Psychiatric Assessments Creating Depression and Suicide among Trans Patients
Around forty per cent of transgender people have attempted to take their own lives at some point in time.
That’s a shocking, harrowing statistic, supplied by the National Centre for Transgender Equality.
And yet, having worked with such patients at my clinic for many years, it’s also not one that surprises me.
We need to address this problem as a matter of urgency – and the starting point should see the complete overhauling of the need for trans patients to undergo invasive psychiatric assessments before they’re allowed access to hormone therapy or surgery.
Because it’s my view that the majority of trans individuals do NOT need mental health assessment prior to starting medical transition.
And all these tests are doing is adding years to waiting lists, prolonging the agony. There’s a set, torturous path most trans patients will tread.
When they initially seek hormone therapy – either oestrogen or testosterone to bring about bodily changes – the NHS will refer them to a Gender Identity Clinic (GIC), which offers mental health assessments and support, as well as speech and language therapy, hair removal treatments and sometimes surgery.
But the GIC waiting times are crippling. One of my patients had to wait three years before she was finally given hormones, and a two year wait before having an initial mental health assessment is common.
Yes, a small number of people do need support for mental health issues – the same as any individual who requires medical supervision, for example, due to high blood pressure or asthma where we need to ensure the most appropriate care is provided.
But it does not make any sense to apply that logic to everyone.
Many will lose faith, or not want to subject themselves to the assessment, and are then buying hormones online, typically from clinics in India.
Without a proper prescription, patients don’t really know what they’re taking and they often end up paying over the odds – hundreds of pounds per month – for the privilege.
And these long delays to access care – only to be refused shared care by their GP – is often enough to destabilise patients and trigger their suicidal ideation into action.
There’s a second option – the private route, away from the NHS. But even privately, there can be long waits.
A patient will have to find a psychologist, then wait around three months for an appointment, and then a further wait for hormone therapy.
It’s a long and convoluted process which needs to be streamlined.
Let’s not forget, once a patient begins hormone therapy, it could then be another six months to a year before any changes become apparent.
But just having the hormones in place makes a patient feel like they’re on the road to where they need to be and it eases some of the anxieties.
I don’t claim to speak for the entire trans community, and there are those who will argue that psychiatric assessments are necessary, particularly for younger patients.
For me, however, it’s obvious the current system isn’t working and something needs to change. And now.
Mr Christopher Inglefield, BSc, MBBS, FRCS(Plast),
Specialist Transgender Surgeon