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.