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Psychiatrists’ college stirs up debate about how to treat trans kids
From Sydney Morning Herlad, this article by Caitlin Fitzsimmons on 31/10/21 is worth a read.
Full text here https://www.smh.com.au/national/psychiatrists-college-stirs-up-debate-about-how-to-treat-trans-kids-20210930-p58w3s.html
Caitlin writes:
In the medical profession, there are few questions more contentious than how to respond to the growing number of children and teenagers seeking treatment for gender identity issues.
This would explain why Australia’s governing body for psychiatrists has come out with its first specific policy on gender dysphoria. It would also explain its ever-so-careful wording.
At first blush, the position statement from the Royal Australian and New Zealand College of Psychiatrists is innocuous, with its acknowledgement of past harms to the trans community and all recommendations couched in caveats.
But the statement suggests a shift in the college’s position that goes to the heart of the debate about transgender treatment, because it moves away from endorsing a “gender-affirmative approach”, particularly for young people.
College president, Associate Professor Vinay Lakra, says the intention was “not to put barriers in place” for trans people but to practise evidence-based medicine.
The position statement, titled “Recognising and addressing the mental health needs of people experiencing gender dysphoria/gender incongruence”, says care should be patient-centred and non-judgmental. However, it also acknowledges “multiple perspectives and views” about whether a gender-affirmative approach is appropriate for children and teenagers and highlights the lack of research on the long-term outcomes.
The document defines a “gender-affirmative approach” as one that accepts rather than questions a child’s statements about their gender identity, potentially easing access to medical treatment such as puberty blockers and hormones with parental permission.
The position statement comes at a time when treatment for transgender young people is more politicised than ever, with much of the debate framed by Britain’s Tavistock scandal. In 2018-2019, psychiatrist David Bell blew the whistle on the Gender Identity Development Service, a clinic at the Tavistock and Portman NHS foundation trust in north London. His concerns included that the clinic employed too many inexperienced psychologists who minimised the complexity of gender dysphoria by prescribing puberty blockers in cases they described as “straightforward”, children being recommended for treatment after only two appointments and followed up poorly, and that children appeared to be giving rehearsed answers to access puberty blockers.
Lakra says the college decided the position statement was needed when reviewing its policy on supporting the mental health needs of LGBTIQ+ people, in part because of the “polarising views” within the wider community.
“Some people are obviously for and some people are against and some people somewhere in the middle,” Lakra says. “It’s an issue that generates a degree of community interest.”
The policy notes the evidence from the World Professional Association for Transgender Health standards of care that a gender-affirmative approach can help children and adolescents, but also highlights the “paucity of quality evidence” on outcomes for people with gender dysphoria.
The document instead emphasises the need for comprehensive assessment to “explore the patient’s gender identity, the context in which this has arisen, other features of mental illness and a thorough assessment of personal and family history”.
Read the full article here (recommended reading)
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2 Replies
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Any reference to the Bell Tavistock case fills me with dread as it was such an I’ll informed and badly executed case. Judges have since thrown out the original finding and openly criticised the judicial process as one sided and lacking fact. It was also more about deficiencies with that centre and not the overall evaluation and care of Trans children, although the media turned it into just that.
My hope is this Australian review is more about strengthening care for Trans children and not putting up barriers. The point the story seems to miss (as always) is that Trans children now feel more comfortable in talking about their disphoria than in years gone bye. We are all prime examples of having to suppress our true feelings due to the stigma and potential ostracisation when we were young and the lack of information, options and support. We should all therefore keep a close eye on this to ensure it’s not another christian lobby funded abuse of power or one nation driven hatred of everyone who isn’t white, straight and angry.
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A followup article by Dr Sandra Pertot
– a Clinical psychologist is supportive of the position taken by the Royal Australian and New Zealand College of Psychiatrists. Again worth a full read here:Dr Pertot writes:
Now I’m hopeful we can talk about teens and gender
In acknowledging there are “multiple perspectives and views” about the appropriate clinical approach towards children and teenagers seeking treatment for gender issues, the college offers a chance that Australian health professionals can have an evidence-based and client-centred conversation about the best way to treat and support young people experiencing symptoms of gender dysphoria or gender incongruence.
It’s an issue I have some first-hand experience with. Earlier this year I was the subject of a formal complaint – my first in 45 years of working as a clinical psychologist. The complaint was brought by a group of people from the transgender community who objected to views I expressed in a podcast for the Australian Psychological Society.
My views were based on my years of clinical education and practice: from the 1970s, I saw clients, until the last 10 years almost always natal male, presenting with gender dysphoria. For most of that time, access to treatment for transition had very strict criteria and was expensive, but the majority of those who did transition were happy with their new lives. In recent years some of my older gender non-conforming clients have finally had access to cross sex hormones and, for some, surgical transition. I felt privileged to be part of this process, which brought relief to them.
But from about 2014, I noticed an increase in natal female between 14 to 20 (so, past puberty), who reported experiencing gender dysphoria and expressed the desire to transition, often asking for support to begin cross-sex hormone therapy. While some described a long history of distress with their bodies, others had only come to the belief in recent months that they experienced gender dysphoria, after learning about it online. In some cases a parent attended a consultation and said this had taken them by surprise as there had been no indications that their child had any confusion about their gender identity.
My clinical training is to assess and treat each client as an individual, and it is not appropriate to have any preconceived beliefs about a diagnosis until a thorough assessment has been undertaken. I would never try to talk a client out of their beliefs, but I do try to give them permission to explore what pathway is right for them. It is a client-affirming approach. Unfortunately, this approach clashes with the gender-affirming approach that now dominates the socio-political discourse about transgender people, and many health services worldwide.
The article concludes:
In a recent legal decision in Britain, the right of people to express beliefs critical of the theories behind the gender-affirmative approach has been affirmed and anyone with those views is now protected from accusations of discrimination. We need this legal right in Australia.
Well worth a read!