I struggled with some wording also Scrimp - it sounds like 'hypothermic blockers' not 'hormone blockers' so I have typed what I heard and noted where something is unclear or inaudible. I found it all very disturbing, her casual discussion of fertility (so now kids are learning about fertility preservation online we should be discussing it with them, right so you never mentioned it before?) and essentially involving children and young people in what services are provided or how to include them...by all means let the lunatics run the asylum Polly, that always ends well!
Here is the second half. She contradicts herself and seems quite aimless in her points sometimes but here it is anyway.
Dr Polly Carmichael
From 9 mins in.
…How things get translated into practice is sometimes very different and certain terms of the affirmative approach we see now with very young children (phone rings)…coming… So anyway so we see very, very young people who have fully socially transitioned aged 3 or 4 and there was one particular case where the parents obviously had the best interest of their child at heart and wanting to be protective for their child and do their best by the…but what they wanted from us really was to get in contact with the school to address a hate crime and the hate crime was that another young child who had misgendered this very young child who had transitioned at school so you know I think at a certain stage these things can become unhelpful and really it needs to be about everyone working together and having a shared understanding rather than these labels being put forward which are then are interpreted in very different ways…so without a doubt there is often an emphasis on physical pathways and a great push from some groups for earlier physical interventions and at the same times things are changing young people are much more aware now of the possibility of fertility preservation and it’s not straightforward because if you have an earlier invention with a hypothermic (?) blocker then you lose the possibility of preserving fertility errm and errm what we’re seeing is a very small handful of young people who, I can literally give you one or two, who have decided to um delay starting the blocker, although they’re certain about the pathway they want to take, in order to preserve fertility and I found myself getting anxious, and saying but you do know, you do know your voice might break, you do know you know, and this young person was like “ I don’t care” and (inaudible) was very confident and I guess I think that’s fantastic and you know so I am left with questions around how much we are trying, are young people caught up in this feeling, that in order to be accepted they need to normalise their bodies. Now without a doubt you know for some young people it feels the right thing to do and it’s something they are very positive about but I think we really do need to be taking on board that as a society we need to be more accepting about gender diversity and different presentations and if we can be, can we support young people, can they feel comfortable enough, you know, to live with their bodies in order to fully explore the decisions they are making and you know I…I think this is really the nub of it for me.
So I think we are all aware it’s not a mental health condition, I put this, I skipped over language by the way just because Jo is going to be talking about this, but I guess the nature of what I said earlier …. which is that people, are finding it (inaudible), I think we are all aware it’s not a mental health condition errm and errm I think there is great controversy about that and just saying that, don’t throw the baby out with the bath water, I think you know umm of course it’s not a mental health condition but we are all complex beings with a mind and body and I think this is something, particularly in health services, where one needs to be attending to both and I think you know I think just to have medical model approach to this would be very retrogressive so (inaudible)
So I’ve talked a little bit about this conversion versus affirmation and that’s pretty much how things are being worded at the moment, so just as gender is accused of being binary, and either or, male female, errm I think also the way we think can get a bit binary errm and I think this idea of this extreme or that extreme is actually unhelpful and we need to be looking at the grey areas in between and to do that we need to be able to keep, to talk and discuss these issues.
So I feel very strongly that gender dysphoria is not a mental health condition and I say that as a health professional. I think the adult services the specifications are out and they are open for consultation until middle of this month are moving towards a very consent based medical model and erm any psychological or social support is very much an add-on rather than an integrated part of thinking of pathways they could take and I guess that’s what I was referring to as retrogressive so I think um we are working very hard not to go down that route with children and young people but of course providing support and err psychological and social support is erm time consuming and slows things down and so I think you know there is a sort of feeling that everything needs to be speeded up and I think that again is the conflation between being practically erm and being (inaudible
So not all gender-questioning young people by any means should have access to healthcare, and I really am talking about health (inaudible) and I hope we’re moving to a society that supports young people in order to express their feelings but care is evolving and at the moment we find ourselves between a rock and a hard place, on the one hand total (inaudible) the feeling that we have a surgeon down in the basement of the Tavistock carrying out surgery on five year olds and on the other, perhaps a feeling that we are very old fashioned and that we should be offering cross sex hormones and physical interventions much sooner um in fact I think we need to be thinking carefully, as we always are, about what we do and the affirmation approach positively does need some defining terms of what it means. There is often a call for consent based approach to treatment but you know what information and when and consent requires autonomy and this is really much more complex rather than a simple thing.
So what constitutes best care and how is it going to evolve and we need to be thinking about the modern scope of the health service and what we’re seeing is there is diverse identifications and pathways coming out erm and things are changing young people are becoming more interested in fertility and so on, but until we have more research we can’t really say what the optimum time really is so I think as a service we continue to take a considered approach that has a process of working with young people over time and really thinking carefully despite a lot of pressure before young people decide to go forward at the clinic.
So we need to distinguish between opinion and empirical data and we need to understand the impact of contextual factors, we need to be working closer with stakeholders and improving the service and importantly as a health service I think we need to be finding ways of getting diversity of voices, I think all too often stakeholders become actually lobby groups and how do we really involve people because the young people we see are so thoughtful and you know sometimes you feel under ginormous attack and you go into a room and you know they’re the ones who are miles ahead so it’s about finding ways and involving them in thinking about what we do. Um we need to define the roles and relationships, especially our vision (unclear), we would love any ideas people have for that during the day but I think that ourselves that are serviced mindful that first we need to do no harm I think finding space for reflection and recognising complexities is really where we are at, so think you very much.