THE LEAST, WORST, OPTION – New Mental Health Services for Trans Kids Just Another Avenue for Detransition

An anonymous source inside of NHS Gender Services answers the concerns posed by trans young people and their family members who feel confused and concerned about receiving letters from the new Young People’s Gender Service offering dubious mental health services.

On 1 May around forty young trans people and their primary carers received letters and emails from a new mental health service offered by NHS England in a response to the anxiety undoubtedly felt by those on the waitlist for specialist Gender Services. At times convoluted, other times wholly misleading, many—young trans people, their parents, gender specialists, etc.—regard the mental health service as another deceitful motion to sway and instil doubt in the confidence trans young people have in their identity as they await to be seen for gender affirming hormone treatment.

NHS England confirmed in early May that ‘some 6,000+ transgender children’ will receive advice that QueerAF warns ‘may leave them no choice but to medically detransition or face safeguarding referrals according to leaked plans’. Good Law Project Executive Director, Jo Maugham KC, also told QueerAF that these processes are a clear attempt ‘to force people to detransition’.

Two years following NHS England’s announcement of the closure of the GIDS for child patients at Tavistock, the NHS Children’s and Young People’s Gender Service for London begun accepting its first patients on 2 April, a year later than originally scheduled. Following the publication of the Cass Review on 10 April, the Great Ormond Street Hospital for Children posted an update on its website on the same day, relaying the address made by a spokesperson for the CYGPS (London). The spokesperson said that, ‘[a]s an NHS specialist commissioned service, we are closely following NHS England guidelines informed by Dr Cass’s interim report. We will continue to do so pending any changes that may follow from NHSE’s response to the Cass Review’s final report.’
The swift incorporation of the—much disputed—Cass Review’s suggestions, released not eight days after the GYPGS allowed patients, leads us to question the intentions of the new service.

Accounts from approximately 40 young patients and their family members have been shared with WTT, QueerAF and Trans Safety Network, compiling the reports of those who have received letters from the Children and Young People’s Gender National Referral Support Service (CYP-GNRSS). On the first of the month many received letters or emails from CYPGS, the emails headlined as an offer of support. The support being offered was that of mental health services (Children and Young People Mental Health services [CYPMH], also known as Children and Adolescent Mental Health Services[(CAMHS]), which asked for the filling out of a mental health assessment and the sharing of sensitive forms saved for gender specialist services. Accounts from the compilation remark that the letter/email is composed like an invitation for a CAMHS session, framed as an acknowledgement and an attempt to assuage the burden young people experience amidst unacceptable waiting times. Though the letter states that ‘gender incongruence is not a mental health disorder’, it nevertheless poses as recognising the anxiety potentially felt by those waiting to access crucial NHS gender services.

‘It claims to sympathise with the long wait to be seen and in the meantime offering mental health support via an appointment with children and young people mental health services’, claims one parent. ‘It also states our GP will be advised whether we reply yes or no to the offer.’

The letter assures that, regardless of whether they accept these services, they place on the waiting list for CYPGS will not be affected, though recipients nevertheless are distrustful. Though the service can be opted out of, the patient or parent will still need to submit a brief form to confirm their answer; the consequences of failing to do so by the end of May are unspecified. In all cases, the young person’s GP will be informed by CYP-GNRSS no matter what decision they make, something another source has stated makes them feel deeply uncomfortable, especially when considering the precarity of their HRT prescription:

‘[The email] Asked me to click a link and agree to them sharing my details with CYMPH with a view that they will assess me. It states “The CYPMH provider should see your child or young person at least once. After their appointment, the CYPMH service will advise you on the best support available to your child. They may also decide that Morgan has a good support network in place and clinical support would be best provided by your GP.”
It is very confusing, saying I Have to say YES or No and that it wont affect my “place on the CYP Gender Services waiting list will not change, whatever decision you make,” but I don’t know if I can trust that. It also states that “In all cases, we will write to your child’s GP to let them know your decision and if they need to do anything to support them locally.” I m really worried about this part of it as I started hormone blocker and T 19 months ago through Gender GP and private prescriptions, but our GP agreed to shared care almost a year ago and I am worried enough about them getting cold feet and pulling this agreement without this report going to them’ – Morgan, young trans person.

‘Ironically this came a few months after I was abruptly discharged from CAMHS after receiving no support from them anyways’, wrote Isaac, another young trans person left feeling concerned by their letter. ‘Also, I am unsure why it says it is from NHS Arden and Greater East Midlands Commissioning Support Unit as I am not from that area. The form just asks whether you want your information shared with you [sic] local CYPMH team and if you are already seeing them or not.’

In response to these concerns, we showed them to an anonymous source who works within the NHS gender services. They replied that, ‘advising families to access mental health services whilst on waiting list[s] for definitive gender identity care is effectively a safety net approach intended to prevent harm. Unfortunately, those who are vulnerable will have already had a deterioration in their mental health thanks to the whole cancellation of Services and inadequate replacement, and those who have been mentally robust, and do not require a mental health assessment will feel pathologised’.
The source admits to the failings resulting in the blanket offering of CYPGS to trans children; a hasty slapping of a plaster over a gushing wound. The anonymous NHS source confesses that in ‘[a]n attempt to have the least worst outcome they have delivered the least, worst, option.’

It is the understandable anxiety of these patients and parents that accepting these mental health services will reverse the mental steadfastness they have built on their way to recognising and accepting their trans identities. Those with less support, however, risk falling victim to mental health services that may wrongfully throw doubt and distress over their transness.

‘I don’t know how we get that balance right of protecting people from conversion therapy and not frightening therapists who are just doing their job and having an appropriate exploratory conversation with a young person,’ said Dr. Cass to Scottish MSPs earlier this month at Holyrood’s Health, Social Care and Sport Committee, not longer after the NHS Scotland paused its puberty blockers prescription for children referred by its specialist gender clinics – action it took after approving Cass’s review.

What guidance NHS England has adopted and applied from the review, claiming to err on the side of caution, has instead eschewed the needs of those who do not need counselling but their rightful medical attention in the form of HRT. In the meantime, young trans children lie paralysed in wait, unsure if the services supposedly dedicated to their mental wellbeing truly have their best interest at heart.