Earlier this month, Dr Hilary Cass published her long-awaited review into support and treatment options for children who suffer from gender confusion.
Writing for the Guardian, Dr David Bell, the former staff governor and Tavistock GIDS whistleblower describes it as the most extensive and thoroughgoing evidence-based review of this topic ever undertaken.
The Cass Review offers a strong – some would say unanswerable – challenge to the ‘gender affirmative model’ which in recent years has become the norm in the NHS’s Gender Identity Development Service (GIDS). Faced with cases of gender distress, this approach encourages clinicians to ‘affirm’ rather than question a child’s chosen gender identity, before then putting them on a medical pathway that can have lifelong, irreversible consequences.
Once this model took hold, the process of ‘differential diagnosis’ which the NHS typically adopts during diagnosis and management of every other form of distress, was entirely ignored. Or, as the Cass Review puts it: “Some practitioners abandoned clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations.”
Dr David Bell continues:
The many complex problems that affect these young people were left unaddressed once they were viewed simplistically through the prism of gender. Cass helpfully calls this “diagnostic overshadowing”. Thus children suffered thrice over: through not having all their problems properly addressed; by being put on a pathway for which there is not adequate evidence and for which there is considerable risk of harm; and lastly because children not unreasonably believed that all their problems would disappear once they transitioned. It is, I think, not possible for a child in acute states of torment to be able to think through consequences of a future medical transition. Children struggle to even imagine themselves in an adult sexual body.
The attempts of Gids clinicians to raise concerns about safeguarding and the medical approach were ignored or worse. The then medical director heard concerns but did not act; ditto the Speak up Guardian and the Tavistock and Portman NHS foundation trust management.
I was a senior consultant psychiatrist, and it was in my role as staff representative on the trust council of governors that a large number of the Gids clinicians approached me with their grave concerns. This formed the basis of the report submitted to the board in 2018. The trust then conducted a “review” of Gids, based only on interviewing staff.
The CEO stated that the review did not identify any “failings in the overall approach taken by the service in responding to the needs of the young people and families who access its support”. I was threatened with disciplinary action. When the child safeguarding lead, Sonia Appleby, raised her concerns before the trust’s review, the trust threatened her with an investigation; and its response, as an employment tribunal later confirmed, damaged her professional reputation and stood in the way of her safeguarding work.
It is misleading to suggest that I and others who have raised these concerns are hostile to transgender people – we believe they should be able to live their lives free of discrimination, and we want them to have safe, evidence-based holistic healthcare.What we have opposed is the precipitate placing of children on a potentially damaging medical pathway for which there is considerable evidence of risk of harm. We emphasised the need, before taking such steps, to spend considerable time exploring this complex and multifaceted clinical presentation.
It has been suggested that the Cass report sought to “appease” various interests, with the implication that those who have promoted these potentially damaging treatments have been sidelined. But in reality, it is those of us who have raised these concerns who have been silenced by trans rights activists who have had considerable success in closing down debate, including preventing conferences going ahead.
Doctors and scientists have said that they have been deterred from conducting studies in this area by a climate of fear, and faced great personal costs for speaking out, ranging from harassment to professional risks and even, as Cass has experienced, safety concerns in public.
Worth reading in full.
