“These proposals are a far cry from the mental health support that many trans young people need”
BY NANCY KELLEY, IMAGE BY INKDROP
New NHS guidance, leaked to The Good Law Project and made public today, sets out a process for assessing the mental health of the 6000+ children currently on the waiting list to be seen by the new Children And Young People’s Gender Service, the majority of whom will wait for many years before seeing a specialist. The process involves asking parents and carers for their consent to a mental health referral and, for those who do consent, conducting an assessment of the child and making onward referrals for mental health assessment and support, and autism / ADHD assessment and support. In practice these services are themselves heavily oversubscribed, so in most cases, children will simply join more waitlists.
Also included in the guidance is a set of instructions to the assessing mental health practitioner that focus on identifying children who are accessing private gender-affirming healthcare and strongly encouraging them to discontinue that care.
Where a child is accessing private or unregulated provision, the assessing mental health practitioner is instructed to: share information about the NHS care pathway, which does not allow access to puberty blockers (outside of a yet-to-be-commissioned research project), advise the child and their family about the side effects of puberty suppressing medication and hormone treatments, and advise the child and their family that they should stop taking any prescribed treatments unless they are doing so with ‘appropriate care’. There is no guidance about what ‘appropriate care’ means, so in practice, this is likely to mean advising medical detransition.
The guidance also states that “if the child/young person or their carer disregards your advice and you consider this puts the child/young person at increased risk, then a safeguarding referral may also be appropriate”.
No information is provided about physical or mental health risks associated with detransition, and there is no process set out for risk assessing whether advising medical detransition is the right approach for the individual child.
This attempt to restrict access to private gender-affirming healthcare comes after the NHS announced it was ending access to puberty-suppressing medication for those under 18s (outside of a yet to be commissioned research project) in response to the Cass Review. It also comes in the wake of a government consultation on schools guidance that proposes very significant restrictions on children’s ability to socially transition (change their name, pronouns and appearance). Taken as a whole, this paints a worrying picture of a government doing all it can to control the choices that trans children and their families make and prevent under-18s in the UK from transitioning in any way.
The leaked guidance document has been met with concern by charities working with trans and gender-questioning children.
Pip Gardner, CEO of The Kite Trust said: “These proposals are a far cry from the mental health support that many trans young people need whilst they endure lengthy waits for gender-affirming care. We have significant concerns that elements of this approach will further exacerbate the trans communities’ lack of trust in the NHS. Families have turned to private health care because the NHS has failed to provide them with timely support and the proposed approach suggests commissioners are more interested in passing the buck and demonising families in difficult circumstances rather than providing them with meaningful support.”
Lauren Stoner, CEO of Mermaids, commented: “Everyone deserves access to timely, supportive and holistic healthcare, including mental health support. NHS England has been failing trans youth for many years, with appalling waiting lists of more than six years, virtually no first appointments offered for over a year, and increased politicisation of the support offered to children and young people. The mental health support being offered, in the form of an assessment followed by likely lengthy waits for other provisions, is far from the holistic support trans young people tell us they need.
We have already heard from families who have turned to private healthcare due to lengthy waits for NHS support who are concerned that elements of this assessment will mean that they and their families are referred to safeguarding teams, who are ill-resourced to support them.”
The Good Law Project, who made this document public, have announced that they are seeking urgent legal advice on its contents.
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