Some of the most senior gender identity specialists in the UK have accused their professional body of “contributing to an atmosphere of fear” around young people receiving gender-related healthcare.
More than 40 clinical psychologists have signed an open letter to the Association of Clinical Psychologists UK in protest at the organisation’s recent position statement on the provision of services for gender-questioning children and young people. They say they believe there was a failure to properly consult experts in the field or service users, resulting in a “misleading” statement that “perpetuates damaging discourses about the work and gender-diverse identities more broadly”.
About half of those signatories are current or former holders of senior roles – including the current director – at what was the only NHS gender identity service for children in England and Wales, the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London.
NHS England announced in July it would be closing the GIDS and replacing it with regional hubs, after being warned by the interim report of the Cass Review into gender services for young people that having only one provider was “not a safe or viable long-term option”.
The co-organisers of the letter, Dr Laura Charlton, who worked at GIDS from 2014 to 2020 and is now clinical lead at the Leeds Gender Identity Service, and Dr Aidan Kelly, who worked at the service from 2016 to 2021 and is now principal clinical psychologist at the Nottingham Centre for Transgender Health, said that the letter was particularly significant because it was the first time that these practitioners, who share many decades’ worth of experience, had come together in public to express their concerns.
“We acknowledge that there were some valid concerns about the GIDS service, not least the significant waiting times, but we take issue with how it is now being portrayed. This is the first time that so many specialists working within UK gender services have come together to speak out about their portrayal, often by people who do not share our specialist knowledge.”
Charlton and Kelly added: “We know that colleagues are especially keen to underline that, if they left GIDS, it was often because of the toxic media and political environment surrounding the service rather than because they disagreed with practice there”.
Other practitioners have raised significant concerns about the GIDS in recent years, with whistleblowers criticising what they described as an “affirmative-only” approach and suggesting that young people were sent down a medical pathway of transition too quickly.
In 2021, inspectors rated the service “inadequate” overall and highlighted overwhelming caseloads, deficient record-keeping and poor leadership, suggesting that record waiting lists meant thousands of vulnerable young people were at risk of self-harm as they waited years for their first appointment.
In a position statement published last month, the ACP-UK wrote that “the new, regional services will have to offer a radical alternative [after the closure of GIDS] to meet the needs of all young people with gender dysphoria.”
The statement suggests that “GIDS took an approach that was predominantly affirmative, rather than exploratory”. But the letter writers argue: “Being ‘affirmative’ is often misrepresented as meaning that a trans identity is encouraged, or treated as a preferred outcome, when an alternative understanding is that this practice is a stance whereby no particular path or identity is privileged over any other.”
The ACP-UK also refers to findings of “diagnostic overshadowing” in the Cass review, a term used to describe situations in which a person’s multiple difficulties are not given equal weight because they are viewed through a single lens.
The letter suggests: “An alternative interpretation is that it is possible to provide support for distress related to gender identity where mental health needs and neurodiversity are also present, and remain cognisant of all factors within formulation-based practice”.
Mike Wang, the chair of ACP-UK, responded: “ACP-UK included gender specialists as well as specialists in children and young people as well as service users in formulating our response. The reaction and feedback to our statement has been overwhelmingly positive apart from the open letter signatories.”
