News

Media enquiries

Topics related to gender identity - and issues that are relevant to many trans people's lives - have thankfully been receiving greater attention in the UK in recent years. This includes increasing interest in our service and what we do.

We welcome media enquiries about our work. Please contact our Trust’s dedicated press office who will be happy to help.

An internal review of our service

As reported in the Observer today, the Trust is currently conducting an internal review into issues raised about the Gender Identity Development Service (GIDS).

The first thing to say is that here at GIDS we have a long track record of thoughtful and high quality care in supporting young people presenting with symptoms of gender dysphoria. This is borne out by independent CQC inspections, as well as the feedback we receive from young people themselves and their families through our Experience of Service Questionnaire (ESQ)

All staff in the service are aware of the review and have been encouraged by both our Medical Director and Chief Executive to avail themselves of this opportunity to express their own views about the service. The Trust is concerned by the tone and manner in which allegations have been made. They reveal a negative attitude to gender dysphoria and gender identity which does not reflect the views or the approach of the Trust or GIDS.

In parallel, similar concerns have also been raised by a group of parents who have shared these with The Observer. They are concerned that the pressure on the service from rising referrals is leading to a fast-tracking of patients and a lack of regard for what they are calling rapid onset gender dysphoria. We recently published our view of the term and the phenomenon it refers to on this site

The GIDS was founded in 1989 and is one of the longest standing services for gender diverse children and young people in the world. Domenico Di Ceglie, who founded the service, wrote a set of therapeutic aims which we still abide by today. This includes the unconditional acceptance and respect for young people’s gender identity. We do not therefore take a view regarding the outcome of an individual’s gender identity development:  rather, our focus is to provide a space for exploration of gender, to ameliorate any negative impacts on general development and to work with young people to think through all the options open to them. These principles remain central to the delivery of the service.

A comprehensive psychosocial assessment precedes any referral to the endocrine clinic for consideration of physical treatments. Whilst it is the case that most young people attending the service have a wish to pursue physical interventions, 59% of those attending under 15 chose not to pursue an endocrine clinic referral.

We recognise that there are strongly held views among patients and families and their representatives including those who wish for physical treatment to be offered earlier or by those who feel that physical treatments should not be offered to young people at all.  The service has worked hard, and continues to do so, to maintain a balanced view in which we are fully aware of wider social, cultural, legal and political factors, but maintain a focus on an individual approach to care informed by the particular circumstances of each young person we see.  

We do not limit or curtail assessments because of pressure to move swiftly to medical interventions. With complex cases, rather than truncating assessments, we will often extend the time given to trying understand what may be going on. Whilst the national specifications against which the service is commissioned describe an assessment phase of between 4 and 6 meetings, one outcome of assessment may be further assessment. Nevertheless, we are always mindful that gender dysphoria is not in and of itself a mental health diagnosis. The young people seeking support from our service frequently experience high levels of distress, victimisation and isolation related to their self-identified gender. We are committed to ensuring we work to recognise and meet the various needs of all the young people we see in this complex and contentious field. 

We hope any families reading today’s news will feel reassured that their children will be cared for respectfully, comprehensively and mindfully. As a Trust and as a service, we are very alive to the current debates raging publicly about the care of gender diverse children and young people and we aspire to remain a safe place for children, young people and their families to come to to explore their feelings around their gender with the wholehearted support of a dedicated multi-disciplinary team of experts in this highly specialised field.

Our response in full to the ITV series Butterfly

The writer of the ITV series Butterfly, Tony Marchant, briefly met with two of our clinicians in 2017 to discuss the work of the Gender Identity Development Service. As part of the process, we were also given the opportunity to view a draft of the screenplay, although we had not viewed the final film at the time this response was drafted.

We frequently receive research requests for drama and documentary projects, and where possible we try to make our clinicians accessible, particularly to those creators who are approaching the issue with an interest in learning and not solely confirming previously held views.

Based on the story as presented in the scripts, we appreciate that Tony and the producers of Butterfly made a good faith effort to capture an understanding of work in this field. Raising awareness of the difficulties that young gender diverse people may face is important, as it can increase societal acceptance and decrease prejudice, and we support the show’s efforts to explore the experiences of the fictional family. However, we feel it is difficult for any single depiction to encompass the complexity and diversity of the journeys taken by the young people who come to our service. Consultation with young people and their families is a vehicle for talking about some of the complexities of the child’s feelings and any treatment decision they and their family wish to make: synthesising such a thoughtful and long term process in a few minutes of drama is difficult.

Given the diversity of the population of young people whom we see and the range of outcomes they may pursue with respect to identity and treatment, Butterfly tells only one version of a story of one young person’s journey, and every journey is different.

The first episode of the series includes an incident of self-harm. Tragically, there is a higher risk of self-harm and suicidal ideation or attempts found in LGBT communities compared to their cisgender or straight peers. Suicidality in young people attending the GIDS is similar to that of young people referred to child and adolescent mental health services. It is not helpful to suggest that suicidality is an inevitable part of this condition. Gender dysphoria is not a mental health condition in itself and we work hard with young people to ensure they can work out any issues they have around their gender identity while feeling supported. These might be internal issues around gender dysphoria, or external ones such as bullying or other adverse experiences they may have as a result of their gender identity. Our focus is on supporting young people to be resilient and positive and many of the young people we see are doing very well. It is important to note that it would be very unusual for younger children referred to the service to make suicidal attempts.

Increasing societal acceptance of gender diverse young people and decreasing gender-based prejudice may help prevent suicides. Suicide and suicide attempts are tragic and it is crucial to identify risk factors and develop interventions that address these. More positive narratives that reflect the evidence we have around risk are important.

Our waiting times and our therapeutic approach

With the continued increase in referrals to GIDS in 2017/18, we are aware that our waiting times have recently increased and that it can now take 14 to 18 months between having a referral accepted and being seen for a first assessment. We know that waiting to see someone at our service can be distressing for young people and their families, especially in a situation where the waiting time might increase. We are working hard to see everyone as quickly as possible.

We continue to work on innovative ways to deliver our service, both to reduce the waiting list and to support young people and their families while they are waiting. This includes running group sessions, and having a clinician rota available over the phone to respond to immediate concerns that may arise while on the waiting list.

In addition we are also working on improving the quality of referrals that come into our service to reduce delays before being added to the waiting list. Once a referral is accepted the original referral date is honoured, but it can take a lot of resources to get the information required to process referrals.

We remain true to our founding values and therapeutic aims – we provide a highly specialised service for children and adolescents who are experiencing gender dysphoria or need support to explore their gender identity.

We do this by fostering recognition and non-judgemental acceptance of diversity in gender identities and gender expression; providing support, advice and treatment to assist in reducing emotional, behavioural, and relationship difficulties and their effects; offering options for physical interventions as appropriate, and working with local services to prevent mental health problems such as anxiety, low mood, self-harm and suicidal thoughts. The service thinks about difficulties associated with gender identity development in the context of general developmental processes.

For families and professionals it can be difficult to know how to support young people with gender dysphoria as there are widely-differing strongly-held views – this social context and debate are moving faster than the evidence base. We are working hard to add to the evidence base and contribute to this changing field but understand that living with uncertainty is challenging.

As a service we need to remain thoughtful and work with young people and their families as individuals. Evidence shows that the physical interventions that some young people may choose to undergo can be tremendously beneficial. We also know that many young people who visit our service decide not to go ahead with any physical intervention.

We believe that individualised care is the best way forward – every young person is different and their needs and the best approach for them must be considered on a case-by-case basis. Many young people, given the space to explore their identity, are creating more varied pathways and understandings of gender, and find different things helpful in reducing their gender dysphoria.