Ireland’s Health Service Executive (HSE) recently announced they are beginning the recruitment process for a new Consultant Child and Adolescent Psychiatrist to lead a team within mental health services which will support the delivery of the National Gender Service.
This team will be responsible for providing healthcare for transgender youth in Ireland, who currently have no public health option available to them.
As the mother of an Irish trans youth, I am concerned that the HSE are specifically seeking a psychiatrist for the lead role. On the HSE website they define the role as follows:
- ‘A psychiatrist is a medical doctor that specialises in mental health. Psychiatrists are responsible for the medical care of psychiatric patients.’
- ‘Gender dysphoria is no longer considered to be a mental illness, and was removed from the global manual of diagnoses by the World Health Organization (WHO) in 2019. Children who are gender diverse are not all “psychiatric patients’.
To specify that a Psychiatrist would be the best person to carry out such a role shows the HSE are persisting with outdated and possibly discriminatory ideas about what it is to be trans. It also shows a lack of awareness of trans healthcare and what trans people need.
Gender specialists can come from a variety of clinical backgrounds and specialties. While there is currently no formal training or qualification in this field of medicine, any doctor can acquire the skills to provide gender-affirming care from peer reviews, personal study and postgraduate education.
My concern is that the HSE are still linking being transgender with mental illness. Being trans is not a mental illness, nor does it mean that someone has psychiatric issues or that they automatically require the assistance of a psychiatrist. Historically mental health professionals have contributed to the stigmatisation of, and in some cases torture of trans people, particuarly in so-called ‘conversion therapy’ efforts. Last year trans people took to social media to share stories about what had happened to them during their appointments with Ireland’s gender identity clinic professionals. Some people shared stories of being under 18 and being asked invasive and distressing questions about their sex lives. It is reasonable to expect that the trans community may harbour some doubts and suspicion about the mental health profession, given how some individuals have been treated in the very recent past.
Currently in Ireland parents are told they need to start on the pathway to support early, as the waiting lists can be years long. We are told to go to our GP, get a referral to CAMHS as soon as possible and then, if needed, try and get on another list to see an endocrinologist. This one-size all model does not work.
I know of one family with a very happy trans child who got to CAMHS only to be told that their child was perfectly well adjusted and happy and therefore after one session was discharged from CAMHS. This child was close to puberty when discharged and now with puberty causing this child distress, they have had to start the process of a referral all over again. That is not a sign of a system that is child-centred. There should be services for all aspects of a trans child’s life in place – people to support parents with their concerns, people to support with schools, and any medical and mental health support needed should be provided on an ongoing basis from a multidisciplinary team of experts.
There are currently around 100 children in Ireland who are being referred to a service that doesn’t exist. Some aspects of trans healthcare can easily be managed by family GPs, as happens in lots of other countries with better trans healthcare than Ireland. There has been no direction from the HSE for GPs to step up and provide care for the 100+ children who are currently left in the lurch with no services.
Study after study has shown that timely gender affirming care is best for trans children and can be literally lifesaving. The pathologisation of trans youth is stigmatising and also a form of gatekeeping – something the HSE has excelled at, particularly in its adult services (or lack thereof). The very least we should be able to expect from our health service is that they would follow the evidence and look to best-practice when it comes to creating a service for trans children.
Now that Ireland is starting from scratch we have a chance to create our own adolescent gender clinic service, one that could also be world-leading. In order to achieve this we need to look to best practices around the world, not just repeat the same mistakes that have led to a model of care which is not fit for purpose.