Study exposes health service failings for trans children and families

New research from Goldsmiths, University of London explores the experiences of transgender and non-binary children and their families in the UK’s healthcare system

Dr Anna Carlile’s report, published in the International Journal of Transgenderism, found high levels of mental distress caused by excessive waiting times for support; direct discrimination within healthcare settings; and a lack of attention or interest from healthcare providers in listening to the voice and expertise of the children and parents involved.

Workshop discussions with 65 people from 27 families focused on gatekeeper referrers (including NHS GPs), primary carers, and England’s sole specialist Gender Identity Development Service (GIDS), known as the Tavistock.

Key findings include:

• Mental ill-health for children and parents due to their experience in a range of healthcare settings

• Mental ill-health caused by long waiting list times and lengthy treatment pathways: this is particularly important given the time-sensitive needs of trans children due to the onset of puberty

• Under-trained practitioners, with a lack of knowledge of appropriate or new clinical research (for example, about cross-gender hormones and blockers)

• Painful mis-gendering and dead-naming experiences in healthcare settings

Dr Anna Carlile, Senior Lecturer in Education, Culture and Society, said: “Despite recent legislation changes and protections for trans people, our study suggests that the development of adequate healthcare for many trans young people in England isn’t close to keeping pace.

“The NHS in general is highly regarded and really appreciated by parents and young people in the UK – many of our participants discussed helpful interactions with some staff members. But themes clearly emerged of mental ill-health and distress, and of feeling ignored and undermined in all care settings.” 

The research project put young people’s voices at its heart, with information collection conducted through patient-to-patient and parent-to-parent interviews, which Dr Carlile then analysed. Half the participants were adults, with the rest aged 12-18.

Reported experiences include a young trans woman who attended an appointment in jeans and trainers being described by her GIDs practitioner as “not serious enough” to warrant support.

Three families reported that their child had been mis-gendered and dead-named (being called by their previous gendered name) in front of people in a busy waiting room. One transgender man was mis-gendered by two GPs and his GIDS clinic, denied the right to a referral, and advised that he would be “ok after therapy”, which resulted in declining mental health.

Several parents highlighted the poor economic sense for the NHS of long waiting times: arguing that short-term cost savings mean that fewer people are seen, and more young people then have more expensive longer-term mental health needs.

Dr Carlile said: “Most prior research about the healthcare experiences of trans and non-binary children has taken place outside of the UK. This new study is particularly timely given the 2016 conclusion of a UN committee that the UK is trailing behind many other countries in the speed and efficacy of provision for child and teen gender affirmative healthcare; and partly because of the recent unprecedented amount of negative and misleading media attention on young trans and non-binary people and their access to support.”

Data was collected with participants in a family support group which offers a parent helpline service, social groups for children and parents, and training for schools and other organisations. Dr Carlile’s analysis did not receive external funding.

'The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England, UK: interviews with members of a family support group' by Anna Carlile was published in the International Journal of Transgenderism on Friday 23 November 2019.