Our Gender Identity Development Service

4 November 2018

As reported in the Observer today, the Trust is currently conducting an internal review into issues raised about the Gender Identity Development Service (GIDS).

Children need our support

The first thing to say is that GIDS has a long track record of thoughtful and high quality care in supporting young people presenting with symptoms of gender dysphoria. This is borne out by independent CQC inspections, as well as the feedback we receive from young people themselves and their families through our Experience of Service Questionnaire (ESQ).

All staff in the service are aware of the review and have been encouraged by both our Medical Director and Chief Executive to avail themselves of this opportunity to express their own views about the service. The Trust is concerned by the tone and manner in which allegations have been made. They reveal a negative attitude to gender dysphoria and gender identity which does not reflect the views or the approach of the Trust or GIDS.

In parallel, similar concerns have also been raised by a group of parents who have shared these with The Observer. They are concerned that the pressure on the service from rising referrals is leading to a fast-tracking of patients and a lack of regard for what they are calling rapid onset gender dysphoria. We recently published our view of the term and the phenomenon it refers to on our GIDS website.

The GIDS was founded in 1989 and is one of the longest standing services for gender diverse children and young people in the world. Domenico Di Ceglie, who founded the service, wrote a set of therapeutic aims which we still abide by today. This includes the unconditional acceptance and respect for young people’s gender identity. We do not therefore take a view regarding the outcome of an individual’s gender identity development:  rather, our focus is to provide a space for exploration of gender, to ameliorate any negative impacts on general development and to work with young people to think through all the options open to them. These principles remain central to the delivery of the service.

A comprehensive psychosocial assessment precedes any referral to the endocrine clinic for consideration of physical treatments. Whilst it is the case that most young people attending the service have a wish to pursue physical interventions, 59% of those attending under 15 chose not to pursue an endocrine clinic referral.

We recognise that there are strongly held views among patients and families and their representatives including those who wish for physical treatment to be offered earlier or by those who feel that physical treatments should not be offered to young people at all.  The service has worked hard, and continues to do so, to maintain a balanced view in which we are fully aware of wider social, cultural, legal and political factors, but maintain a focus on an individual approach to care informed by the particular circumstances of each young person we see. 

We do not limit or curtail assessments because of pressure to move swiftly to medical interventions. With complex cases, rather than truncating assessments, we will often extend the time given to trying understand what may be going on. Whilst the national specifications against which the service is commissioned describe an assessment phase of between 4 and 6 meetings, one outcome of assessment may be further assessment. Nevertheless, we are always mindful that gender dysphoria is not in and of itself a mental health diagnosis. The young people seeking support from our service frequently experience high levels of distress, victimisation and isolation related to their self-identified gender. We are committed to ensuring we work to recognise and meet the various needs of all the young people we see in this complex and contentious field.

We hope any families reading today’s news will feel reassured that their children will be cared for respectfully, comprehensively and mindfully. As a Trust and as a service, we are very alive to the current debates raging publicly about the care of gender diverse children and young people and we aspire to remain a safe place for children, young people and their families to come to to explore their feelings around their gender with the wholehearted support of a dedicated multi-disciplinary team of experts in this highly specialised field.

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http://gids.nhs.uk

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