CW: This article contains references that some readers may find distressing


Despite our general policy of not sharing distressing or upsetting content, a number of disturbing accounts have recently come to light about the Belfast Gender Identity Development Service for Children and Adolescents (known as ‘Knowing Our Identity’, or KOI). We felt it was important for these young peoples’ stories to be heard.

The KOI website provides scant information about their services. This is the entirety of their “What the service does” section:

“The Knowing Our Identity (KOI) team provides expert help to children, young people and their families in relation to gender related problems. We make sure children and young people are listened to and helped by those around them. We work with children and young people up to the age of 18.”

Parents who spoke to GenderGP referenced years-long waiting lists, a lack of communication from the clinic and punitive treatment for children whose families were labeled ‘difficult’.

Antrim mother Olive* shared her daughter Orla’s* experience with us. Orla had attempted suicide several times, and after her fifth attempt she confided in her mother that she was trans. Olive says this revelation came as a relief to her.


“I thought now that we knew what was upsetting and causing her so much distress that we would get help from CAMHS. But we didn’t, they refused to help her, they took all her hope away. I literally begged them to help her but they just ignored me and wouldn’t.”


Olive was told that Orla needed to be tested for autism first, and that was going to take at least two years.I told them she wouldn’t be alive in two years but they refused to listen, she repeatedly hurt herself, on her tenth suicide attempt she was in a coma and I was told she wasn’t going to live through the night, they told me to kiss her goodbye.

Orla recovered and was placed in a children’s psych ward. Olive says that the staff told her that KOI were in the same building and that she was assured that Orla would get help with her gender issues.

“They lied, no one came near her at any point, they refused to call her by her chosen name, they strip searched her with a male nurse, the male nurses watched her shower, it was horrific.”

Hospital staff told Olive that Orla needed to stay at least another four months, but due to how her daughter was being treated she refused and told them she was taking her daughter home. “When I asked about help with her gender issues they told me that she was too ill to be referred to KOI. Too ill to get help, have you ever heard anything so disgusting in your life, who tells a suicidal child that they are too ill for help? That’s how my child was treated.

Olive says she made a promise to Orla that she would find someone to help them. Olive contacted the Rainbow Project, who put her in touch with Nicola Doran from SAIL NI, and Ellen Murray of the trans resource centre. “Within twenty four hours Nicola had me a lawyer and was coming to meetings fighting CAMHS with me to get Orla her referral to KOI. Nicola Doran is a force of nature and has been our literal lifeline.

Olive believes that because she got lawyers involved she was labelled a “problem” parent. When Orla’s appointment letter arrived for her first appointment with KOI it came in her old name. Olive called to ask them to change it to Orla and was told they would do this. Olive explained that Orla’s name had already been changed by deed poll and on her medical card.

Olive says she was very concerned that KOI staff would call Orla by the wrong name at the appointment, but she was assured that they wouldn’t. “They did. When I pulled them up on it they told my daughter that I had directed them to use her old name and it was my fault they did this to her. Orla was distraught and embarrassed.

As the initial appointment letter had said the appointment was for Orla AND family, Olive took her son, Orla’s brother too. Olive says the HCPs they dealt with were rude to her son and asked him why he had come.

During the third appointment, which Olive says was with one woman from KOI, Orla was told she needed to go home and “try harder to be a girl”.

“When I asked what they meant by that, she was told to go away and put on a dress and makeup. She was also told if she didn’t go back to school in a skirt they wouldn’t do her referral to endo as she didn’t meet the criteria. They literally blackmailed her into going into school in a skirt when she was still presenting as male, her hair hadn’t grown out yet etc. She had already told them she wanted to wait to come fully out until she left school a few months later and went to college but that wasn’t good enough for them.”

Olive says the appointment and instructions left Orla “distraught” and resulted in another suicide attempt. At the next appointment Olive brought a social worker in to witness the appointment as Orla had said she didn’t want to be left alone with the KOI staff. During this appointment, the same woman who had told Orla to try harder to be a girl, took Orla into a separate room along with the social worker.

Olive says that Orla (then aged 15) told her that the KOI staff member proceeded to ask her extremely intimate sexual questions about who she was sexually attracted to and if she masturbated.

A few weeks later Olive and Orla received copies of a letter from KOI with her diagnosis and with information about an endocrinologist referral for blockers. The letter also detailed that Orla masturbated. The letter made it clear that KOI had sent a copy of the letter to their family GP, the social worker, both of Orla’s therapists, and her psychologist.

“It was stated for everyone to see that Orla masturbated. They felt the need to degrade her.”

Understandably angry, Olive spoke with the children’s services manager in a meeting SAIL’s Nicola Doran had set up. “I explained what had happened, she told me that would never have happened, that that did not need to be in the letter and none of her staff would do that, so I took the letter out of my pocket and offered it to her to read to prove they had actually treated my child that way, but she refused to look at it. We have never got an apology or explanation.

Olive made an official complaint which she says was never responded to. KOI then canceled Orla’s blockers two days before they were due. By this stage Orla was 16. “I strongly believe it was punishment because I complained, again I had to get a lawyer and kick up a stink to get her blockers.

The following year Orla was due to start hormone therapy and the clinic cancelled her hormone treatment the day they were due to start. “I contacted GenderGP to get her help in the interim, and again got a lawyer onto them. Thankfully they backtracked and just a few weeks later she got her hormones, but again to punish her, the usual starting dose for her was supposed to be 2mg – I had letters from them stating that’s what they were starting her on – but they started her on 1mg.

Olive explained that KOI oestrogen treatment starts at 2mg, “then every six months it goes up until you reach the maximum dose of 5mg which you stay on for life. This is explained and discussed at numerous appointments, so you know the plan and what to expect at the appointments.”

Olive says they “took great pleasure” telling her and Orla that she would only be receiving the lower dose and that it wouldn’t make much difference to her.

“The children’s endocrinologist refused to speak to me at this appointment, addressed Orla and totally blanked me, she was obviously very annoyed we had got a lawyer involved and she had to fly to Belfast just to see Orla. She told Orla she was starting her on 1mg, I interrupted and said don’t you mean 2? You told us 2, we have paperwork stating 2? She ignored me, then said to Orla, ‘yes well you won’t see much difference on 1’ but refused to say why she changed her mind or why she wouldn’t give her the correct starting dose.”

Orla started on 1mg and at her follow up six month appointment the dosage wasn’t increased. “I didn’t let it drop and she put them up at the next appointment after I told her I would again make an official complaint. I showed her the paperwork I had stating what Orla was supposed to be prescribed, since then all the appointments have been repeatedly postponed and she won’t put the meds up.

Olive says even now, 16 months later Orla’s appointments keep being cancelled and they refuse to increase her dosage. “They do not like when you stand up to them or fight back and they will punish the kids if you do.

Olive says her daughter, now 18 now is doing much better, “but that’s in spite of them, certainly not because of them, they have made this process very, very stressful.


*names anonymised

**Orla gave permission for her story to be told.


Photo by Denin Lawley on Unsplash