Trans Hate on Sunday

I know many people’s leisurely Sunday was disturbed yesterday by another malicious piece of so-called journalism in the Mail on Sunday. I wonder if the Sanchez Manning the transphobic journalist who wrote for the third consecutive week about trans issues, this sensationalist article in the Mail on Sunday has ever sat with a suicidally depressed trans young person or bothered to explore the impact of transitioning on young trans people’s lives? Gendered Intelligence and Mermaids do masses of work in supporting young people and families in this area, and the YouTube is full of fantastic first-person accounts which offer hope and help save lives. The majority of parents of trans and gender-questioning young people are loving caring folk who are doing their absolute best to support their child.

The article referred to the new Memorandum of Understanding (MoU) which I reported on a couple of weeks ago. The MoU working group were always at great pains to ensure that therapists felt competent to have the difficult conversations about gender with their clients but to do so in a way that doesn’t privilege one decision over the other. Had the journalist and Stephanie Arai-Davies bothered to read the MoU they’d have seen that therapists need to be able to work with ambivalence and uncertainty about gender concerns without bias towards a particular outcome. Therapists support the person finding their answers to what they want to do about reconciling the conflict they feel about the gender they were assigned at birth and how they experience themselves.

The MoU stresses the importance of therapists being trained in working with concerns about gender and sexuality and seeing the quotes from Bob Withers, a member of both British Psychoanalytic Council and UKCP; it seems this part of the MoU is both relevant and necessary.  It seems like Bob Withers has a long history for expressing transphobic comments and this is particularly concerning since the clinic he co-founded in Brighton with his wife claims to work with a large number of LGBTQ clients.  Looking at his self-congratulatory posts and retweeting transphobes on his twitter timeline, I would concerned for any trans clients consulting him and wonder whether he might be in breach of the British Psychoanalytic Council and the UK Council for Psychotherapy’s Codes of Ethics for bringing the profession into disrepute?

Sanchez Manning’s interest in negatively reporting on trans issues is relatively apparent and verging on the obsessive. The week before they wrote another sensationalist piece about puberty-blockers under the headline: “We’ll give our son, 12, sex-change drugs: Parents want NHS to give their boy powerful puberty-halting treatment so he can be a girl” which probably wasn’t anything the parents said, but that didn’t seem to worry Manning, who must have missed the style guide on reporting on trans topics issued by Trans Media Watch. Oh, and publishing Alex Bertie’s photos without consent is SO not cool.

The use of anti-androgens (hormone blockers) is a standard treatment recommended by the World Professional Association for Transgender Health (WPATH) and based on best clinical practice.  It’s only used in exceptional cases after comprehensive and careful assessment, usually taking many months, and often at a time when the rapid changes of puberty make their benefit greatly diminished. The decision to use these medications is made by a multidisciplinary team (MDT) of doctors, therapists and social workers usually along with the parent’s support and the theory is that halting puberty will allow space for reflection, more significant cognitive and social development to occur. It’s not unusual to have other co-occurring mental health problems, and this is one of the reasons why an MDT is necessary. If the young person decides not to progress onto cross-sex hormones (currently at 16), they can stop the treatment at any time and puberty will continue.

Let me make this abundantly clear: An appointment with the Gender Clinic doesn’t mean someone IS going to transition, merely that they have someone who is skilled in helping them explore the issues.

The fact that someone in CAMHS refers a young person for specialist assessment could be seen as (a) how poorly trained most mainstream therapists are around these issues, (b) an entirely appropriate response to working within the limits of one’s competence or (c) a highly proper assessment and referral to specialist services. I would like to think it’s (c) because presenting with concerns about one’s gender identity is pretty standard nowadays for CAMHS staff to deal with although there is still a massive need for adequate training. The fact that a parent is unhappy with the referral needs to be worked with by the therapist, but we need to remember a 15-year-old is likely to be Gillick competent and should with all haste be referred. Research tells us that suicide attempts and self-harm rates for young trans people are running at around 50%. So we need to listen and promptly act when a young person finds the courage to come and talk to a mental health professional about their gender dysphoria.

The week before last, Sanchez Manning reported on sperm and egg preserving of trans young people before taking hormone blockers. Again, a recommendation of best practice laid down by WPATH. But Manning doesn’t seem to be that bothered about speaking to those involved in trans health care. They’re working for the Daily Mail after all which seems to revel in peddling hate and misinformation.

I wonder how a fringe group, Transgender Trend is telling a ‘story’ about youngsters being forced by the NHS into transition when quite the opposite is true. I’ve often felt the process of access to treatment (which may include hormone blockers, but more often simply involves psychological support) is incredibly slow, taking account of waiting times for a referral and then the process of assessment to determine suitability. If it’s agreed the young person should go on blockers, there is a further wait for the endocrinologist to see the young person and assess physical suitability (there is one paediatric endocrinologist working alongside the Tavistock GIDS). It has been known to take up to two years. Physical intervention isn’t a rushed process, and by the time someone starts (depending on where they were in their puberty when they entered the system), the impact of the hormone blockers could be very negligible.

What should concern parents is the bullying of gender-diverse young people.  Stonewall recently reported LGBT Bullying which is still rife in schools despite some progress being made in recent years and schools are doing better to address it.  However, 8 in 10 trans pupils are bullied, 4 out of 5 trans young people report self-harming and 1 in 10 receive death threats, there is clearly much more to do and I wonder whether Sanchez Manning and Transgender Trend think they are contributing to this problem?

The current best practice is to respect where the child or young person is at, to believe them, to help the parents support their child. Yes, some many children will change their mind about their gender after a period of social transition, but they will feel loved and respected whatever they decide to do. Childcare has moved on from the authoritarian days of the pre-1950’s where one was supposed to obey one’s parents at all costs to a more collaborative model of consent led mutual respect and where unconditional love is at the centre of ethical parent-child relationships.

Dominic Davies
CEO – Pink Therapy

 

Trans Health Care by GP’s

s300_nhs_gp_laycock_st_gp_consult_32-10777_960x640

I’ve recently learned that it’s not uncommon for a trans person, who has had a diagnosis of Gender Dysphoria and requested their GP to enter into a shared care plan with the GIC or specialist treating the person to be declined hormones or shared care by the GP.

It would appear that this could be an offence worthy of reporting to the General Medical Council as it goes against advice from the Royal College of General Practitioners and the GMC.  UPDATE 15/3/2016: The GMC have recently issued this guidance to GP’s

UPDATE: 6/4/2016: Dr James Barrett from Charing Cross GIC has written to the British Medical Journal “Doctors are failing to help people with gender dysphoria.”

I appreciate that some GP’s may feel unqualified to treat trans patients and so decline hormones.  I doubt this lack of confidence gets applied to patients presenting with depression that the GP feels they must refer to a psychiatrist rather than prescribe anti-depressants!  There is a very helpful online e-Learning programme made by GIRES which can bring a GP up to date on how to treat a trans or gender diverse person.

I have it on good authority that NHS England knows about this problem but has so far been ineffectual in addressing it.  This is remarkable given that NHS England commissions each General Practice in England!  They have contract non-compliance powers and they often fail to instigate them equality matters.  If these GP’s are failing their trans patients they are probably also discriminating in other areas (failing to provide teenage girls with contraception or treating their LGB patients with sensitivity).

Some years ago the Lesbian and Gay Foundation (now the LGBT Foundation) produced quality standard for practices ‘Pride in Practice’.

In addition to the links above, I’ve put together a list of useful documents to help trans and gender variant people inform their GP and negotiate for better health care:
Royal College of Psychiatrists guidelines for the assessment and treatment of adults with gender dysphoria

Guidance for GP’s and other clinicians on the care of gender variant people

A guide to hormone therapy for trans people

Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guidelines (US Document)

GMC Good practice in prescribing and managing medicines and devices (2013)

There is also this excellent health guide for Trans men, trans masculine and non binary people

Finally, since most people can’t afford to consult private therapists, there is this excellent guide written for trans and gender variant abuse survivors on accessing therapy

Dominic Davies
CEO Pink Therapy