Improving healthcare for trans and gender-diverse young people

Specialist trans health care in the UK is provided within the NHS for adults and children. For under 18s, care is provided by the Gender Identity Development Service (GIDS) based at the Tavistock and Portman NHS Trust. Adult care is provided by Gender Identity Clinics (GIC).
In the UK, there are several ways for trans and gender diverse people to access specialist healthcare. Being referred by a GP or Child and Adolescent Mental Health Services (CAMHS) are the most common ways for young people. Read more about GIDS appointments.
Parents and carers we spoke to had many ideas about how to improve the current gender identity services and pathways for trans and gender diverse children and young people. Their suggestions on what was needed were:
  • Additional, quicker and more local provision of services;
  • Support to people on the waiting list and their families;
  • Practical advice offered in the GIDS appointments;
  • Making the pathway clearer; and
  • Changing the pathway.

Adele encourages decision-makers, including within the NHS, to really engage with trans children and young people and consult them for ideas on improving the services they use.

Additional, quicker and more local provision of services

One of the strongest messages from parents and carers we spoke to was that the time it took to get support and access specialist care needs to be shorter. As Josie said, ‘These huge waiting lists really need to be dealt with. And another thing that would be really nice would be if there were more [gender identity] centres’. For Georgina, the timing of care was crucial and she spoke about the importance to support young people who were ‘on the cusp of puberty’ in particular.

Mel felt there was need for additional resources and more provision.

Find out more about experiences of waiting lists for GIDS.
Many parents we spoke to thought that the services should be made available more locally. They also felt that the appointments need to be more frequent. One parent said: ‘To have to travel for well, an hour and a half, two hours in order to get to the session. The session is every four to six weeks and they tail off to less. It’s difficult. Puts a lot of pressure on the young person to come up there and be forthcoming on that day. Something more locally accessible, I really dont see without a massive injection of funding that the sessions could be brought closer to the individual, be more frequent.’
Other parents emphasised the importance of ‘joined up care’ that would support the young people more holistically. Several parents we spoke to thought that CAMHS and GPs should be more involved in providing local services and support.

Support to people on the waiting list and their families

Another improvement suggested was that psychological support should be offered to people on the waiting list. Parents and carers we spoke to thought that there is a huge need for support while people are waiting and many people cannot afford to pay for therapy or counselling privately. Jan felt that GPs should continue to provide support even if or when a referral for GIDS was made. She said: ‘GPs need to be educated and they need to have an obligation to provide care and not just refer them on and then leave them floundering.’

E and D say people on the waiting lists are left high and dry.

To support families on the waiting list, some parents thought that all familes should be signposted to national and local support groups like Mermaids. Oonagh felt that GIDS had not provided this signposting.

Oonagh says that all families should be signposted to trans positive support groups.

Practical advice offered in the GIDS appointments

Parents also spoke about what they would like the GIDS appointments to offer. Some felt that practical advice on how to deal with everyday problems and challenges of living as a trans person would be beneficial. As one parent said what is needed is ‘resources on a practical level. Being able to access additional help, things like the speech and language therapist.’

Ali felt the Gender Identity Development Services (GIDS) could offer more practical advice.

Read more about the GIDS appointments.

Making the pathway clearer

Some parents felt that the current pathway needed to be clearer for the young person and their families. Kate, Oonagh and Georgina felt there should be more clarity and more transparency so that they could understand the process of going through GIDS. Kate also talked about how having more clarity about the waiting times for particular interventions would allow her family to consider private care, without feeling that they are left ‘on hold.’

Kate says the pathway needs to be clearer and quicker.

Changing the pathway

For some parents we spoke to, the improvements needed were much wider and related to how gender identity services were set up. Some of the concerns raised related to funding available for trans health services and support, which many parents felt were not sufficient. This meant that some interventions that trans people might need were not available on the NHS. For example, one parent felt that not being able to have facial feminisation surgery, on the NHS was unfair, as she felt it was key for the wellbeing of trans people.
Other parents felt that having specialist services with many psychologists and psychiatrists was based on an outdated model. Two parent thought that the care for trans and gender diverse children and young people should be separated out from mental health services entirely. Some parents wanted to emphasise that being trans was not a mental illness. Josie felt that being trans was not a ‘mental health issue’. For example, VM felt that ‘the vast majority of kids would be able to be supported by their GP. Gender services belong in primary care.’
Some parents felt that services needed more investment in gender affirming mental health and that additional psychological support was needed especially before and in-between appointments.

Josie says that gender identity services should be separated out from psychology and psychiatry.

You can also find out more about people’s messages for healthcare professionals.

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