Often contending with other difficulties

Hannah Barnes in The New Statesman:

[Hannah Barnes is associate editor of the New Statesman and author of “Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children” (Swift)]

The report confirms that the majority of children referred to Gids had complex needs, and alongside their gender-related distress were often contending with other difficulties: anxiety, depression, eating disorder and autism were all over-represented when compared with what you would see in the general children’s population.

It also vindicates what so many former Gids staff have been saying for years: that there was no consistency in its clinical approach; that some assessments – prior to referral for puberty blockers – could be just one or two sessions long; that there was wide variation between clinicians; that “sexuality was not consistently discussed”; that assessments lacked structure; and that “there was a lack of evidence of professional curiosity” as to how a child’s specific circumstances may impact on their gender identity and decisions.

Cass describes how several staff in adult gender clinics have “contacted the Review in confidence with concerns about their experiences working in adult gender services”. These clinicians, from NHS gender clinics across the country, describe how a large proportion of patients have “various combinations of confusion about sexuality, psychosis, neurodevelopmental disorders, trauma and deprivation… and a range of other undiagnosed conditions”, yet there was an expectation that they would be started on hormones by their second appointment.

It’s very odd, isn’t it. Wouldn’t you think all these other issues would prompt the medics to be very cautious about prescribing puberty blockers as opposed to prompting them to rush to do so?

Perhaps the most shameful thing detailed in the final Cass review is the revelation that NHS adult gender services – paid for by the tax-payer – have refused to cooperate in sharing data that would improve the evidence base for this group of people. The review had aimed to track what happened to the 9,000 young people who had gone through Gids, with the government even changing the law to help researchers do this. But the gender clinics refused to help. Follow-up is standard practice in the NHS, Cass explains, but “has not been the case for gender-questioning children and young people”. Finding out how thousands of young people had fared after receiving different help represented “a unique opportunity” to provide more evidence to help gender-questioning young people and their families make informed decisions about what might be the right treatment pathway for them.

It is baffling that those working in services purportedly aiming to help these same people have refused to help make their care better, safer and more evidence-based. “I don’t understand the reasons why they wouldn’t cooperate,” Cass told me. Some of the clinics raised issues about ethics – yet the research design had been granted official ethical approval; others raised issues about it requiring extra resources, but NHS England said it would pay for it. “So, it is mystifying to me,” Cass said. “Particularly when you would expect that they would be curious about outcomes for the patient cohort going through, and if they are confident in the management approach, they would want to be able to demonstrate that.”

It has a kind of Jonestown feel to it – that they were all addled by the same bizarre atmosphere as each other, and all bumbled over the same cliff.

Staff from Gids have been making these points for almost a decade. Two decades if you go back to the very first whistle-blower who raised concerns before puberty blockers were given to under 16s. Some in the media have amplified those concerns, too, as have women’s rights activists, former Gids service users, and parents. Those who have spoken out should be applauded. But, we should be asking the question: where has everyone else been?

What about all the others who have not spoken out? Those who were told what was going on, who saw what was going on, and did nothing. The NHS, the government and political classes, the media.

Jonestown is everywhere?

I don’t have anything more intelligent to offer. I’ve never understood the power of this ridiculous ideology. I’ve never understood why so many formerly intelligent people rushed to sign up to it and demonize their friends who said no.

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