Gender Identity Development Service
National Health Service Gender Identity Development Service | |
 Statue of Sigmund Freud at the Tavistock Centre | |
| Formation | 1989 |
|---|---|
| Purpose | Gender identity services for under 18s |
| Headquarters | Tavistock Centre |
| Location |
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| Coordinates | 51°32′48″N 0°10′29″W / 51.5466°N 0.1748°W |
Parent organisation | Tavistock and Portman NHS Foundation Trust |
| Affiliations | Tavistock Institute of Medical Psychology & NHS England |
| Website | gids |
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The NHS Gender Identity Development Service (GIDS) is a nationally-operated health clinic specialising in working with children with gender identity issues, including gender dysphoria. Although based at a Tavistock and Portman NHS Foundation Trust site, it is commissioned by NHS England and takes referrals from across the United Kingdom. It is the only gender identity clinic for people under 18 in the UK and is the subject of much controversy.
History
Pre-establishment
GIDS is a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children’s department, which developed many works by Robertson and Bowlby on attachment theory.[1] In 1959, it opened an adolescent department and in 1967 absorbed in the London Child Guidance Clinic.[2] Following this, in 1989 the Tavistock Clinic established GIDS, the first and only service of its kind.[3]
Childhood mental health services
Child and Adolescent Mental Health Services (CAMHS) provides the NHS support for children with mental health issues. However, CAMHS is organised by local government area and thus coverage varies significantly. The development of CAMHS within a four-tiered framework started in 1995. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.
GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists. GIDS is distinct from CAMHS as is it is nationally run, not by the local authority. However, in the CAMHS framework it sits in Tier 4, as a highly specialised service.
Recent history
In 2009–10, 97 patients were referred to GIDS. By 2015–16, this had increased fourteen-fold to 1419 and in 2017–18 to 2,519. Due to reduced funding and increased referrals, the average wait time is two years from referral to first appointment.[4][5]
In 2018, the parents of patients complained in a letter to the Trust board about the ‘fast-tracked’ nature of the services.[6] This led to the commissioning of an internal report by Dr. David Bell, which found the service was “not fit for purpose”. Marcus Evans, a member of the Trust board resigned in February 2019.[7] Subsequently it was revealed that 35 psychologists have resigned since 2016, including six psychologists who claimed there was “over-diagnosis” of gender dysphoria and a push for early medical intervention.[8][9] Alongside this, the National Institute for Health Research (NIHR) announced a £1.3 million grant for a study following young people referred to GIDS, to compare mental and physical health outcomes for children referred. The study will compare the effectiveness of different interventions, including psychological, endocrinological and alternative interventions.[7]
In July 2019, the Tavistock Centre was flooded which temporarily affected the IT servers at the clinic.[10]
In October 2019, a lawsuit was launched against GIDS by a mother of a patient at GIDS and a nurse who formerly worked there.[11][12]
Services
Services provided include:[13][14]
- Assessments, to assess primary medical aims and necessary support;
- Gender development support, including access to therapy, tailored support and therapy groups;
- Physical intervention, including endocrinological intervention such as puberty blockers and sex hormones;
- Mental health support, usually working alongside CAMHS;
- Ongoing support post social or medical transition and referral to adult gender identity services.
No surgical transition options are available through GIDS.[13] People referred to GIDS may also contribute to NIHR studies into gender dysphoria in children.[7]
Referrals
In the financial year 2018–19, 31 referrals were made for children aged 5 or under. 30 referrals were made for adults over the age of 18. In 2018–19, there was a year-on-year increase of 6%, a relative plateau compared to previous year-on-year increases.[5]
| Financial year | 09/10 | 10/11 | 11/12 | 12/13 | 13/14 | 14/15 | 15/16 | 16/17 | 17/18 | 18/19 |
|---|---|---|---|---|---|---|---|---|---|---|
| Total Referrals | 77 | 138 | 209 | 309 | 471 | 678 | 1361 | 1919 | 2444 | 2590 |
| 09/10 | 10/11 | 11/12 | 12/13 | 13/14 | 14/15 | 15/16 | 16/17 | 17/18 | 18/19 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Assigned female at birth | 32 | 57 | 106 | 169 | 257 | 399 | 852 | 1265 | 1657 | 1740 |
| Assigned male at birth | 40 | 75 | 87 | 111 | 180 | 250 | 433 | 542 | 624 | 624 |
Children who present may identify with a number of different labels, including non-binary, transgender, genderqueer, questioning or otherwise as simply dysphoric or gender non-conforming. GIDS say that the way children identify is changing, which may be due to cultural and societal shifts.[15]
Controversy
As the only gender identity clinic for children in the UK, the service has been the subject of much controversy related to the broader topic of gender dysphoria and transitioning in childhood.[15]
High resignation rate
A 2019 Sky News report found that 35 psychologists resigned between 2016 and 2019. Six psychologists who resigned raised concerns about the over-diagnosis and medicalisation of young people experiencing gender identity difficulties. In February 2019, Tavistock trust member Marcus Evans resigned, citing similar concerns.[8][9] In July 2019, Kirsty Entwistle wrote a public letter about the GIDS service, saying professionals were often labelled “transphobic” if they raised doubts.[11][16] Clinicians have stated that concerns over children's welfare were "shut down".[17]
Bell Report
Following a letter to the board at Tavistock, an internal report was commissioned to look at the functioning of GIDS.[6] Dr David Bell authored the report which found that the service was “not fit for purpose”. It considered that the service could result in “damaging consequences” to children’s lives and failed to fully consider a child’s mental health background.[7] However, it did not identify any “immediate” issues with regards to safety and in 2018 the CQC rated the effectiveness of the Trust as “outstanding”.[18]
Conversely, there is a long wait time for a first appointment at GIDS, averaging at two years as of January 2020. GIDS blame high referral numbers and low staff numbers for this wait time.[19]
Lawsuit
In October 2019, lodged a legal complaint against GIDS at its satellite site in Leeds. The suit was brought by “Mrs. A”, a mother of a 15-year-old patient with autism, and Sue Evans, a former nurse at the Leeds GIDS satellite site. It alleges that advice around hormone therapy was “potentially misleading” and that true informed consent could not be given under such circumstances. The suit describes hormone therapy as “experimental” and that there was “robust evidence” to show long-lasting medical effects of hormone therapy.[11][12]
Royal College of General Practitioners (RCGP) position
The RCGP report on transgender healthcare in the UK found several flaws in the NHS approach. It called for a "whole system" change, including addressing waiting times and the lack of research around gender dysphoria in children.[20]
See also
- Transitioning (transgender)
- Transgender health care
- Transgender rights in the United Kingdom
- Childhood gender nonconformity
- Gender dysphoria in children
- Transgender youth
References
- ^ Dicks, H.V., (1970). 50 Years of the Tavistock Clinic. London: Routledge and Kegan Paul. Reissued by Routledge, 2014, ISBN 978 1 138 82194 1
- ^ "The London Child Guidance Clinic in Islington". Lost Hospitals of London. Retrieved 10 January 2020.
- ^ "Gender Identity Development Service (GIDS)". tavistockandportman.nhs.uk. Retrieved 13 January 2020.
- ^ "The Times view on the Tavistock clinic and hormone-blocking drugs for the young: Informed Consent". 12 October 2019. ISSN 0140-0460. Retrieved 13 January 2020.
- ^ a b c d "Referrals to the Gender Identity Development Service (GIDS) level off in 2018-19". tavistockandportman.nhs.uk. Retrieved 13 January 2020.
- ^ a b Doward, Jamie (3 November 2018). "Gender identity clinic accused of fast-tracking young adults". The Observer. ISSN 0029-7712. Retrieved 13 January 2020.
- ^ a b c d Doward, Jamie (23 February 2019). "Governor of Tavistock Foundation quits over damning report into gender identity clinic". The Observer. ISSN 0029-7712. Retrieved 13 January 2020.
- ^ a b Donnelly, Laura (12 December 2019). "Children's transgender clinic hit by 35 resignations in three years as psychologists warn of gender dysphoria 'over-diagnoses'". The Telegraph. ISSN 0307-1235. Retrieved 13 January 2020.
- ^ a b "NHS 'over-diagnosing' children having transgender treatment, former staff warn". Sky News. Retrieved 13 January 2020.
- ^ "Flood at the Tavistock Centre – Sunday 28 July 2019 | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
- ^ a b c "UK mom sues Tavistock children's clinic over 'misleading' & 'experimental' gender change treatments". RT International. Retrieved 13 January 2020.
- ^ a b Social Affairs Editor, Greg Hurst (12 October 2019). "Mother sues Tavistock child gender clinic over treatments". The Times. ISSN 0140-0460. Retrieved 13 January 2020.
{{cite news}}:|last=has generic name (help) - ^ a b "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
- ^ "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
- ^ a b "Current debates | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
- ^ Entwistle, Kirsty (18 July 2019). "An open letter to Dr Polly Carmichael from a former GIDS clinician". Medium. Retrieved 13 January 2020.
- ^ Barnes, Hannah; Cohen, Deborah (19 June 2020). "NHS child gender clinic: Staff concerns 'shut down'". BBC Newsnight. BBC News. Retrieved 19 June 2020.
- ^ "Tavistock and Portman NHS Foundation Trust". www.cqc.org.uk. Retrieved 13 January 2020.
- ^ "About us | GIDS". gids.nhs.uk. Retrieved 13 January 2020.
- ^ "RCGP calls for whole-system approach to improving NHS care for trans patients". www.rcgp.org.uk. Retrieved 13 January 2020.