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Provision of care for children and young people when accessing specialist gender dysphoria services


The national investigation

This investigation will explore the care of patients who present to child and adolescent mental health services (CAMHS) with questions about their gender identity and are referred to specialist gender dysphoria services.

Some people feel their gender identity is different from their biological sex, or gender registered at birth. Gender dysphoria is a sense of unease, distress or discomfort that a person may have because of a mismatch between their biological sex, or gender registered at birth, and their gender identity.

Gender dysphoria is not a mental illness, but some people may develop mental health problems because of associated difficulties. This may arise where their sense of unease or dissatisfaction with their gender may be so intense it can lead to depression and anxiety and have a harmful impact on daily life. People may also experience bullying or discrimination.

HSIB was contacted by a mental health trust and asked to consider issues surrounding delays in accessing specialist services and the support available to patients with gender identity concerns presenting to CAMHS.

The NHS gender identity development service (GIDS) for children and young people provides specialised care for gender dysphoria to young people up to 18 years old. It has experienced year on year growth in the number of referrals received into its service, with over a 2800% increase in referral numbers since 2009/2010 and current waiting times of 22 months from the point of referral.

In addition, NHS England and NHS Improvement commissions seven adult gender dysphoria clinics (GDC) throughout England to care for adult patients. Current waiting times to access a GDC can be more than 44 months from the point of referral.

Reference event

HSIB identified a patient safety incident involving an 18 year old transgender man. The Patient had been referred to CAMHS at 15 years old with concerns about his mental health and gender identity. At 16 years old, the Patient was referred to the GIDS.

At 17 and a half years old, the Patient was advised by the GIDS that he would not be seen within GIDS before he turned 18 years old. His referral was then transferred to the waiting list of a GDC, where his previous waiting time with the GIDS was accounted for. However, the Patient was told that this would still incur a further 22 month wait before he could access specialist gender dysphoria services.

The Patient continued to receive care from CAMHS beyond his 18th birthday while he waited to access the GDC, during which time expressed frustration at the waiting time to access specialist gender dysphoria services. The Patient sadly died by suicide before his 19th birthday.

Investigation summary

The investigation will:

  • Consider the systemic factors impacting on the identification, care, and referral to specialist services of patients presenting to CAMHS with gender identity concerns.
  • Consider whether ongoing national work to review and develop gender services addresses issues highlighted by the investigation.