of the service. Obviously, specific safeguarding concerns should be raised with line managers and our safeguarding lead. Staff can also avail themselves of the Trust’s Freedom to Speak Up Guardian.
It remains that there are different views about how best to support young people with gender dysphoria. Fewer than half of patients who present to the service go on to our endocrine clinics and we do not hold a view on what the outcome will be for a child when they come in to the service. There is no pressure to provide medical intervention from the service, though there can often be from the young person or family. Our work seeks to minimise the impact of distress associated with gender development on general development, whilst spending time exploring gender identity and the range of possible pathways which may or may not include physical treatment.
We appreciate that people may want wider discussions about how best to care for this population and for this reason we continue to engage with a range of stakeholders, including our staff and patients. It is vital that the voices of young people are heard. We will continue to deliver our service in a considered, ethical and caring manner, as endorsed in our CQC inspections.