I work in Child and Adolescent Mental Health Services (CAMHS). One of the roles of CAMHS is to act as a gateway to the Gender Identity Development Service (GIDS) at the Tavistock and Portman in London. GIDS is the only service in the NHS that can prescribe hormone treatments to young people under 18 with gender identity issues. I’m something of a CAMHS jack-of-all-trades, and gender identity issues aren’t a large part of my role, but they’re a part of my role nonetheless.
The purpose of this blog post is to assemble some of my thoughts on the role of CAMHS with regard to gender identity. It’s a bit different to my usual blogging content in that it isn’t so much giving my own views as inviting others to give feedback. I think I should give the usual preface that any opinions I state here are personal ones and not necessarily those of my employer.
If somebody under 18 wants to reassign their gender, then the usual route to do so is for their GP to refer them to the local CAMHS team. CAMHS then carry out an initial assessment before referring them to the GIDS. In Wales, where I work, the local CAMHS also have to apply for funding from the Welsh Health Specialised Services Committee. I’m happy to say I’ve never heard of the funding being turned down. CAMHS then remain involved to act as a local point of contact for GIDS.
I’ve heard the view expressed that access to a gender service shouldn’t be via CAMHS, because being transgender is an identity, not a mental illness. These objections are reflected in the new DSM5 retitling “gender identity disorder” to “gender dysphoria”. I have some sympathy for this view. After all, we’re agreeing that it’s not the young person’s mind that is necessarily “wrong” and might need to be changed, but their body. On the other hand, I know that GIDS feel it is very important for the local CAMHS to be involved, not least because the big changes a young person may be going through (not to mention the huge levels of stigma, harassment and discrimination still sadly faced by transgender people) can trigger a mental health crisis. Either way, CAMHS remains the route of access for a gender identity service in the NHS whether one agrees with this or not.
I’m not an expert on the process that a young person goes through, but my understanding is that it generally starts with psychological therapies, before proceeding to hormone treatment if the young person and the GIDS agree that this is the right option. They start with the more reversible treatments. Surgical procedures can only happen after the young person turns 18. It’s a long and arduous process, and some young people find the length of time extremely distressing, especially if they already feel certain who they are and what they want. Though I also know that the GIDS would say that these are huge changes, and by no means everybody will eventually go on to gender reassignment. They would argue that this makes it right and proper to take it slowly.
The main question I find myself pondering is this. Given that the local CAMHS teams are not specialists in gender identity, but nevertheless act as the gateway to a service, do we do a good job of treating young transgender people with respect and dignity? I would hope that we do. However, the stigma transgender people face in society is enormous, and the people who work in CAMHS are just as much products of society as anyone else. I wouldn’t be at all surprised if comments left in response to this post wind up not being flattering at all to CAMHS.
As I said before, this post is more of a request for feedback than me standing here as the “expert”. Is CAMHS doing a good or bad job when working with transgender young people? If it’s a bad job, what do we need to do better?