Parents of a 17 year-old with transgender ideation should consider allowing their child to be referred into NHS child services.
Our standing advice for UK members has always been that the NHS and CAMHS are unsafe for children presenting with transgender ideation. However, there are changes resulting from the Cass Review which force us to revise our recommendation that these services are to be avoided as if your child’s life depends on doing so. The Cass Review has introduced the concept of a follow-through service for 17-25 year-olds, which means that those in the children’s service at 17 will remain in its remit until 25 or desistance. However, should your child be referred to ‘gender’ services at 18, they will go straight into the adult services.
Our Duty has written to the Secretary of State for Health requesting that the child services be made available to adolescents (17-25) in line with the NHS Long-Term Plan for Mental Health.
The adult services are profoundly dangerous places where ideological harm is delivered with religious zeal. Their arrogance and complete disregard for patients’ wellbeing is typified by their refusal to cooperate with the research required for the Cass Review. Some even claim their services are “by trans for trans”. Thus, we have a situation in which your child will be safer (but not safe) if referred into the children’s services at 17 where the adult services can be avoided until 25. While the emerging changes to the children’s services will render them less likely to result in the iatrogenic harm for which they became infamous, that risk of harm does remain. There remain staff wedded to gender identity ideology, and this results in ‘institutional inertia’ – i.e. practices do not change as quickly as they should. Moreover, once children are over 16 they are at risk of seeking medicalisation outside the NHS, particularly if they have access to funding.
Consequently, our recommendation that NHS and CAMHS are to be avoided remains in place unless your child is 17 and shows no sign of desisting. Referring a seventeen year-old to child services will protect them from adult services. Taking this risk-management approach to the available pathways merits consideration.
In changing our recommendation in this manner, we appreciate that the net effect is to put children at greater risk by advocating referral into the NHS of 17 year-olds to the child services. This is a classic case of unintended consequences – we can be confident that Dr Cass did not intend for children to be put at greater risk. However, we consider the risk differential between adult and child services to be so great that this additional risk (compared with avoiding the NHS entirely) needs to be understood by parents.
