That UK Report On Healthcare For Trans Kids Just Gets Eviler And Eviler
That UK Report On Healthcare For Trans Kids Just Gets Eviler And Eviler
The Cass team knew. They knew and did nothing. They knew and said nothing.
Earlier this year Dr. Hilary Cass, a respected but conservative pediatrician in the UK, released a report reviewing how Britain’s National Health Service does (and doesn’t) provide gender-related health services to youth under 18 years of age. The report was supposed to clearly establish what was and wasn’t working in NHS’s “Gender Identity Development Services” and provide the recommendations that would determine the level and types of care that would be provided to trans youth for years — maybe decades — to come.
When it landed, the report was widely panned for omissions, distortions, and double standards, all consistently slanting the recommendations toward denying gender-related care. Ironically, denying care wasn’t needed: the Tories had starved Tavistock, the national centre for GIDS, to the point that no one added to the long waitlist for services likely to ever reach the top of the list before being bounced for turning 18. While that was bad enough, whistleblowers have now come forward to share that as the wait times grew longer, the number of children dying by suicide erupted to unprecedented levels. That fact alone would have argued for more access to care, not less, but Cass and her team not only rejected the obvious conclusion, they buried the evidence that children were dying.
Before December of 2020, possibly for as long as Tavistock Gender Identity Development Services (“GIDS” or just Tavistock) had maintained a waitlist, but at least for seven years, there had been one suicide of someone who could not get in for services, and though reporting is slightly unclear on this point, there don’t seem to have been any suicides for minors receiving treatment.
This date is important because this is when a court in the UK issued a terrible opinion in Bell v. Tavistock, and for the next three years as both wait times and suicides increased, the restrictions that started as a result of this case continued to be justified by the unfinished Cass Review. The two created interwoven rationalizations for denying care, or at least for delaying it indefinitely, which to both reasonable people and those suicidally hopeless appear indistinguishable.
But as we said months ago, “Recommendations against treatment are not neutral.”
While the Cass Report would like you to believe that there are no risks associated with denying GIDS to teens and tweens, as wait times grew, suicides shot up dramatically. The primary source documenting all these suicides is Jo Maugham of the Good Law Project, a progressive law center in the UK with a solid reputation. Maugham is reporting that he now has two sources — actual whistleblowers who are not revealing confidential patient identifiers like some people we could name — detailing that the Cass team knew about the increase in suicides and in the very best interpretation failed to act. It’s highly possible, though, that their sins are worse than omission.
W1 tells me that in the seven years before the High Court decision (on 1 December 2020) there was one death of a young trans person on the waiting list but in the three years afterwards sixteen deaths.
These figures are said to come from a presentation to Tavistock staff given by the Named Doctor for Safeguarding Children.
W1 also says they raised these concerns with Hilary Cass and a Director of the Tavistock. I have seen an email to both which sets out these death numbers.
That email also complains, vigorously, of the failure of both to engage with these numbers or W1.
When challenged, Cass pointed to paragraph 5.65 of her report, which states:
Text:
The Review met with the Tavistock and Portman NHS Foundation Trust to discuss deaths of patients (where known) who had been referred to or were currently or previously under the care of GIDS. The patients who died by suicide between 2018 and 2023 were described as presenting with multiple comorbidities and/or complex backgrounds. In addition the trust observed that risk of suicidality was heightened at transition points in care; for example between child and adult services. The young people were more likely to be registered as female at birth, identifying as male in adolescence.
If you look closely here, there’s no dividing line between the first suicide (July 2019) and the series starting after services were restricted (2021-2023). It’s also written in such a way as to obscure any role that denial of care might have played. They blame “complex” histories and comorbidities and difficulties after youth leave the GID list for the adult list, but they spend not a word of thought on the inaccessibility of care. The idea that treatment might help children more than infinite delay is not even a hypothesis Cass is willing to investigate.
The way 5.65 blames the transition “between child and adult services” is particularly insidious, given that teenagers are seeing their chance for care disappear as they are stripped from the Tavistock list and added to the back-end of the adult waitlist, without ever having been seen by GIDS clinicians. As 18-year-olds, they are effectively starting their wait over. This is a transition from one hopelessly long waitlist to the ass-end of a new hopelessly long waitlist. “Transition points in care” is itself an artful weasel phrase concealing the lack of care — in all senses — these teens received.
At a minimum this should raise the question of whether the long wait times are causing harm or, conversely, whether treatment actually saves lives. In a way, this seems similar to the research Cass called “missing”: one cohort of kids were given a waitlist with hope of services. After December 2020 another cohort was given an infinite waitlist and no hope at all. One group had a single death. One group had 16. Yet this politics-induced study informs Cass’s recommendations not at all.
It gets worse, of course.
Maugham is very careful to document (as well as is possible) the timing of instances of suicide associated with GIDS using published minutes of Tavistock board meetings. He finds that beginning January of 2022 the deaths of people on the GIDS waitlist are combined with those on the GICs (“Gender Identity Clinics” for legal adults) waitlist and those lucky ones receiving adult care as deaths of people ambiguously described as “in gender.” This protects the decision-makers denying care, but also compromises clinically significant information needed by providers.
In April of 2023 there is an age-disambiguated report of five deaths associated specifically with GIDS, but the causes of death are now obscured, so it is impossible to say if any of these children died of suicide or unforeseeable llama incidents. Again, clinicians really ought to know how their patients (or waitlisted patients-to-be) are dying, but this report scrubs that entirely.
And then? Then, Maugham reports, Tavistock stopped releasing its board minutes. They were also denying FOIA requests “due to poor performance and the potential reputational impact.” In other words, “We fucked up and we don’t want to look bad.”
Also over 2021-2023, Maugham finds that gender-critical harassment of staff was lowering morale, and there is a mention of a GIC-waitlist suicide that was connected with treatment delay and ongoing anti-trans harassment.
“If GIC waitlists continue to grow, there may be an increased chance of a serious incident” and “The risk is very real, and sadly we have lost a patient on the waiting list in this past quarter to suicide.”
On the adult (GIC) side, things have become so bad that in a breakout of the budget you can see a line item for suicide-proofing the clinics’ gender neutral bathrooms. The mind reels that they could justify £50,000 for suicide-proofing bathrooms but nothing for expanding actual care. What argument wins over the penny pinchers in one case but not the other, and why? (Spoiler: it’s anti-trans hatred. It’s always anti-trans hatred.)
All of this puts an exclamation point on criticisms of Hilary Cass and her recent statement that success of the GID and GIC programs should not be measured against whether trans people are happy with and for themselves.
Erin in the Morning’s latest reporting has a few details on several individual cases and how they were or were not identified, but one thing that no one seems to have done is present just how alarming this rise in suicides is mathematically. Because your friendly, neighborhood Crip Dyke is such a glutton for punishment that reading about trans kids dying isn’t enough, she went and did that math for you. According to her quick back-of-the-napkin calculations, the rate now is one death by suicide per thousand kids on the goddamned infinite waitlist per year.
That would be at least 38 times the risk for non-trans kids.
No one seems to want to report that; not Cass, not the NHS, not most media. While demographics on trans lives are often imprecise because of how often trans people are unrecognized and misidentified, but these are some solid numbers. There is a crisis among trans youth who can’t get care, but the one source that was supposed to give the public honest, unbiased information about exactly those youth and exactly that care launched a coverup instead.
The coverup is supposed to be worse than the crime, but how do you get worse than 16 dead children?
@CripDyke - A belated thank you for this article, as it let me contribute some meaningful information to a discussion on trans health in the UK last night. I was glad to have had it at hand.
You people act like this is a no-brained without any perplexing problems. What about people with penises in women’s locker rooms when girls are 14 or 15. What about chest binders for 13 year olds? To me that’s self-harm.