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Academic and Head of the Education Department at Goldsmiths University, Dr Anna Carlile, joins Dr Helen and Marianne, to discuss her research paper, “It’s like my kid came back overnight”, which focuses on the experiences of trans youth and their families accessing clinical care in the UK. Together they discuss inclusive education for trans youth, the issues faced when young trans people try to access care and how the approach needs to change.

If you have been affected by any of the topics discussed in our podcast, and would like to get in touch, please contact us via the Help Centre. You can also contact us on social media where you will find us at @GenderGP on Twitter, Facebook and Instagram.

We are always happy to accept ideas for future shows, so if there is something in particular you would like us to discuss, or a specific guest you would love to hear from, let us know. Your feedback is really important to us. If you could take a minute or two to leave us a rating and a review for the podcast on your favourite podcast app, it will help others to discover us.

 

Links:

“It’s like my kid came back overnight” – https://www.tandfonline.com/doi/abs/10.1080/26895269.2020.1870188
Follow Anna on Twitter – @anna_carlile
Find out more about Anna
The adverse childhood experience study: https://www.cdc.gov/violenceprevention/aces/index.html

 

We help teenagers who have nowhere else to turn

 

The GenderGP Podcast

Giving trans youth a voice with Dr. Anna Carlile

 

Hello, this is Dr Helen Webberley. Welcome to our GenderGP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.

 

Dr Helen Webberley:
Marianne and Helen here today, we have another lovely guest with us. We have Anna Carlile, who wrote a really lovely research paper on the experiences of parents of trans youth accessing services in the UK which caught my eye. It was really very enlightening. So, Anna, what I’m going to do, if you don’t mind, is pass this over to you to introduce yourself, tell everyone who you are, what inspired your research and a little bit about what the article was all about really. So, over to you.

Dr Anna Carlile:
Okay. So I work in educational studies. So I have a background as a secondary school teacher. And as a teacher of young people, who’d either gone to prison or were coming out of prison and had extra mental health needs and also children and young people with autism as well. I was working with young people who were permanently excluded from school. And I got, just got very frustrated about the institutional prejudice that they were experiencing around race, around sex and gender, and also around sexual orientation and social class. And somebody said to me, you should do a PhD on that if you’re frustrated. So, so I did, and that’s how I ended up as an academic at Goldsmith’s. I’m currently head of department, of the department of educational studies at Goldsmith’s, and I’m a senior lecturer in inclusive education. So all of my research is around children and young people’s experiences. And particularly my methodological approach is to draw on young people’s own voices and their own stories. So I see them as experts by experience. So that kind of drives everything I do. I never intended to be a queer academic doing all queer stuff, but I’ve kind of gone off into that direction. I don’t know. You just end up with your family, don’t you somehow. So I did a piece of work on LGBT inclusive education in schools serving faith communities. And then I did something around LGBT parenting families. And then I ended up talking to some support groups of young people who are trans, and they asked me if I would help them evidence the kinds of problems that the family say we’re working with were having in accessing clinical support. So I did an initial kind of piece of research about that. And then through that group, I met people who are with WPATH, including Annie Pullen Sansfaçon, who’s a professor working in Canada. She’s a Canadian professorial chair in trans children and families funded for 10 years by the Canadian government to work on that, which I think is fantastic. She had pulled together an international group of people who were interested in looking at the experiences of families trying to access clinical support. So she’s got someone working in Switzerland, we’ve got Damien Riggs in Australia. We’ve got Annie in Canada. And she asked me if I would do the UK side. So she had produced this set of questions. And the idea was to talk to pairs of people, a parent, and a child in the same family about their experiences and to interview them separately, to find out how their experiences were similar or differred. And the only requirement for inclusion was that they had some contact with some kind of clinical input around gender. So that’s how that came about.

Dr Helen Webberley:
See, that’s really interesting, isn’t it? Because I hadn’t appreciated that your background is in educational studies rather than healthcare, because it gives them, it actually should probably be why your article caught me and interested me so much because it was a different approach to the one that I’m used to reading or absorbing or learning from. So that’s really interesting. But you know, this kind of derived from your work on young people who are permanently excluded from school, because that’s something that we see quite a lot, Marianne, isn’t it? Trans youth who are unable to, for whatever reason, engage with their studies, with their social life, with schooling, even with home and family life, because of the difficulties that they’re facing across the board.

Marianne Oakes:
I’m not sure whether I’d consider them permanently excluded or permanently on able to attend because the support isn’t there. And I wouldn’t know what the difference is, what the truth of the matter is the struggle to get into mainstream school, because there are no protections. There’s no understanding and the prejudice that they received, but also I think a lack of understanding of what they’re actually going through within the family home and within the healthcare system. I think it all plays in. So yeah.

Dr Anna Carlile:
Yeah. I mean, the kids that I looked after, I used to work for a London borough, supporting children who are out of school. Most of them were permanently excluded, but some of them were labeled as school refusers and they were educated in the hospital school, which was basically just a little building where they would go every day instead of going to school and have one-to-one. And that’s where those sorts of kids would have ended up, I think. So it would have been young people with eating disorders, mental health issues, and other kinds of experiences of bullying and that sort of thing. I mean, what drew me to look at this crossover between kind of young people’s educational and health experiences was in that work, I did a lot of multi-agency support planning, and I found that first of all, education, social care and healthcare professionals, it was incredibly hard to get them in the same way, just because of timing. Secondly, nobody seemed to understand what everybody else was doing and what their job was. So it was, my job was to bring all of those things together as a key worker for those children, but it was very, very difficult. And it just struck me as terribly unfair that we were working with young people who already had a set of needs, so with no fault of their own. And then the institutions tasked with supporting them were inadequate. And that’s what really frustrated me. And that’s why I wanted to do that initial work in the first place.

Dr Helen Webberley:
Yeah. That’s really interesting because the small, very tiny list you just gave us then, you know, eating disorders, but on people who’ve experienced bullying and mental health issues, you know, there are trans youth who experienced all of those three or some of those three all the time. And it’s almost like the child themselves gets the label of being the one with the eating disorder or the one with the mental health issue the one that has been bullied. And what we forget is that there’s a step before that. And for trans people, it is a, being trans. And then the step between that and the eating disorder bullying or mental health, which is what happens to them, their experiences, which, which then results in eating disorders, because they haven’t got any other way of controlling their body shape or what have you and mental health issues, because they’re so frustrated. And then the non affirmation and the bullying just simply because they’re different. And I think you’re right, you know, it’s very difficult to get those professionals together. Can you get the doctor, the GP, the specialist, the school nurse, the teacher, the education minister, you know, the mental health doctor, all of those people need to be involved and getting them all together is really tricky. And then you’ve got that poor kid, who’s like, okay, I’ll go to the hospital school instead. You know, that’s really sad. You mentioned the young people’s stories in their own voices. And I think that’s certainly something that we’ve always tried to do. There’s a lot of talk about trans representation in decisions that are being made about them. And, you know, by the cisgender people are making decisions on the behalf of transgender people’s needs. And when we’re talking about child healthcare, how often does the young trans person get their voice heard? So, and I think, again, that’s what made your articles so powerful. We were hearing them from the core. We weren’t hearing a bunch of people discussing it out there on a limb. We were hearing it from their own voice, from their bedroom, from their computer, from their heart. Had you met any trans people or trans youth before you did this piece of work at all? Or was this kind of a new thing to you?

Dr Anna Carlile:
I have a background before being a teacher as a youth worker and being in the queer community, I’ve got lots and lots of trans friends and lots of LGBT parents had families who were friends who had many of the children in those families are somehow gender creative. Some of them are identifying as nonbinary. And my oldest child is also nonbinary as well. One of the important things about gathering young people’s stories and their parents’ stories, one of the reasons we wanted to talk to them separately was to ask them about how people in the family started talking about gender and possibly being trans. And whether there was a gap in time between when the child started thinking and talking about it to their friends and when the parent realized. And also whether there was a gap in time in terms of the beginning of the conversation and the parents affirmative actions, because often the criticism level to this sort of research is that, well, where did you get those parents from? You know, you’ve already got affirmative parents. So that’s going to skew the data. Where are the voices of families where people don’t agree? And the thing is, what I realized is that you can’t make that distinction actually, because first of all, the kids tended it to start thinking about this stuff for good, nearly a year, usually before they talk to parents about it. And then after that first conversation, it was taking parents a good year, year and a half to take it seriously. So we were talking to families where there was a period of non-affirmative interaction. They changed their minds over time, often in response to distress in the child, but also in response to persistence in the child, in the child’s own kind of narrative of themselves. This is something that I didn’t have space for in this particular article, but it’s something I really want to write about because I think it’s really important that first of all, you know, we can’t think of parents is either supportive or not supportive. Some are ambivalent and some become more or less supportive over time. So that’s something that I just wanted to include.

Dr Helen Webberley:
I mean, I think that’s, that would be an amazing piece of work to do. Funnily enough, for this morning when I was preparing for the podcast, I just wanted to get your article up to have a refresh and a reread. And my pitch it’s like my kids came back over night put into Google and you came up to top two and then rapid onset gender dysphoria came up as the third link. And I’m like, how did that come about? I guess it’s the overnight thing. And you’re so right. These young people don’t wake up overnight and say that I’m trans, but actually at the end of it, but by the time they found the guts and the language to speak to their parents about it, which takes some time, let’s be honest. And then by the time that their parent has learnt enough and accepted them enough to actually support and affirm their child, that’s when the kid comes back overnight and again, Marianne, you know, I’m sure you’d be, you’d be really excited about doing a bit of research. You know, perhaps in conjunction with Anna, on this. That people didn’t do this overnight, do they, Marianne? They don’t wake up in the morning, go, come on mum, take me to the doctor.

Marianne Oakes:
Well, the first, the first thing I to say, when I read the research, or what you’ve written, it was one of the first times, don’t want to say the only time, probably one of the first times where I read it. And I thought this comes from the right angle because I read so much research of some crazy professor or somebody academic that is trying to come from a cis perspective on what’s actually going on. And I didn’t feel that with what you’d written and I don’t know quite how you did that, but it was so refreshing. This notion that, and just going back to join everything up, not that you were saying before, where trans people, you know, that they are trans and potentially given the wrong environment, it leads to, you know, mental health issues, which can lead to suicidal ideation, which can lead to eating disorders. And, you know, all that could, I won’t say be eradicated cookbook could be eased by good education around gender and the acceptance that trans is real, that it isn’t a mental health issue, that some people are trans and it doesn’t have to be more complicated than that. And then I think I’m getting lost now with what I’m saying, but that, that’s what I was feeling when you was doing it. The idea that this is something that is rapid onset, that it’s, you know, there’s a social contagion that you can catch being trans, you know, a message that I put out to people all the time. They think because I’m trans that when people come to speak to me, I’m going to coerce them into being trans, which is quite the opposite. The last thing I want is somebody that isn’t trans trying to be trans. Does that make sense? Because it wouldn’t do me any good and it certainly wouldn’t do them any good. And there is no benefit to me. People who work in transgender health care for people to get it wrong.

Dr Anna Carlile:
Thank you for saying that. I think it comes across like that, partly because I’ve always tried to foreground the voice of the people I’m working with. And I take a participatory approach also for the last, I’ve taken a kind of academic ethical stance that I will no longer or ever again write about a group of people without somebody from that group of people, co-authoring with me. So Ethan Butteriss, he co-authored that paper, he’s trans, an out trans academic. And I always send it off for sense checking to members of that group as well. So if, you know, I recently wrote an article with a colleague about black girls in urban settings and my colleague’s back, and I would not have written an article like that without somebody from that community. So I think that’s really, really, really important. Around rapid onset, one of the things that I want to write about is this idea that children think about this stuff for a good several months before they tell their parents. So it might seem like a sudden thing to the parent, but it’s not a sudden thing with the child. So you might call it sudden disclosure. I don’t think you could call it rapid onset. So I think we’ve got evidence to show that actually. On social contagion, I mean, what’s interesting from these stories, is that what’s good about that (unclear 15:17) that those kids came from all over the country, including lots of, kind of small towns and rural areas, where they were the only trans person they knew. And some of them went on the internet and found that group of people, but not all of them did. And generally it wasn’t, they all had stories where they could talk about, I didn’t realize what was going on with me. I always had these thoughts about myself, but I didn’t have the words until I read this. So it’s not as if they read something and then thought, Oh, I’m trans. They were like, Oh, something’s going on with my gender? Oh, it’s called trans. It was more that way around. So we got loads of evidence to show that which kind of undermines the social contagion idea. The other thing is, in order to kind of persist, you, you would ideally want to have a nice experience if it was a social contagion thing, actually being a young trans person isn’t very nice. If you’re in school, you know, you’ve got all that bullying and stuff to contend with. It’s not the sort of thing you would, you would hang on to if it was just a social contagion thing. That doesn’t make sense to me at all.

Marianne Oakes:
Hardest thing for me to understand is to sell trans as a, you know, cool thing to do, or be. It is probably the hardest of anything in the world that there is no good reason to be trans unless you are trans, you know, I would not want somebody to even try, you know, try it because it could destroy you. You know, I don’t, I don’t deny that some people who are feeling lost and, you know, disconnected from the world, I know within the trans community or the trans scene, people forget, it used to be the trans scene when I first came out, talk about the trans community now, but we used to get a lot of people who were disaffected from society in different ways that would gravitate towards us because they felt we would understand what it’s like. So we would get lots of, you know, I hate to say, you know, women basically with self-esteem issues, you know, it might be weight issues. It might be issues around how they look. It might be that that they’d suffered trauma, you know, as a child because of their, and they want to feel warm and safe within the trans community. But I don’t think they would ever doubt that they weren’t safe, if that makes sense, but I can understand that some people will gravitate towards us. You know, they assumed it was being bullied. I’ll stand with the others being bullied and safety in numbers. And perhaps if I stand next to the trans girl, people will ignore me.

Dr Anna Carlile:
There’s an area of education called trauma informed education, which looks at the neurology of trauma and how people working in institutions like schools can act to counteract those effects and sort of basic stuff like, you know, if you’re working with a child and they’re completely neurologically dysregulated, then there’s no point in trying to teach them maths until you’ve built the relationship and calm them down and calm yourself down with them. Only when they are regulated can they think clearly enough to learn the maths content? So it’s this idea that trauma is something that should be in mainstream education, as understood as an area of understanding and linked to trauma informed education is this big research study, which you might’ve heard of called the ACEs study, the adverse childhood experiences study. So somebody in the States looked at a huge data set from the healthcare provider, Kaiser Permanente, it was actually from an obesity clinic and it was in, it was over 50,000 medical records and they looked at the adverse childhood experiences people had, and they came up with 10. And if you have four or more, you’re more likely, very much more likely like four times more likely to go to prison, have a drug addiction, lose your job, get divorced, and also to have inflammatory diseases like heart disease, cancer, and things like that. So what it did was it showed and that they numbered these 10 adverse childhood experiences. One was bullying. One was childhood physical abuse. One was neglect. There was sexual abuse. There was a parent goes to prison, a variety of things. So that was a few years ago now. And the problem that I had with it was, you know, there were other kinds of trauma that we’re not including hair. THE ACEs study really seems to focus in on the family. What about minority stress? What about institutional racism? So I’ve had a look and people are starting to write about this now, and they’ve added in four more, which are related to the stress experienced by people who are in minority groups. So I think it’s useful to think about the sort of negative presentation of dysmorphia and dysphoria as a result of trauma, as opposed to some kind of genuine problem inside the trans child. And so what all that builds up to in my mind is that it’s much easier for an institution like a school or the NHS to pathologize individuals than it is to turn their attention on the institution and find out what the institution should be doing better or doing differently.

Marianne Oakes:
If I am understanding you correctly. And what I was thinking about there, that there’s, there’s a tendency. When we talk about trauma, we dissolve, there’s probably more research into dealing with trauma than dealing with the problem that causes the trauma. If that makes sense. So in other words, we, we can understand trauma and how it works, and we can understand what it does to a child’s ability or anybody’s ability. But what there doesn’t seem to be enough focus on, is that a, you know, why have we got this happening in 2021? Why, why do we have this trauma? Why is this such a lack of understanding? But the thing that bothers me as a therapist, and I hear it all the time, the trauma hasn’t stopped for certainly for trans children, it hasn’t stopped. It’s relentless. You know, not only are they bullied in the school ground, they then go and speak to the teachers who kind of say, well, what do you expect if you’re going to wear a skirt? And then they go to the medical professionals who said, well, you need to tell us more about this. You need to, and then it just goes on and on and on. And it never stops. The trauma is being reinforced for them. And actually it’s stopping it at the start. That’s really important, I would say.

Dr Anna Carlile:
Absolutely. And that’s why we need to look at how things operate. And that’s why I’m interested in kind of schools and clinics, but some other data from that same piece of research, it was so much of it. We obviously have to be very focused in that one article, we’re working on another one now called the Buddhist Center and the Ballet Class. What we want to show is that outside of those big institutions that are told what to do by big policy makers, like the department for education and things like that, people are actually just getting on with being really nice and increasing. So one story is from a young man who was a ballet dancer, and he went to ballet class. And when he talked about it at CAMHS, where he was seeing a therapist about gender, trying to get a referral to GIDS, his CAMHS, therapist said, well, that’s not very masculine. Is it? Why are you still doing ballet? If you’re serious about this? Like, ridiculous. But then he goes back to his ballet class and they, they are, they’re like, Oh, okay, you are a boy, fine, let’s give you a men’s part in the Christmas show. Let’s really showcase your abilities. And again, another young man him and his mom went to this, Buddhist center, and off their own back with no prompting, they said to the family look, would you like us to do a renaming ceremony for you? We can do that if you like. And they, and they were really pleased. It felt very held. It was very inclusive. So this article is going to be about how outside of these large institutions, people are just getting on with being affirmative and inclusive. And what we want to show is that it’s not difficult.

Marianne Oakes:
And that, you know, if you want to believe what’s in mainstream media, you might think that everybody’s super anti-trans, especially anti trans children, but actually there’s evidence to show that out in the real world, people are getting their heads around. It just fine. Lots of possibilities and models for being inclusive and supportive.

Dr Helen Webberley:
You almost made me cry, Anna. That’s really powerful. Please make sure you let me know when you write that article. Part of the problem here is exactly what you said. We’re pathologizing. So you go to the doctor and the doctor says, are you sure? Go away and think about it a bit more. Tell me more about it. If you look at the research that informs doctors, and then they all right, there’s not enough research, but the research they want to read is, does that pill harm or help that person? And that pill or that gel or that patch is such a small part of all of what we’re talking about. And you’re quite right. It’s pathologizing it and bringing it, boiling it down into what medicines should be used for this person and how many blood tests should we do. And what will the outcome be and how will we manage it, and how do we make sure it’s safe? It’s such a tiny part of this. And when people say there’s not enough research, they need to go and read research like yours, which is showing other bits, which are so vitally important to the health and wellbeing of trans youth in the UK and further afield. And those you want to mention further afield. I was really interested to hear what you said about your co-author, another Anna, wasn’t it, you said?

Dr Anna Carlile:
Annie.

Dr Helen Webberley:
Because she was from Canada. And we had we had a lovely person from Canada who came on the podcast with us, and she was telling us about the Canadian government and that they’d had an interested person high up in policymaking in the government. And therefore they’ve got funding, they’ve got education, they’ve got interests, they’ve got policies. And once again, we can see from this, that that’s what we need. We need someone at the top to say, this is important. We need to invest in this. And then you’ve got the other side of the coin, which is what you were just talking about that even at the local Buddhist center or the local ballet class, they’re getting it completely and utterly right. And that’s so heartwarming.

Marianne Oakes:
I just wanted to support what you said there as well. I feel I should say that despite what I read in the newspapers, and despite, you know, what’s said on Twitter and other social media platforms, you know, I live in a really conservative area me, and I’m integrated into the community and the people, I always. My mother, bless her, you know, grew up in a different area, she made a racist comment once. And I said, why, you know, why are you saying that? What about our doctor? And she said, oh, he’s different, he’s nice. And I think there’s that thing that when, you know, people actually, when they read about trans children or they read about trans women or whatever they read, it’s just a faceless, meaningless piece of work. And then when they meet somebody and you join in and you just, somebody that’s got an interest in life, all that other stuff fades, falls away. And I think that’s really important to remember.

Dr Anna Carlile:
Absolutely. And that’s why we have, that’s why we have to collect people’s stories and tell people’s stories because representation matters hugely. There’s a lovely piece of research, which my colleagues in the psychology department at Goldsmiths did on something called imagined contact. And what they did was they use Playmobile figures with children in a classroom, primary school kids about welcoming a new child who was a refugee into their classroom. And they found that, they did the psychological tests before and afterwards. And they found if they play role-played meeting this kid with Playmobile that the children were more accepting and better at supporting that child to integrate when they arrived. And, you know, you can have imagined contact with people who are not like yourself through all sorts of things. Through watching TV programs, reading things in books, and the opposite is true as well. If you get all of these negative stories all the time, then that will also affect your understanding of things. And that’s why it’s so important to get these stories out. And that’s why it’s so important to have things like podcasts like this one, so that people can get the stories out there and people can hear what life is really like for people. I think I see myself as a storyteller really.

Dr Helen Webberley:
Anna, tell us more stories about the people that you researched through your article and the instances of navigating the young people’s view UK national health service for transgender youth.

Dr Anna Carlile:
So one really striking set of stories. So what we do as qualitative sociological researchers, is listen for research saturation. So that’s when a theme emerge is a few times from more than one, two or three stories, and you think, Oh, hang on, I’ve heard this before. This is starting to be a theme. Now this is starting to take on a, this is a thing, isn’t it? Well, I need to look at this and listen out for it. And one of the themes that emerged was how families on very low incomes were scraping together money to buy support privately, to buy clinical input privately because they just couldn’t get what they needed on the national health service, which they paid into for years and years and years. So one family had a total income between both parents of 16,000 pounds a year, and they were scraping together the money to pay for hormones for their kid. Another kid had given up his favorite sport because he needed that time for a Saturday job to pay for his hormones. And so, you know, there was story after story like that. So that really told me, you know, people, this is not an easy, you know, it’s like you were saying earlier, Marianne, it’s not just an easy thing to do. You don’t just do it because other people are doing it. This is major life changing stuff, and it’s hard work, you know, and, you know, you can really see it in the way that people, they were borrowing money from friends. They were borrowing money from family members, just any way they could scrape it together to support their child in some way. So that’s one major story that emerged from it. Another one was the, the interesting experiences that children were having in school, especially what I found interesting was that single sex schools are not necessarily the worst place for trans kids, particularly trans boys. What we found was that it was in some ways easier for a trans boy to be a boy in a girl’s school, because they were the boy in the girls school. They weren’t being compared to all the other boys like they would in a mixed school. And actually teaches where I, you know, teachers were okay about it. One of my PhD students is doing work on LGBT inclusion, kind of lunchtime groups in single-sex schools. And she runs, her name is Alison Zions, and she tweets as @getupandteach on Twitter. And she runs a rainbow club at lunchtime. And some of her kids asked if she could set up a lads club. So this is a girl’s school, but she had some trans boys in her group. And now she’s got a lab’s club. That’s what they wanted to name it. And so they, they found a supportive space in that single-sex school. So that’s an interesting one that I didn’t think I’d find. The problem with the way that schools respond to trans kids, and they don’t always respond adequately, either, that has to be said. Usually, it’s inadequate, but the problem with the way they respond, even when it’s positive is that they tend to respond to the trans children they have rather than thinking beforehand about what they would do if a trans child arrived. So what that means is that because they’re in the very small minority, when they do come out as trans and they need that support and they need somewhere to go to the toilet and they need guidelines around what uniform they can wear and where they change for PE and what, what sports they do and all of that kind of stuff. They have to do their own self-advocacy to make changes in the school. So what really needs to happen in schools need to think about how they’re going to support all kinds of children before that child arrives and has to advocate for themselves. Another interesting one is faith schools and school serving faith communities. It doesn’t seem to matter whether we’re talking about a Catholic school or a state school. What seems to matter is the willingness of the senior management to implement inclusive actions. Some Catholic schools, and some church schools are very inclusive and some aren’t, some state schools are inclusive and some aren’t. So it’s much more to do with the, the people in power, in positions of power than anything else. And then, you know, building on what you were saying earlier. I’ve I think I’ve always thought, I remember when I was training as a teacher and I read the African-American educator, Lisa Delpit. And she said, if you’re not, if you’re white and you’re not actively, anti-racist, you’re colluding in a racist system. And I think that as a cis person as well, if you’re cis and you’re not actively anti transphobia, then you’re colluding in a binary gender system, which is harmful to trans people. So I think that in terms of our positions of power, what you were saying about earlier, Helen, as being a member of the medical community and feeling responsible, I think if we’re in those positions of power and we’re actively working against that prejudice, then we’re doing what we can to kind of challenge that system. It’s if you don’t act and are just passive that that’s the problem.

Dr Helen Webberley:
Well, it’s a start. I mean, I think building on your last comment that we’ve said this so many times that the person who’s, you know, all of these schools, all of these health services will have their inclusive policies or their policies that will affirm people’s gender or their position or their healthcare needs. Cause we’re talking about health care. But the policy doesn’t get always get adhered to, and you’re quite right to have the piece of paper. Policy is one thing. And to have it checked by a trans person to make sure it’s fit for purpose is another thing. And then to actually enforce the implementation and keep refining it and developing it requires that person at the top of the leaderboard to help us on that. And we see that time and time again. And I’m thinking about those poor case studies that you’ve just shared with us, you know, if people giving up their favorite sport and, you know, literally scrambling around for pennies. And again, that makes me feel guilty because I founded GenderGP as a private health service to fill a needed gap. I honestly wish that there was funding for it and that the NHS could step in and provide, that the NHS does provide care, but the care isn’t available at the right time, at the right level at the moment. And that’s a problem. We introduced the GenderGP fund, which has been a tremendous success. I think that the people who’ve been running the fund have kind of just set it up and said, okay, let’s see what happens. And we had a couple of amazing donations and there have been people who donated even just three pounds, which just, just so amazing to help and, you know, and the people that that helps is amazing, but what we do so desperately desperately need is to make sure that that service, like you said, that people are paying into all (unclear 35:57) produces what’s needed. And it feels like such a long way away, but I hope, I hope we can get there, but in the meantime, you know, if anybody is struggling, then I know GenderGP has a Fund and it is there to help alleviate suffering. So please, please use that. And if anybody wants to support somebody who needs funding you know, I know there’s lots of places where everyone’s money is needed, but it does save lives.

Dr Anna Carlile:
And also, you know, it’s very easy to criticize the marketization of healthcare. And there are huge problems with that, obviously, but it also does, you know, if you’re thinking critically, if you practice a bit of critical bureaucracy, you can use those spaces to create alternatives. Well, GenderGP does, is it demonstrates what can be achieved given the space and, you know, without that model, I appreciate what you’re saying. Absolutely. But without the model that you’re providing, I think it would be hard for people to imagine another world other than (unclear 37:02) one that we have in the NHS. I mean, another example of what, what the families we spoke to said about being able to access private health care in this area was that a lot of them, we got a good data set because we got families that were living all over England, as opposed to just in the main cities, which is what you often end up with. But what they were saying was that it was very difficult to travel to their appointments because the appointments were so few and far between they never get choice as to what day they can do it on. So when they do travel, they’re going to miss a whole day of school. And I remember one of the kids saying, so what I have to do is I get a taxi and then a bus to the station. Then I get a train. Then I get in another taxi. I go to the clinics and it’s a taxi back to the train and it’s a train back and then a bus and then a taxi home. And it costs me 56 pounds. And I don’t like it, but you know, I have to do it because that’s where my nearest clinic is. And that’s just completely irrational. You know, this stuff, we ought to be able to access this kind of stuff through our local GP, actually. The other thing that I noticed the difference between in terms of what the children and young people said, it was around their appointments with around the assessment and intake and assessment appointments, comparing NHS to private services, the NHS kind of questions, whether they were at CAMHS or at GIDS, and there’s a whole set of problems, cancer, which should probably unpack a little bit as well. The sorts of questions I got were incredibly intrusive and driven by very strange assumptions. So they were one of the themes that emerged came from quite a few young people who said that they questioned over and over again as to whether they weren’t just actually a lesbian rather than a trans boy. And they found, first of all, they found being called a lesbian, very triggering for the dysphoria, because that would imply they were gender that they weren’t. And secondly, it was kind of like, what are you actually implying that it would be easy to be a straight trans boy than a lesbian girl? And actually, are you assuming that I’m a straight boy anyway, so those sorts of questions were both very intrusive and they would also ask questions like were you sexually abused as a child? And is that why you don’t want to be a little girl? So there were asked very direct questions like that, which were kind of offensive and triggering and not relating at all to what children were saying about their own lives and what young people were saying about their own lives. And they said that when they access a private service that was much more oriented towards their needs, the questions were the same questions, but asked in a hugely more respectful way in a much more open way. So they won’t ask, they weren’t asked things like, are you sure you’re not a lesbian? They were more likely to be asked something like tell me about your, you know, who you fancy or your sexual orientation. So they left it open. So I really saw a difference in terms of the quality of interviews that the families experienced between the two kind of sectors of public and private sector. Around CAMHS, there was a lot of confusion about the route of referral to NHS GIDS services. What most families didn’t know is that, of course this is pre Tavistock v. Bell, but what most families didn’t know is that they could refer themselves straight to Tavistock, if they wanted to. GPs thought that they had to be kind of ratified as trans by CAMHS before they could go to GIDS. So that was often a confusion. And then often you’d get this back and forth where CAMHS were like, no, your GP has to do the referral. And then the GP was like, no CAMHS has to do the referral. And then there were months wasted while these conversations were being held. And then once children were at CAMHS, they were faced with a therapist who was not specialist in the area of gender. And that’s when all of these ridiculous questions would emerge. And some of the CAMHS therapists were so worried about making the wrong decision that they would wait and wait and wait, and have more and more appointments where they tried to decide if a referral was appropriate. It was quite interesting about CAMHS. And I want to say, you know, I love the NHS and CAMHS does amazing work for a lot of children, but I’ve got friends, who’ve got children who are fostered and I’ve got friends, who’ve got children, who’ve got autism and ADHD and things like that. And problems getting appointments and specialist expertise at CAMHS are not limited to trans kids actually. So I think he’s really useful to think about the need to kind of look at how CAMHS operates. Because if we look at it from a broader point of view, I think it will become something that more people become interested in as something that needs to change. If it’s always about trans children, people will view it as a niche thing. But if we say, you know, foster children, aren’t getting the service they need either. And children with ADHD aren’t getting the services they need either. No one’s getting the service they need at this point. Then I think there might be some kind of impetus to change was happening in CAMHS.

Dr Helen Webberley:
Marianne, I know you’re going to have views on the style of questioning. I think our questioning has changed, hasn’t it? Over time as it’s developed. And I know you’ll have some say on that.

Marianne Oakes:
Two things, I was going to say, I think one real good piece of research that would be useful is working out what the role of therapy is for a trans person, because the reality is to go, I don’t care where you go, whether you go to CAMHS, whether you go to GIDS, whether you come to GenderGP, or whether you go to the local charity or some private practitioner. What is the role of the therapist? I really think that is confusing because there’s no reason why a CAMHS person needs to ask about your sexuality or get clarification on whether you are trans or not. And that’s where Helen’s taught me because, you know, I came into this really nervous and you know, they wouldn’t be here if they weren’t trans, why do we need to establish that this child believes they are trans? We don’t, they are trans. What we want to do is say, how can we help you? What does that mean to you? What, so I think actually establishing what the role, I think some research into actually what’s the motives behind the clinicians coming into this area? Do they believe that trans is real? Do they, can they say that a child is trans because they are saying they’re trans? Because if they can’t, they could potentially cause damage. It doesn’t mean, so we’ve got to comply with the child’s wishes. We’re there to help them to understand themselves better and you know, the implications and inform them, but we’re not there to invalidate their feelings. What if they genuinely believed they’re trans and some, some highly qualified psychiatrist saying, well, I don’t think you’re trans enough. Damaging. If you stifle somebody’s identity on any level, you’re going to damage them.

Dr Anna Carlile:
Absolutely.

Marianne Oakes:
So, yeah, I think research into what’s the role of therapy. What’s the role of a psychiatrist. You know what determines that somebody is at such a level that they need to see a psychiatrist, they’ll be sent to CAMHS. And what point, how do we educate them? I hope Helen’s going to agree with me here. She does shout at me on occasions. You know, on what level does a GP send a child outside of their surgery?

Dr Anna Carlile:
That’s a very good set of questions. Actually. Interestingly, now I’m in the middle of submitting a research based on some of that. Well, two different research groups, one’s Damian Riggs in Australia. And the other one is Ruth (unclear 45:10) trans learning partnership. So actually, with Damian Riggs, we’re going to look into the question of what questions are asked and why do they need to be asked. And with Ruth, we’re looking at why are people kind of directed down the line of needing to be interviewed by two psychiatrists? Could we cut waiting lists by getting rid of that requirement? Because it actually turns out that the only reason that adult services do that is history. There’s no, there’s no research that shows that you should be interviewed, by two, and have the agreement of two psychiatrists. before proceeding into care.

Marianne Oakes:
As Helen, as all our listeners know, I I’m an NHS patient basically. And I went through that system. I don’t believe I have gender dysphoria. I just believed I was a trans woman. I don’t believe that I was in any disturbed state yet. They insisted that I had to have a diagnosis of gender dysphoria. What I would argue is that I didn’t want to be gender dysphoric and I was seeking care to prevent that happening. And all they did was reinforce that that’s what I needed for them to be able to help me. I think that there’s so many misconceptions. We’ve come a long way. We know enough about ourselves and trans people to be able to filter out. Some people do need that level of intervention. I would not want to be dismissive of it where it’s filtering out, who needs that level of intervention and what role did I want the GIC to play? And I wanted them to stop me being traumatized by transition. That’s all.

Dr Anna Carlile:
Well, it’s a good way of putting it. And that actually came out some of the things the kids that I interviewed said, because basically they would kind of think about how they needed to talk about their experience to the clinicians. So a lot of them talked about having gender euphoria because they were in very supportive environments and they could just be themselves and they were perfectly happy and they didn’t have dysphoria at all, but they were worried about saying that to clinicians. So sometimes they would hammer a bit how stressed out they were by the whole thing, in order to get service they needed. And we got the same. We got the same input around being nonbinary as well. More of the kids had nonbinary kind of identities that they would talk about privately than they actually had externally. But there’s no way they would have shared that when they went to their appointments, because they worried about not being understood and not getting the treatment they needed, because they didn’t think that the clinicians they spoke to could understand that you could both want top surgery and feel nonbinary. They felt that that was completely anathema to the way that the clinicians they met worked. So the problem is that the clinicians see over and over again, these very binary, dysphoric kids. That’s what they thing they’re seeing. But actually, because of the assumptions that they’re making, that perpetuates the sorts of narratives and stories that children, young people feel that they have to tell about themselves. And that also came out in another piece of work by Andolie Marguerite. They did a PhD on that, which found that children and young people change what they say because they are strategically trying to access clinical services.

Marianne Oakes:
So to put it into perspective, the, you know, the reality is gender affirming care means we’re here to help you explore your gender and what that means to you. And as you explore that, you will get the care package that is suitable to your requirements, not go down and actually have treatments that you didn’t want, but you felt if you didn’t say you wanted them, then you wouldn’t have got what you did want.

Dr Anna Carlile:
Yeah. I mean, you make it sound so reasonable. Common sense, right? That’s how it should be.

Dr Helen Webberley:
On that note, we could talk forever on this. And I would really like to have you back. I’d love to have you back once you’ve done some more research and have some more stories to share. It’s been an amazing discussion. And once again, this is the future. It is simple. And this is the future of trans healthcare, gender-affirming care, no need to lie, and accessible to everybody in the way that they need it. So thanks for your research and helping us to inform health care policies and educational policies for trans youth. And as always, Marianne, thank you to you for joining us too.

 

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