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Journalist Hannah Barnes on the inside story of the collapse of Tavistock’s gender identity clinic

LONDON, ENGLAND - JULY 29: A general view outside The Tavistock Centre on July 29, 2022 in London, England. The Gender Identity Development Service (GIDS) clinic at Tavistock and Portman NHS foundation trust in North London is the UK's only dedicated gender identity clinic for children and young people. It is set to close after an independent review criticised its services. (Photo by Guy Smallman?Getty Images)
LONDON, ENGLAND - JULY 29: A general view outside The Tavistock Centre on July 29, 2022 in London, England. The Gender Identity Development Service (GIDS) clinic at Tavistock and Portman NHS foundation trust in North London is the UK's only dedicated gender identity clinic for children and young people. It is set to close after an independent review criticised its services. (Photo by Guy Smallman?Getty Images)

The United Kingdom’s only dedicated gender identity clinic opened nearly 35 years ago.

In recent years, those inside the clinic began to raise concerns.

After a scathing independent review, the National Health Service decided to close the clinic.

Today, On Point: Journalist Hannah Barnes tells us what happened.

Guests

Hannah Barnes, investigations producer at BBC Newsnight. Author of Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. (@hannahsbee)

Also Featured

Dr. Anna Hutchinson, clinical psychologist based in London who was part of the Gender Identity Development Service (GIDS) senior team from 2013 to 2017.

Dr. Marci Bowers, OB/GYN who specializes in gender affirming surgical care. President of the World Professional Association for Transgender Health (WPATH)

Jamie Reed, former case manager at The Washington University Transgender Center at St. Louis Children’s Hospital.

Read: Jamie Reed’s affidavit to Missouri’s attorney general. Her allegations have been denied by some families whose youth received care at the St. Louis transgender center.

Transcript

MEGHNA CHAKRABARTI: Until this past year, the Tavistock Gender Identity Development Service was the U.K.’s only center for treating children suffering from gender dysphoria. In March 2022, an independent report commissioned by Britain’s National Health Service found that the type of care provided at Tavistock was, quote, ‘Not safe or viable as a long-term option for the care of young people with gender related distress.’ It also found that the center had not used customary control measures that are typically in place when new treatments are introduced. Nor had the center collected consistent data on its patients and treatments.

Following the report, the National Health Service decided to close the Tavistock Center and find a new model of care for gender questioning young people. Hannah Barnes is an investigations producer at Newsnight, one of the BBC’s flagship television news programs, and she writes about what happened at Tavistock in her new book, Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. And she joins us today from London. Hannah Barnes, welcome to On Point.

HANNAH BARNES: Thank you so much for having me.

CHAKRABARTI: So when the Gender Identity Development Clinic was first opened in London in 1989, what was its original mission?

BARNES: Its original mission was to provide a space for a very small group of very distressed children and young people to talk about the difficulties they might be having with their gender. So originally, [it] opened at another London hospital, but really in those early years we were talking a couple of handfuls of young people each year. I think actually there were only two in the first year. And it provided a space for young people in their families to go and talk about what they were going through.

The idea was always that it wouldn’t aim to change a young person’s gender identity but would help them tolerate the distress they were experiencing. Tell them that they weren’t alone, that there was nothing wrong with them. Sort of break down stigmas, really provide a safe space, if you like, and predominately provide talking therapies for this very small number, but albeit some of them very distressed children.

CHAKRABARTI: That’s why in the book you emphasize that its original mission was to support gender identity development versus change.

BARNES: Exactly. Exactly. And that that aim continued through to the present day.

CHAKRABARTI: Okay. But so then how what how small of a percentage of young people are we talking about that were seen at the service in the early days?

BARNES: It’s difficult to know in terms of percentage of the population, but we’re talking, you know, a handful of children per annum that were referred out of millions of young people here in the U.K. And at that time, the founder of the clinic, a psychiatrist called Domenico Di Ceglie, he would often talk to the press as we went into the 1990s, saying that the vast majority of these young people would come through their period of gender related distress and a small minority would indeed transition and live their lives as trans adults.

CHAKRABARTI: So then at around approximately 2005, if I remember correctly from your book, there was an internal audit done by the gender service center there. What did that internal audit find?

BARNES: So there are two things here. There was a report into the service in 2005. There was also an audit carried out in about 2000. So I can talk briefly about both of them, if that’s helpful. So in 2000, by this point, the service had moved to its current home, the Tavistock and Portman NHS Foundation Trust. And really there was a request made that the trust wanted to learn a bit more about these young people that the trust was seeing.

What other difficulties might they be experiencing? How did they arrive at the clinic? What was happening to them? Basically. So a group, including Domenico Di Ceglie, they audited the first 124 young people that had gone through. So from 1989 to 2000, and they excluded the very current patients. And that showed that the vast majority of these young people absolutely were experiencing distress around the agenda. But actually, so much else besides. A large, very large proportion had been in care.

So not living with their parents or their immediate family, that was up to a quarter. A large proportion had experienced abuse, either physical or sexual. They experience depression, anxiety, all sorts of things. And what they found was that only a very small proportion didn’t have any other difficulties alongside their gender distress. But I think what you were talking about in 2005 was that some concerns were being raised at that point within the service about how it was functioning.

And although puberty blockers, as we know them colloquially were available at that point, a young person had to be 16 here at that point. But there was still concern that some people were going forward for these interventions quite quickly. And in some people’s eyes, without adequate assessment or talking beforehand. And the then medical director of the entire Tavistock Trust conducted a review, if you like. He spoke to endocrinologists; he spoke to people in the service in the wider trust. It was really thorough, and he called for lots of things.

He called for better data collection. He said, We don’t really know any of the outcomes of the young people we’ve seen so far, even though we’ve been going at that point, what, 15, 16 years. He said, We need to collect outcomes on those who go forward for the physical interventions. We need to collect data on those who don’t. We need to collect data on how the young people who do go forward for physical interventions are using that time on the blocker. Is it that they’re using it as time to sink and explore their gender identity or is something else happening?

And he identified this core, not disagreement, but sort of conflict, if you like, in the service surrounding the use of physical interventions, I suppose, and how quickly they should be provided. Who was responsible for it? Was it the mental health practitioners working in the service, assessing the young people, or was it ultimately the endocrinologists? All kinds of things. And Dr. David Taylor was the man who did the report. He made a number of recommendations, and frankly, none of them were really taken forward.

CHAKRABARTI: Well, in your book, you talk about how in this report by Dr. David Taylor, again, this is the 2005 review. That the pressure, he talks about the pressure to provide puberty blockers became much more intense around that time. Where was the pressure coming from?

BARNES: It was coming from all quarters, really. It was coming from trans support groups. Absolutely. But I think there’s a danger that especially here in the U.K., that it’s felt that all the pressure was coming from them alone, and that isn’t the case. It was also coming from clinicians working with gender diverse young people in other countries, particularly in the Netherlands at that time. Some conditions in the United States as well.

And it was also, I’m told, coming from endocrinologists who obviously work with hormones in the body. And the pressure was saying, look, it appears at this moment in time the Dutch are doing this thing where they’re using puberty blockers in very highly screened young people who have this distress around the gender. And it appears that it could be a good intervention. So why aren’t you doing it? That was the message, really.

CHAKRABARTI: Well, and also around this time, there begin to be quite a significant rise in the number of referrals right to the Tavistock Gender Service in the U.K. We spoke with Dr. Anna Hutchinson, who Hannah, you spoke to extensively for your book, and she was part of the senior team at Tavistock between 2013 to 2017. She went on maternity leave shortly joining after joining the team. And then when she came back at the end of 2014, she had noticed that in that time the number of referrals for hormone blockers had rapidly increased.

ANNA HUTCHINSON: I’d have the referrals from the week on my desk and it was very visceral. The numbers are going up, you know, week to week. That pile of referrals would be getting more remarkably larger. So there was a sense of everybody was really busy trying to keep on top of the deadlines. At that time, we were aiming to see all young people within 18 weeks and the team was just really running around trying to meet young people on time.

CHAKRABARTI: So that’s Dr. Anna Hutchinson. Hannah Barnes, If you could sort of summarize, there was also a growing chorus of concern coming from practitioners within the clinic at this time. What were those concerns?

BARNES: So what had happened at this point is because of the pressure that we spoke about before coming from all quarters, GIDS, the Gender Identity Development Service … had started a research study to say, well, look, let’s test this out for ourselves. Are the puberty blockers beneficial to a selective group of young people?

And in 2014 they rolled out the early blocking of puberty as policy anyway, without waiting for that data. So that’s the context. So you’ve got the wider availability of puberty blockers at younger ages. And that point there was no actual lower age limit. It moved to a stage of puberty rather than age. And you had these referrals that Dr. Hutchinson speaks about really increasing at a very, very rapid rate.

And in 2014, in fact, they were sticking to that 18-week target. But as we went into 2015, that was the year that referrals actually doubled. And so, they’d been increasing at 50% per year from 2009. They absolutely rocketed in 2015, they doubled. And at the same time, more and more young people were wanting this medical intervention. There was pressure on them to provide it. They were trying to get through the numbers. Caseloads were absolutely exploding. And a single clinician might have 100 families on their individual caseload. And to put that into some context, that would compare to, I’m told, around 20 to 30 in any other regular National health service setting.

CHAKRABARTI: Hannah, as you well realize, you’re speaking to a largely U.S. audience in this program here. And as I’m sure you know, the political situation around the issue of care for gender questioning youth, the political situation in this country is extreme, to the point where the trans community legitimately has fears, existential fears. So I wanted to ask you briefly for all that you spoke with many, many clinicians who worked at the Tavistock Center. Were any of them, you know, even questioning the existence of trans identities, or did they have some kind of, you know, political concern? What was their approach to the whole issue of gender questioning youth?

BARNES: No, absolutely not. And thanks for giving me the opportunity to say that, because really the motivation for these clinicians speaking out and raising concerns over many, many years, both within the service and then outside of it, was really the care of these young people who were often very vulnerable and very distressed. And what they were saying was just as there appeared to them to be different ways, perhaps into a young person’s gender related distress, then perhaps there needed to be different ways out of it.

And they were seeing with that increase in referrals, a sort of increase in the complexity of the young people coming forward too, and often they were contending with so much more besides the gender identity difficulties. And that’s what was really worrying these clinicians. And at no point will they ever questioning these young people’s identity or that trans people exist. Of course they do. And that’s absolutely not anything that is questioned in the book. And I’ve spoken to trans people, their stories, their successful transition stories are in the book, too.

It’s just that it was felt that the way the Gender Identity development service was practicing was risky and that perhaps a one size fits all approach, a referral for puberty blocking medication, wasn’t the safest route, nor the best one for each and every one of those young people, both for whom you know it will benefit. And we have to provide the best care for them. And we also have to provide care for those for whom it won’t.

CHAKRABARTI: Okay. So we spoke with Dr. Hutchinson, who we heard from earlier. We’ll hear a little bit more from her in a moment. But we also spoke with Dr. Marci Bowers. She’s a leading OB-GYN in gender affirming surgical care. And Dr. Bowers is also the president of the World Professional Association for Transgender Health. And she told us that what happened at the Tavistock Clinic, in a sense, shouldn’t have been a surprise because of that really big spike, that increasing demand for this kind of service.

MARCI BOWERS: Like anything that expands rapidly, sometimes we see health systems overrun and this is the case as it is in Tavistock. They saw referrals rise. I think they were like 250, in I believe it was 2012. And then in the last two years, they were over 5,000 referrals for gender related care.

CHAKRABARTI: We’ll hear more from Dr. Bowers a little later in the show. But on that point of trying to manage that massive rise of referrals, here’s Dr. Anna Hutchinson again, who worked at the Tavistock Center. And she told us, she told you as well, Hannah, that for some young people in their families, once they were on hormone blockers, they would actually disengage from the service, no longer come to Tavistock. But for others who wanted to explore potential consequences of continuing to cross-sex hormones:

HUTCHINSON: We as a service weren’t providing any therapeutic space to explore identity once the young people were on the blockers. So I was beginning to really worry. The blockers themselves were possibly and inadvertently shutting down options rather than opening them up.

CHAKRABARTI: Dr. Hutchinson also talked about concerns over the lack of data being collected on the patients, and the services and their effectiveness that were being provided to young people. And she said that one piece of early data, in fact, did find that most people who were on puberty blockers had proceeded on to cross-sex hormones. And Dr. Hutchinson told us that concerned her.

HUTCHINSON: I was being asked to sign off on something and I wasn’t sure it was in their long-term best interests. Because there wasn’t the data there. But I was beginning to think, okay, so if a young person blocks their puberty early in adolescence and then proceeds to cross sex hormones and maybe or maybe not surgery later on in life, and then it doesn’t work out for them because, you know, some of these kids were telling us their identity was fluid. You know, we know that. My concern was, what would that be like for them? You know, it suddenly felt like we had to make a huge sort of cost benefit analysis.

CHAKRABARTI: So Hannah, help us understand how this happened, because as you said earlier, the the Tavistock Center’s own internal studies and audits from 200, 2005 found that, you know, perhaps a very small percentage of young people would go on at that time to take puberty blockers and then cross cross-sex hormones. And then most of the other children coming to the center would have hopefully been able to access treatments to assist whatever their other core needs were. But it sounds like later on there was this rush to puberty blockers and then, as Dr. Hutchinson said, to cry onto cross-sex hormones. I mean, I don’t quite understand how the Tavistock Center got caught up in all that.

BARNES: I think that’s a really difficult question to answer definitively. But I think, you know, it depends who you ask. I mean, I’ve spoken to dozens of clinicians and they’ll give you slightly different reasons. But I think there are a number of factors that explain how things went wrong. And I think it’s difficult to deny that things have gone wrong. Partly it’s about numbers, as Dr. Bowers said, but it really can’t explain it all. And I don’t think anyone I spoke to would say it was just that we had too many young people coming forward. Of course, those huge pressure as the numbers really increased very, very dramatically. But it can’t just be put down to the numbers.

What happened was, as one would expect in sort of areas of medicine, when new data comes to light that questions the way you think and intervention is working, that should provide pause for thought. And I think what Dr. Hutchinson, what she told me certainly is when that data came back, that early data that showed that at that point, every single one of the young people who started on puberty blockers had chosen to go into cross-sex hormones, that kind of exploded this idea that the puberty blockers were providing time and space to think. Because, as she puts it in the book, what are the chances of every single young person with their very different needs and backgrounds given time to think, and all thinking in the same way?

And GIDS would counter that and say, well, these people that we chose were the ones that we thought were most likely to transition. So it’s not surprising. And we picked those who were the most distressed and whose gender related distress was very lasting and had, you know, been going on for years. And we do very thorough assessments. But the difficulty with that is that I have clinicians who have spoken to me bravely, on the record, who say actually our assessments weren’t always very good, they weren’t always very thorough. They could be two, three sessions. And I’ve taken part in those. So it’s just not the case that each and every one of those young people going forward for the blocker was subject to a very detailed assessment and had lifelong gender dysphoria.

And I think what you saw, what they did was they started to apply an albeit quite limited evidence base from these two early Dutch studies, which only allowed young people who had lifelong gender dysphoria, a very stable, supportive environment in which they lived and who was psychologically stable. They applied that to a completely different cohort of young people. And they didn’t pause to reflect on what was happening. I think at the same time, not all of this was their fault. There was very limited oversight, if any, from the Central National Health Service that was commissioning them.

It’s something that the independent review, which you referred to right at the beginning has commenting on, that this clinical approach has not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are offered. That just didn’t happen here. And a further aspect was the GIDS would say that they were only there. Their job, if you like, was to tackle and addressed a young person’s gender difficulties. All the other things that they might be struggling with at the same time should have been dealt with by local mental health services and that didn’t happen. And that’s because those services themselves were completely overwhelmed. They had their budgets cut.

So there was a whole host of reasons why the model wasn’t working. And as Dr. Hutchinson said in one of those clips, not only was the rationale for the blocker exploding in terms of everyone was thinking the same way. But actually GIDS didn’t provide any opportunity for those young people to use that time to actually explore their gender identity. Rather than increase the number of appointments. They became very few and far between. And as she said, people would skip them, so they might only check in twice a year.

CHAKRABARTI: Now I want to just clarify something for people who aren’t familiar with it, because you mentioned this Dutch study, which it comes up rather frequently in discussions about care for gender questioning youth. The Dutch study was one that was done, I believe the cohort was mostly people who were born male. And then as you specified, they had long term gender dysphoria or gender questioning, mental status, and no other concurrent mental health issues. And it’s that group of young people then who were put on puberty blockers and later on, I believe, cross-sex hormones as well, and had largely positive outcomes, correct?

BARNES: Correct. I mean, there were girls as well. I think the majority were male, but not the overwhelming majority. And you’re right, these Dutch studies, these formed the basis really of all gender, affirmative medicine, pediatric medicine taking place across the world today in gender clinics, both in the United States, here in the U.K. and in the rest of Europe. And those young people had to be screened in the way that I’ve suggested, but also, they received ongoing talking therapies at the same time.

And those studies themselves … they’re not the be all and end all. They’re the best that we have in terms of longitudinal data. We’re awaiting actually an update on those very first group of young people who receive puberty blockers, then cross-sex hormones and then surgery. And those are the criteria. So actually, there were two studies of the same group of people, but we lost 15 out of 70 by the time we got to the second one, one of whom actually died tragically during gender reassignment surgery.

And a close look of those studies really calls into question how robust they are. But, yes, so this arguably limited evidence base has been used as the basis for gender affirmative care in young people. But it did apply to quite a different group of young people than the ones we see today.

CHAKRABARTI: Right. And one of the key differences is all of the concurrent other mental health issues.

BARNES: But also sorry to interrupt, but also the fact that we have this, it’s been witnessed in every single gender clinic across the world, this preponderance of females now. But not just females, but females whose gender related distress only started in adolescence or after the onset of puberty. And that absolutely was not the presentation of those young people in the Dutch study. And we’re also applying this evidence base, if you like, to young people who identify as non-binary, as other gender identities. And again, there was no evidence for that whatsoever.

CHAKRABARTI: Hannah, I appreciate that clarification because it’s an important part of the overall story and especially regarding what later on happened at the Tavistock Center. I want to hear a little bit more from Dr. Hutchinson, because, again, this lack of data, it comes up as a as a regular concern. And Dr. Hutchinson says that, in fact, there wasn’t even clear evidence about … the long-term outcomes of some of the procedures and medications that the young people were taking, about whether or not they were successful.

HUTCHINSON: Once they were referred to adult services or they left the service, or whether they left because they decided not to get on the medical pathway or any other reason, we didn’t have data on any of those young people. We didn’t have any outcome data. When I was there, we had only had the data of those who were within the service. And you know, what was striking about the early intervention study was that the patient satisfaction was high, but the clinical outcome measures were not particularly positive in terms of reduced distress or reduced dysphoria.

CHAKRABARTI: People like Dr. Hutchinson and others that you interviewed extensively for the book had been raising concerns internally for some time. But what finally triggered that independent commission that the NHS called for a couple of years ago?

BARNES: A number of things, I think. Dr. Hutchinson was one of ten members of staff who took their concerns to a then very senior psychiatrist at the Trust. He’s now retired, called Dr. David Bell, and he wrote a report in 2018. And it was really when that was leaked to the media. And in 2019, and we heard some of these concerns that were very, very serious, that clinicians had, really things started to sort of gain momentum. And we started looking at this for BBC Newsnight in 2019.

And our reporting certainly prompted a inspection of the service by the health care regulator in England, which then rated the service inadequate. … Some court proceedings were instigated against the Tavistock by a young woman who transitioned, then de-transitioned called Keira Bell. And that really brought the world’s attention on onto GIDS, if you like, in a way that never had been before. And it really highlighted this absence of data. And I think it got to the point where NHS England just couldn’t avoid tackling it head on. They had to do something. And that’s what led to the independently commissioned report.

 

CHAKRABARTI: Hannah Barnes, I had mentioned at the top of the show the independent report that was commissioned by the NHS, and I believe that an interim report was published in March of 2022 that found that the type of care provided at Tavistock was not a safe or viable long-term option for young people with gender related distress. This is the Cass report. So can you tell us a little bit more about what it found?

BARNES: Well, interestingly, it vindicated, I don’t know if that’s the right word, but it vindicated what so many clinicians had been saying for four years and who hadn’t been listened to. So Dr. Cass acknowledged that there was an issue of what she called diagnostic overshadowing. So this was where a young person who may have multiple coexisting difficulties but who had gender related difficulties as well, once the word gender was mentioned, everything else got parked, if you like, it wasn’t dealt with.

So she would call this diagnostic overshadowing. And she said this is just not good enough, that young people with gender related distress aren’t being given the same amount of care and attention that any other young person would. She said this has got to change. She talked about a real lack of consensus amongst clinicians working in the service. She said there were completely different views within the staff group, some more strongly affirmative and some much more cautious when it came to the use of physical interventions. Again, this is something that clinicians have been talking about for four years and that might be problematic.

I mean, it’s quite striking that in the leads that the site that GIDS had in the north of England, there were clinicians whose approaches, if you like, were deemed to be so incompatible that they couldn’t work together with any given family, which is quite striking. Dr. Cass found that the service was providing a predominantly affirmative, non-exploratory approach, often driven by a family’s expectations and how far or not, the young person had gone in a social transition prior to starting the service.

She found, as you’ve mentioned several times, that there had not been routine and consistent data collection in the service. And actually it was still difficult writing in 2022 for staff to raise concerns about the service. Now, she absolutely acknowledged, and I do throughout the book, and even the regulator who rated the service inadequate, acknowledged that the staff at the service care about these young people greatly. That has never been called into question. But one clinic dealing with the nation’s distressed children could not work.

And there’s been a temptation among some in the trans community in particular here to say that all that Dr. Cass said is that we need more services and we can’t have one clinic. But I think really any reading of that report highlights a certain number of difficulties that the service is explaining. And she talks about the lack of evidence base as well, particularly for this cohort of young people that we’re seeing in gender clinics across the world who are predominately female, whose gender related distress started in adolescence and who have multiple other mental health problems. And she said that’s the group which are greatest in number, but actually for whom we hold the least data and the data we have is not persuasive.

CHAKRABARTI: And so as a result of the Cass report, the NHS decided to close down. I don’t know if that’s the right word, but —

BARNES: It’s still open.

CHAKRABARTI: It’s open.

BARNES: So that’s why they decided to call it. Well, they decided that, you know, when one of the country’s most respected and senior pediatricians says we need a fundamentally different service model, then the NHS has listened to Dr. Cass, and that’s what they’re trying to do now. So it made the announcement in summer 2022 that GIDS would close and be replaced initially by two. But the plan is to have more regional services, which would be far more holistic, if you like, in their approach, taking in all aspects of a young person.

And it’s acknowledging the work that has been done as part of Dr. Cass’s review, looking at the evidence base for both puberty blockers and cross-sex hormones. And what those systematic reviews have shown is that really the evidence base is wanting and it’s not clear really the benefits and harms of those treatments and whether one outweighs the other. So going forward, and these new services are not ready yet. And the plan was to close GIDS in the spring and that isn’t going to happen.

But the plan is that no one plans to take away, it seems, obviously the option of transitioning for young people. We talked about this really early on. It’s not about denying health care, it’s about making it better for each and every one person. But Dr. Cass has said, look, we have to plug these gaps in the evidence base, because they’re big. And so the plan, it seems that we haven’t heard the final details yet, is that puberty blockers will still be available to young people after a decent assessment, but they will have to be enrolled on a research program to try and get some better data.

It’s long term data. And crucially, what Dr. Cass said and what these new services going forward will offer is different treatment pathways, because she has said that not one approach is going to benefit each and every young person experiencing gender related distress or gender dysphoria. And, you know, physical interventions for some. Yes, but that won’t benefit everybody. And we need to care for those people, too.

CHAKRABARTI: Well, in fact, Dr. Marci Bowers, again, currently the president of the World Professional Association for Transgender Health and a leading surgeon, OB-GYN, in gender affirming care, she told us that she sees it very similarly. This is a moment sort of accelerated by the Cass report that we should encourage and allow an improvement in care for gender questioning young people. And here’s what Dr. Bowers told us.

BOWERS: It’s a supportive environment where ongoing evaluation continues. And if they meet certain criteria entering adolescence, at that point, a decision would be made as to whether or not they would be candidates to have puberty blocking. And we have to be mindful that ultimately it has to be informed consent and it has to be a volitional decision on the part of the child.

CHAKRABARTI: So that’s Dr. Marci Bowers talking about what improved care for gender questioning young people ought to look like. Now, Hannah, if you could just listen along with me for a minute. We have to acknowledge that obviously, the question about what should care for young people entail is very, very, very urgent here in the United States.

And we recently spoke with Jamie Reed. She’s a former case manager at the Washington University Transgender Center at Saint Louis Children’s Hospital. And earlier this year, she used Missouri’s whistle blower statute to raise public concerns about the care she saw children receive at the Washington University Center. And she closely tracked the cases of at least 600 children.

And some of her concerns mirror what we’ve been hearing about what was happening at the Tavistock Center, both reported by Hannah Barnes and in that independent review as well. Reed talked about a lack of consensus amongst care providers at the St. Louis Center about the best standards of practice for treating gender questioning youth.

JAMIE REED: The documents that I believe the doctors were working under were routinely cast aside and considered on some level suggestions. Which from a medical perspective felt like it was whatever the doctor decides at that day in time goes. And there was no operating framework or guideline to provide this care.

CHAKRABARTI: Reed also says the Washington University Center lacked appropriate resources to provide comprehensive mental health care for its patients.

REED: The center provides some basic mental health medications … for some patients, for depression and anxiety. But that’s if you get scheduled with that certain provider. The system as a whole did not actually put in place the necessary care availability for patients.

CHAKRABARTI: And Reed says that while some patients may have received longer term mental health support for others, that was not the case.

REED: I do not believe that the quality standard of care to medicalize a child with interventions that are lifelong, that can impact their fertility for life, that the quality of care is two visits with a kid.

CHAKRABARTI: Now, Jamie Reed herself identifies as a queer woman. She is married to a trans man and says that she firmly supports trans rights and has previous experience working with trans youth in clinical environments. She says her concerns, though, were not taken seriously by leadership at the Washington University Center.

REED: Part of the problem with this kind of care right now is it’s become … this huge extreme thing where you can’t say anything questioning this care without. I mean, I’ve basically been told that I’m going to be, like, responsible for children’s deaths. You cannot question a care model, and that is not how medicine is supposed to work. Medical staff are supposed to be the people in the room with the doctors who see things going on and have the backup of the medical institution to be able to say, Hey, pause, timeout. Something’s not going right here. Without being absolutely vilified. From every angle.

CHAKRABARTI: That’s part of our conversation with Jamie Reed, and a longer version will be available in our podcast feed later this week. Now, following Reed’s accusations, Missouri’s Republican Attorney General Andrew Bailey launched an investigation into the facility at Washington University. And as a result, Washington University is not commenting. The St Louis Post-Dispatch and Missouri Independent have spoken with families who report positive experiences at the center.

… Now, Hannah Barnes, again, just to put a fine point on it, here in the United States right now, we’re in a political environment where, you know, in some places like Florida there even, you know, the legislature there is considering violating people’s First Amendment rights by banning preferred pronouns. We have other states in the United States, Tennessee, Texas, more who are contemplating making seeking care for gender questioning youth equivalent to child abuse.

So we have parents who are concerned about their children being taken away from them. So it does very much feel like an existential threat, as I said earlier, to members of the trans community. I’m wondering what the political environment around this issue of quote-unquote, gender affirming care is like in the United Kingdom.

CHAKRABARTI: Well, fortunately, not like that. No, I mean that’s appalling, isn’t it? And as Jamie Reed said, there so many things. You have so many parallels with what clinicians have said and have told me about their time at the Tavistock. And I think I hope that books like mine, that testimony like Jamie Reed’s and like Anna Hutchinson and others, and of course, leading trans doctors themselves, like Marci Bowers in the position she has … everybody working in this field really wants the same thing, which is the best care possible for each and every one of those young people.

Making transition as safe and positive as possible for those for whom it will be the right option, and preventing those for whom it won’t be going down that path and making their lives better as well. And it’s about having a calm conversation where you can question the standard of care being provided to a group of young people without questioning them themselves, without questioning their identity or their rights, and doing that without being vilified.

And for those concerns to be taken in the spirit in which they’re intended, which is from concerned mental health practitioners or clinicians who have dedicated their entire working lives to helping young people, it’s just not credible to write them off as transphobic. But we are fortunate here in the U.K., it’s obviously very heated as well. But we don’t have laws going through our Parliament or even proposed that pronouns shouldn’t be respected, or that care be taken away.

CHAKRABARTI: … I understand that you had trouble finding a publisher or even someone to do the cover art for your book, is that right?

BARNES: The cover art thing is a bit of a misnomer, but yes, it’s been widely reported here in the U.K. that the proposal, which was very detailed in itself, and we’d been looking at this together my colleague Deborah Cohen and I for Newsnight for well close to two years. I wrote a 17,000-word book proposal and it was rejected by 22 publishers. And interestingly, the responses didn’t they weren’t negative. They didn’t say, No, this is this is something we don’t want to do. Just really this is an important story. But not for us.

And actually, almost half didn’t reply at all, which I’ve been told by my very experienced agent is almost unheard of to get a rate of, you know, almost a half of norm responses. I mean, you’d expect 90% to reply. So it was, it was pretty demoralizing for a while. But fortunately, Swift Press … did want to take it on and I’m delighted that they have. And it’s a Sunday Times bestseller, so I’m really grateful to everyone that’s read it and bought it.

CHAKRABARTI: And for the people who spoke with you both.

BARNES: Oh, absolutely. Yeah. There’ll be no book without any of those people, and particularly the young people who went through. It’s both those who had a great experience and are happily transitioned and those who didn’t and frankly have been harmed and those clinicians as well. And I’m so grateful to each and every one of them.

Book Excerpt

Excerpt from Time To Think by Hannah Barnes. All rights reserved. Not to be republished without permission.

Related Reading

BBC: “Tavistock children’s gender clinic closure leaves uncertain future” — “There are more than 7,500 children and young people with gender incongruence or gender-related distress waiting for help from the NHS.”

This article was originally published on WBUR.org.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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