Achi news desk-
How can the NHS provide safe and effective gender identity healthcare for young people when it is hampered by “major gaps” in children’s mental health care and “fear” among healthcare practitioners?
‘toxicity’
Speaking to MSPs on Tuesday, Dr Cass said most NHS staff faced with a young patient expressing gender dysphoria tended to “bypass” them with a direct referral to the Gender Identity Development Service in instead of that.
Health professionals “feel nervous because they don’t feel they have the skills, they worry about the toxicity of the debate, they worry about saying or doing the wrong thing”, he said Dr. Cass.
This echoed some of the findings of the Cass Review, which noted that this approach “has had the unintended consequence of de-skilling the rest of the workforce and producing unmanageable long waiting lists”.
Although the Cass Review was specifically concerned with practices in England, Scotland’s own huge waiting lists for children and young people at the Sandyford clinic (more than 1000 on the waiting list and average waiting times of four years for a first appointment) speak to a similar reluctance among clinicians here to support these patients through Child and Adolescent Mental Health Services (CAMHS) or other pediatric services.
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Why?
The toxicity review described the debate as “extraordinary”, saying there are “few other areas of healthcare where professionals are so afraid to discuss their views openly”.
Some staff outside the sex services said they were afraid to accept referrals for fear of being accused of potentially illegal “conversion practices”.
It doesn’t help that CAMHS waiting lists are also under pressure.
Meanwhile, there is discord between doctors: “Some feel strongly that the majority of those presenting to gender services will go on to have a long-term trans identity and should be supported to access a medical pathway in early. medicalizes children and young people whose multiple other difficulties are manifested through gender confusion and gender-related distress.”
This “emotional and political” atmosphere – together with the “weakness of the evidence base and lack of professional guidance” – has made it much more difficult for new services to recruit, exacerbating waiting lists.
family doctors
What happens when NHS waiting lists spiral? The private sector is stepping in.
The Cass Review noted that young people on long NHS GIDS waiting lists for assessment have resorted to buying medicines, either through independent healthcare providers or by “obtaining unregulated and potentially dangerous hormone supplies over the internet”.
Campaigners have warned that one consequence of delaying puberty blockers and other medical interventions is that even more distressed young patients will feel forced down this path.
This is likely to be felt by GPs.
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According to the Cass Review, the current situation has already led to GPs being “under pressure to prescribe hormones after these have been initiated by private providers”, noting that there is a “lack of clarity around their responsibilities in relation to monitoring”. but that” no clinician should prescribe outside of their competence, and GPs should not be expected to enter into a shared care arrangement with a private provider, especially if that private provider is operating outside of guidelines the NHS”.
Holistic care
The solution identified in the Cass Review is regional hubs with a “broad multi-professional workforce” to end the situation where gender disparity is treated in silos and potential confounding factors (trauma, mental health, undiagnosed autism , repressed sexuality etc.) are excluded. from the equation.
Young people should be “treated holistically and not just on the basis of their gender presentation”, with access to “psychiatrists, paediatricians, psychologists, psychotherapists, clinical nurse specialists, social workers, specialists in autism and other neurodiverse presentations, speech therapists and language, occupational health specialists and, for the subgroup for whom medical treatment may be considered appropriate, endocrinologists and fertility specialists”.
It remains to be seen whether the Scottish Government will adopt such a model north of the border and – more problematically – how easy it will be to staff.
