In response to concerns about long waiting lists and accessibility problems in the centralised gender identity service for children and young people in the United Kingdom, the interim report from the Cass Review has recently recommended “commissioning a national network of regional services across the country over the coming years”. The PATHA Executive Committee is concerned that this has led to media reports suggesting that the recommended closure of the current service is due to “safety concerns”. In fact, the UK National Health Service’s response has focused on ways to “improve and expand the support offered to children and young people who are questioning their gender identity”. This approach would increase services as well as accessibility and be more similar to how gender affirming care is provided for children and young people in Aotearoa New Zealand. 

Some media reports have mentioned the use of puberty blockers. In Aotearoa New Zealand, these are prescribed based on a carefully considered decision made by the young person and their family in partnership with the health team, where the benefits are considered to outweigh potential risks.

PATHA supports the use of a gender affirmative approach to care, which is based on listening to the individual person and working with them to achieve the outcomes that are most appropriate for their individual needs. The PATHA Executive Committee is concerned about statements in the Cass Review questioning this approach and urges the Review to consider the international evidence more widely.

The PATHA Executive Committee endorses the recent AusPATH statement on this matter, which gives further details and context. This includes a link to a British Medical Journal editorial regarding this interim Cass report, whose title reiterates the need for the review to be based solidly on existing international evidence and consensus. The full AusPATH statement is copied below:

1. There have been articles in the Australian media recently about the Cass Review. These articles have misleadingly suggested that the recommended closure of the Gender Identity Development Service by the Cass review is due to “safety fears” and “rushing children into treatment”. These articles have prompted this statement by the Board of AusPATH.

2. The Board of AusPATH notes that in the UK, all gender identity services are provided by a single specialist clinic called the Gender Identity Development Service (GIDS) through the Tavistock and Portman NHS Foundation Trust. The Review has proposed the prompt development of regional centres that will develop links and work closely with local services. A system of regional centres working with local providers would be very similar to the model that provides care for children and young people with gender incongruence in Australia. Potentially, more regional centres would mean that services are more accessible especially if there is investment to increase the amount of services provided. These regional centres could also assist in the training of the local medical workforce.

3. The Board of AusPATH is concerned about the use of language in the review that talks about causation of gender incongruence. Such language is often used as a preamble to conversion therapy, which the Board of AusPATH unequivocally opposes.

4. The Board of AusPATH is concerned about statements in the review questioning an affirmative approach to gender affirming care. An affirmative approach is about listening to the individual person and working with them to achieve the outcome that is most appropriate for each individual person and this is consistent with a person-centered approach to health care. The Board of AusPATH supports the use of an affirmative approach to gender affirming care.

5. The Review suggests putting in place standardised approaches to the assessment of children and young people with gender incongruence that also includes a full mental health and neurodevelopmental assessment. In Australia, a full psychiatric/psychological assessment which can include a neurodevelopmental assessment is done before the commencement of medical treatment. The Board of AusPATH is aware of evidence showing that children and young people with gender incongruence often have high rates of mental health concerns and neurodiversity. Identifying these early and putting in place strategies to identify these concerns and support for managing them is appropriate. The Board of AusPATH do not support“ exploratory therapy” which is often used as a euphemism for conversion therapy.

6. The Review suggests putting in place research protocols to support long-term data collection with the consent of participants and the Board of AusPATH is supportive of this proposal. This is also common practice in Australia.

7. The Board of AusPATH considers that there is significant international evidence about the use of puberty blockers and gender-affirming hormone treatment for young people with gender incongruence. There is also accumulating evidence of the harm that ensues from denying puberty blockers and gender affirming hormone treatment. We urge the Review to consider the international evidence more widely. The Review has not said what model it proposes as an alternative to gender
   affirming care nor what evidence it has for any alternative model.

8. The Board of AusPATH urges any further development of policy regarding the care of children and young people with gender incongruence to work closely with young people and their families and peer-led services as well as clinicians who have experience and expertise in working with his population. We also urge the Review to consider getting input from international experts in this area.

9. The Board of AusPATH would like to draw attention to the excellent editorial in the British Medical Journal, regarding this interim report authored by Assoc Prof Ken Pang, Mr Jeremy Wiggins and Assoc Prof Michelle Telfer. Access it here.

https://auspath.org.au/2022/08/11/auspath-statement-about-the-independent-review-of-gender-identity-services-for-children-and-young-people-interim-report-february-2022-in-the-uk-cass-review/