| Formation | 1989 |
|---|---|
| Legal status | Closed (28 March 2024) |
| Purpose | Gender identity services for under 18s |
| Headquarters | Tavistock Centre |
| Location |
|
Director | Domenico Di Ceglie (1989–2009) Polly Carmichael (2009–2024) |
Parent organisation | Tavistock and Portman NHS Foundation Trust |
| Affiliations | Tavistock Institute of Medical Psychology and NHS England |
| Website | gids |
The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with transgender and gender diverse youth, including gender dysphoria. Launched in 1989, GIDS was commissioned by NHS England and took referrals from across the UK, although it was operated at a Tavistock and Portman NHS Foundation Trust site. GIDS was the only gender identity clinic for people under 18 in England and Wales and was the subject of much controversy.
GIDS faced significant criticism from both transgender people who argued that the service delayed people too long before offering gender-affirming healthcare and required invasive assessments and gender-critical people who opposed gender-affirming care for youth. [1] By 2020, a drastic increase in referrals led the waiting lists in excess of two years. Between 2020 and 2021, GIDS stopped offering hormonal treatments to youth per Bell v Tavistock before it was overturned on appeal.
In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres, following the release of the interim report of the Cass Review, in order to reduce waiting lists and provide better quality care to young people. [1] [2] The service closed in March 2024.
GIDS was a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children's department, which developed many works by Robertson and Bowlby on attachment theory. [3] In 1959, it opened an adolescent department and in 1967 it was absorbed into the London Child Guidance Clinic. [4]
GIDS [6] was founded in 1989 by Dr Domenico Di Ceglie, a child and adolescent psychiatrist. [2] It was one of the first child gender services in the world. After its opening, "it got two referrals over the whole year." [7] It was initially based at St George's Hospital before moving to the Tavistock and Portman NHS Trust in 1994. [8] The clinic saw 12 patients that year, increasing to 24 two years later. [8]
In its early years, the service took a primarily psychoanalytic approach reflecting object relations theory, drawing from Di Ceglie's training. Di Ceglie dubbed children referred to the clinic as suffering "atypical gender identity organization. [1] In the early 2000s, some of Di Ceglies colleagues at Tavistock published articles in the Guardian arguing that medical transition was a form of "mutilation" and that rights won in the European Court of Human Rights for transgender people were a "a victory of fantasy over reality". [1]
Di Ceglie estimated in 1993 that only 5% of his patients would "commit themselves to a change of gender". [9] [1] Puberty blockers were considered a usable option by the end of the 1990s but only for patients aged 16 or over who had first tried extensive therapy. [10] In 2000, a retrospective audit led by David Freeman looked at the records of 124 patients the service had seen since opening. The audit showed it was very rare (2.5% of the sample) for young people referred to GIDS to have no associated problems and that children do not "grow out of it" and problems increase with the onset of puberty. [11] [12]
In 2009, Dr Polly Carmichael, a consultant clinical psychologist, succeeded Di Ceglie as the clinic's director. [13] [7] [14] [15] In that same year, GIDS became a nationally commissioned NHS service. [13]
In 2011, in response to changing international standards for gender care, the clinic began a research study allowing a "carefully selected group of young people" to receive puberty blockers after the age of 12. In 2014, prior to the study's completion, the clinic received NHS approval to offer them without mandating enrollment in a research study. [1] In 2012, the service was extended to a satellite site in Leeds. Endocrine support was also extended to Leeds Children's Hospital at the Leeds General Infirmary site in 2013. [16]
In 2011, a patient satisfaction survey found the majority were satisfied. However, a quarter expressed dissatisfaction with long wait lists and dissatisfactions noted also included geographic inaccessibility and the requirement of real-life experience. [17] Other research and NHS consultations in 2015 found transgender people who'd been through GIDS described strict assessment procedures as demeaning, invasive, and disempowering. Patients reported being asked irrelevant prying sexual questions and a lack of power over their own health decisions coupled with a requirement to perform their gender in ways amenable to the staff. [18]
Between 2014-2015, 697 youth were referred to GIDS and in 2015-2016 1,419 were. In September 2015, GIDS overshot it's 18-week waiting time target for the first time. The same year, an external report by Femi Nzegwu stated that GIDS was "facing a crisis of capacity" and recommended capping referrals. [19] By 2016 average wait times rose to nine months. [7]
In February 2019, it was revealed that the National Institute for Health Research (NIHR) had announced a £1.3 million grant for a voluntary study following young people referred to GIDS, to compare outcomes for those who elect to medically transition and those who don't. [20]
In 2020, over 2,000 children were referred to GIDS and in 2021 more than 5,000 children had been with waiting lists of over 2 years. [21] [19] In January 2021, the Care Quality Commission rated GIDS as "inadequate" citing the high caseload. [19]
In the mid 2000s, gender-critical psychoanalysts and psychologists became GIDs' most prominent critics, opposing gender transition altogether, particularly in young people. [1]
In 2018, Dr David Bell wrote a critical report of GIDS based on conversations with other GIDS staff. He argued that transgender children who desired medical transition were suffering from other psychological factors such as internalized homophobia, intergenerational trauma, social media, and commodification of the body. He further argued that most transgender children would desist and that medical transition should be a last resort for adults. [1] In November 2018, parents of 17-25 year old patients complained in a letter to the Trust board that their children were transitioning too quickly and they felt psychosocial factors made them want to transition. [22] In December 2020 Bell reported that he now faced "disciplinary action" from the Trust though he retired later than planned in January 2021. [23]
Dr Marcus Evans, a longstanding member of the Tavistock and Portman NHS Foundation Trust governance board, resigned that week in response to Bells' report whose arguments he supported. His wife, Sue Evans, had resigned from work as a psychoanalyst a decade previously. Together, they wrote a book in 2021 advancing their views on how to help a young person overcome their wish to transition and supporting gender exploratory therapy. Reviewers noted the book was full of prejudicial value judgements about transgender people. [1] Marcus Evans went on to co-found the Society for Evidence-Based Gender Medicine, which the Southern Poverty Law Center described as a hub of anti-LGBT pseudoscience. [24] [25] Subsequent to the Bell report it was revealed that 35 psychologists had resigned since 2016, including six psychologists who claimed there was "over-diagnosis" of gender dysphoria and a push for early medical intervention, [26] because "psychologists fear being branded transphobic." [27]
In July 2020, it was reported that Sonia Appleby, the "Named Professional for Safeguarding Children" at the gender identity clinic, had been in dispute with her employers since November 2019. [28] Appleby stated staff had come to her in 2015-2016 with "a worry that some young children are being actively encouraged to be transgender without effective scrutiny of their circumstances". Between 2017 and 2019 she made six protected disclosures and in 2018 told a colleague that there could be a "Jimmy Savile-type situation". In 2019, she was called to an informal meeting with the Trust's medical director who said a letter was placed on her file due to the Savile comparison. [29] In September 2021, it was reported that Appleby was awarded £20,000 by an employment tribunal who found the Trust's "quasi disciplinary treatment" of her damaged her professional reputation because she became well-know for the Savile comment and "prevented her from proper work on safeguarding". [30] [31] [29] The trust will not be lodging an appeal. [32]
In the early 2020s The Telegraph and gender-critical figures alleged that transgender youth charity Mermaids may have exerted undue influence on GIDS's clinical decisions, particularly concerning the prescription of puberty blockers and cross-sex hormones to minors. [33] [34] In October 2024 an inquiry by the Charity Commission found no evidence to suggest that Mermaids had inappropriate influence or ties to GIDS. [35]
In October 2019, the mother of a 15 year old patient on the waiting list for GIDS and Sue Evans filed a lawsuit against GIDS. [36] The pair's solicitor argued that "the provision at the Tavistock for young people up to the age of 18 is illegal because there isn’t valid consent" and that Gillick competence - a UK legal principle that those under 16 can make their own medical decisions "if and when the child achieves sufficient understanding and intelligence to fully understand what is proposed" - should not apply to gender-affirming care. [37] Later, Evans passed their role as complainant to Keira Bell, a previous service user and detransitioner. In a judgment delivered on 1 December 2020, the judges said that it was "highly unlikely that a child aged 13 or less would be competent to give consent to the administration of puberty blockers", and that it was "doubtful that 14 or 15 year olds could understand the long-term risks and consequences" of this form of treatment. Where the young person is 16 or over, "we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment." [38]
Following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020 or until appeals are exhausted. [39] Amnesty International and Liberty issued a joint statement emphasising their concern on "the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily autonomy." [40] Consortium issued a statement stating that the ruling "could have a potentially devastating impact on young people seeking access to medical services." [41] The judgment was overturned by the Court of Appeal in 2021, who found it "innapropriate" as it was established legal principle that "it was for clinicians rather than the court to decide on competence". [42]
In 2020, due to a significant rise in the number of referrals to GIDS, NHS England and NHS Improvement commissioned paediatrician and former President of the Royal College of Paediatrics and Child Health Hilary Cass to lead a review into gender identity services for children and young people. [43]
In March 2022, Cass published the interim report of the Cass Review. The report found that the existing model was "neither safe nor viable", partly as the rise in referrals had left GIDS staff overwhelmed and led to "unacceptable" waiting times, and recommended the creation of new network of regional centres. [44] It criticised the care at GIDS, saying that its clinical approach "has not been subjected to some of the usual control measures" expected of an innovative treatment and sidelined the patients' other mental health needs. [45] [46]
In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres. [47] [2] The regional centres are intended to provide more "holistic care", linking to other mental health services. [48] [2] After a delay, [49] GIDs closed in March 2024, and was replaced with two new services at Great Ormond Street in London and Alder Hey in Liverpool, which are intended to be the first of eight regional centres. [50]
In February 2023, documentary journalist Hannah Barnes published a book on GIDS, titled Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children . [51]
Services provided include: [52] [53]
No surgical transition options are available through GIDS. [52]
People referred to GIDS may also contribute to NIHR studies into gender dysphoria in children. [20]
Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.
The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.
The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kingdom and abroad. The Trust is based at the Tavistock Centre in Swiss Cottage. The founding organisation was the Tavistock Institute of Medical Psychology founded in 1920 by Hugh Crichton-Miller.
Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.
Kenneth J. Zucker is an American-Canadian psychologist and sexologist known for the living in your own skin model, a form of conversion therapy aimed at preventing pre-pubertal children from growing up transgender by modifying their gender identity and expression.
Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.
Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. Since the 1990s, they are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity under what became known as the "Dutch Protocol". They have been shown to reduce depression and suicidality in transgender and nonbinary youth. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.
Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:
Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.
Transgender rights in the United Kingdom have varied significantly over time.
Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. The term is distinct from the concept of 'regret', and the decision may be based on a shift in gender identity, or other reasons, such as health concerns, social or economic pressure, discrimination, stigma, political beliefs, or religious beliefs.
Mermaids is a British charity and advocacy organisation that supports gender variant and transgender youth. It also provides inclusion and diversity training. Mermaids was founded in 1995 by a group of parents of gender nonconforming children and became a charitable incorporated organisation in 2015.
A gender identity clinic is a type of specialist clinic providing services relating to transgender health care.
Bell v Tavistock was a case before the Court of Appeal on the question of whether puberty blockers could be prescribed to under-16s with gender dysphoria. The Court of Appeal said that "it was for clinicians rather than the court to decide on competence" to consent to receive puberty blockers.
Transgender Trend is an anti-trans British pressure group, which describes itself as a group of parents, professionals and academics who are concerned about the number of children diagnosed with gender dysphoria. It was founded in 2015 by Stephanie Davies-Arai.
Stella O'Malley is an Irish psychotherapist and author, with three books on parenting and mental health. She is a regular contributor to Irish national newspapers, podcasts, and TV. She made a documentary about gender dysphoria in children for Channel 4, and is the founder of Genspect, a self-described gender critical organisation opposed to gender affirming care.
Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.
Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children is a 2023 nonfiction book by BBC Newsnight investigative journalist Hannah Barnes. The book is about the NHS Gender Identity Development Service (GIDS) based at the Tavistock and Portman NHS Foundation Trust. Barnes said, "I wanted to write a definitive record of what happened [at GIDS] because there needs to be one."
GenderGP is an online gender clinic founded in 2015 by English physicians Helen Webberley and Mike Webberley. It is based in Singapore but provides services worldwide. It has been the subject of controversy within the United Kingdom as a result of regulatory actions taken against its founders.
The Independent Review of Gender Identity Services for Children and Young People was commissioned in 2020 by NHS England and NHS Improvement and led by Hilary Cass, a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health. It dealt with gender services for children and young people, including those with gender dysphoria and those identifying as transgender in England.
