The Cass Review- Interim Report

[rogdmum]

The Cass Review Interim Report has been released. 112 pages long and it’s such a bloody relief to read common sense.

cass.independent-review.uk/publications/interim-report/

There’s so much in it, but emphasis on taking a holistic approach with a great chart on page 57 showing the complex presentations in and complex pathways.

And social transitioning has been recognised as an active intervention!

“Social transition – this may not
be thought of as an intervention or treatment, because it is not something
that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning. There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes.” Pages 62/63

So much in it. So much. And there’s more to come as the review continues to work on the issues.

The weasel rewording is a strong signal that they're banking on their supporters not consulting the original report but to take it on their word

Maybe Mermaids are trying to let the kids and families down gently by drip feeding and gradually changing the narrative?

I do hope that's the case as we always said when this unravels it will leave behind some devastated children and families.

'At the moment, in society as it is now, transition genuinely does make life better for a subset of children.'

This simply is not evidenced, other than anecdotally. I'm not dismissing it as a possibility but at the moment it's just an assertion.

Mermaids- where affirmative care “simply means supporting a young person’s understanding of who they are while taking an exploratory approach”

Reverse ferret reverse ferret

Schools that pushed unquestioned affirmation, often behind parents’ backs are going to be thrown under a bus by the lobby groups. 😈😈😈

'How do wait times for Tavistock compare to wait times for CAMHS?'

I don't know, but I suspect the two issues are linked. If you can get the gender-questioning children in front of good, ethical therapists before they seek help from motivated adults, you have a much better chance of getting to the bottom of the issue than you do after they've waited three years to see someone, and spent that time in a binder or sourcing drugs off the internet. Bloody disastrous.

Mermaids' take on the affirmative model stands out.

First, on language, Cass says:

"There is sometimes no consensus on the best language to use relating to this subject...
The terms we have used may not always feel right to some; nevertheless, it is important to emphasise that the language used is not an indication of a position being taken by the Review. The glossary below sets out a description of some of the terms we have used in the Review."

The Cass glossary - on theaffirmative model - says:

"A model of gender healthcare that originated in the USA which affirms a young person’s subjective gender experience while remaining open to fluidity and changes over time. This approach is used in some key child and adolescent clinics across the Western world."
(With 4 footnotes)

Mermaids say:

"It is worth addressing confusion on what is meant by affirmative care. Mermaids supports both national (British Psychological Society) and international (WPATH) guidance and best practice on the use of an affirmative approach to trans healthcare, which simply means supporting a young person’s understanding of who they are while taking an exploratory approach. The two are not mutually exclusive. In our view, this aligns with the interim report’s approach of supportive, exploratory intervention. We welcome clarification from the Cass Review team on this."

Other terms are worth checking in the Cass glossary.

For example, gender incongruence is deemed a "diagnostic term", while gender-questioning is "a broader term that might describe...".

Some things are terms and some might be broader ones. The "might bes" will be worth looking out for as regards where they pop up, in what context, and who uses them.

There is a difference between supporting the subjective experience ('Yes, I accept that you feel X and you are supported while we explore what's happening') and supporting a young person's understanding of who they are ('Yes, you are trans'). These things aren't the same.

Exactly tabby and of course another risk under affirmation only therapy is that the focus becomes helping the child accept their “trans” identity rather than exploring the underlying reasons for their gender distress/dysphoria.

@tabbycatstripy

'How do wait times for Tavistock compare to wait times for CAMHS?'

I don't know, but I suspect the two issues are linked. If you can get the gender-questioning children in front of good, ethical therapists before they seek help from motivated adults, you have a much better chance of getting to the bottom of the issue than you do after they've waited three years to see someone, and spent that time in a binder or sourcing drugs off the internet. Bloody disastrous.

Wait times for CAMHS are 18 months to 2 years here. And I don't think we're outliers. But even if children are seen by CAMHS, I'm not sure outcomes would be different.

AFAIK psychs within CAMHS or the NHS generally can't advocate a watch and wait policy unless the family is pursuing that. The consultation that ended last month considers a watch and wait approach to be conversion therapy

Agreed rogdmum . It's long overdue for schools to be challenged about their unthinking promotion of this ideology. James Kirkup pointed out how Life-changing and sometimes irreversible medical treatment is being administered to a growing number of females, without evidence for how that treatment will affect females but mainly on the basis of limited evidence about how such treatments affect males.

The main influence for this (as evidenced by all the whistleblowers) has been those birth registered males who run the lobby groups and have been given unprecedented access to GIDS, schools and children to promote their ideological views. To the detriment of all children.

Yes, there is no 'open-mindedness' to an affirmation-only approach and it is an outright lie from Mermaids (colour me shocked) that they have always supported an exploratory, child-centred approach. They're just lying as usual. These are the same people who have been shrieking about 'conversion therapy' as if trying to explore whether a child being bullied might contribute to their distress about their sexed body is some sort of attempt to 'convert' 'trans youth'.

'But even if children are seen by CAMHS, I'm not sure outcomes would be different.'

I'm not sure either. I do know affirmation-only is unethical and liable to push certain outcomes. The approach - whether through a GIDs-style clinic or other service, needs to be exploratory on every level.

@tabbycatstripy

'But even if children are seen by CAMHS, I'm not sure outcomes would be different.'

I'm not sure either. I do know affirmation-only is unethical and liable to push certain outcomes. The approach - whether through a GIDs-style clinic or other service, needs to be exploratory on every level.

At the moment even the kids presenting at A&E in acute life threatening crisis are getting a telephone appointment ten days later at which there's a bit of a chat about whether the prescribing psychiatrist can be discussed as an option at the upcoming meeting in a few weeks' time. CAMHS is absolutely broken.

'CAMHS is absolutely broken.'

And I think that has contributed directly to the surge of trans-identifying adolescent females turning up at GIDS desperate for hormones and surgery. They needed far earlier intervention and they needed that intervention to assess their psychological health in the round.

How do wait times for Tavistock compare to wait times for CAMHS?

A major concern is that if there is a diagnosis of Autism CAMHS will wash their hands of the YP, even if the issue isn't related to the autism diagnosis or is something that needs specialist input. The danger therefore is that a significant cohort of children will still effectively be ignored by CAMHS.

@tabbycatstripy

'CAMHS is absolutely broken.'

And I think that has contributed directly to the surge of trans-identifying adolescent females turning up at GIDS desperate for hormones and surgery. They needed far earlier intervention and they needed that intervention to assess their psychological health in the round.

^^

That.

Plus the frequent lack of any urgent, purposeful action to address the situation for a kid in distress, which makes anything within the power of the child and family to do themselves so much more attractive.

If you look at narratives like the fox basher's, it's all to do with now now now, action, fast, change, do something. That's very attractive when the actual services are swamped, slow, ineffective and in practical terms offering very little. And inevitably gatekeeping and channelling happens in swamped services; there will be the temptation there to funnel certain kids straight to another service without unpicking more complex needs.

There's the other problem in that narratives that are about respond immediately to the intense distress and do something, anything, to alleviate it is not a professional or therapeutic approach. Helping someone to be able to tolerate distress and uncomfortable feelings is a huge part of helping, but it has to come fast enough and purposefully enough that the person doesn't just feel abandoned and grabs for any other pain relieving solution.

But yes. Mental health services for kids are abysmal and have played a very large part in all of this coming about.

Artichoke

Which is why I think the approach outlined in Cass is right: more services, more widely distributed, more easily accessible, but not necessarily giving the service users what they think they need - instead, actually giving them what they need.

I just hope this is what occurs.

@ResisterRex

Mermaids' take on the affirmative model stands out.

First, on language, Cass says:

"There is sometimes no consensus on the best language to use relating to this subject...
The terms we have used may not always feel right to some; nevertheless, it is important to emphasise that the language used is not an indication of a position being taken by the Review. The glossary below sets out a description of some of the terms we have used in the Review."

The Cass glossary - on theaffirmative model - says:

"A model of gender healthcare that originated in the USA which affirms a young person’s subjective gender experience while remaining open to fluidity and changes over time. This approach is used in some key child and adolescent clinics across the Western world."
(With 4 footnotes)

Mermaids say:

"It is worth addressing confusion on what is meant by affirmative care. Mermaids supports both national (British Psychological Society) and international (WPATH) guidance and best practice on the use of an affirmative approach to trans healthcare, which simply means supporting a young person’s understanding of who they are while taking an exploratory approach. The two are not mutually exclusive. In our view, this aligns with the interim report’s approach of supportive, exploratory intervention. We welcome clarification from the Cass Review team on this."

Did anyone click the link 'best practice'?

It takes you to these New Zealand Guidelines!

researchcommons.waikato.ac.nz/bitstream/handle/10289/12160/Guidelines%20for%20Gender%20Affirming%20Health%20low%20res.pdf

We know that Mermaids have form for executing the reverse ferret. Remember how you could be born in the wrong body but then it turned out that’s not what they meant to say? Except by that point, the concept of being born in the wrong body had been well and truly cemented in the minds of many kids, families, schools……so, damage done.

Regarding the lack of access to timely care, I think one problem is that the demand for gender services has absolutely erupted in recent years but where were the specialist clinics and professionals suddenly supposed to emerge from at the same rate? From an epidemiological point of view, these services don’t just emerge from nowhere, the need for them has to be tracked and planned for. But it’s hard to do that when the population they’re trying to serve has just appeared en masse as if from nowhere. It’s hardly a normal pattern in most areas of public health.

On best practice... the Cass Review only says "this term exists and is used in some locations". There's no opinion given about it. There's information in the report such as:

"From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition that has developed due to the delay in service provision"

But no view expressed about it.

The organisations that have espoused social transitioning and ideas of having an "innate gender identity" etc aren't going to stop. What will their training deliver? Who would pay for it? They need "best practice" to be accepted as such.

I don't think this is a reverse ferret. They've slightly softened their position by saying good care must be provided but then they go right back to where they were. And none of what they point to, is produced by them so it'll be "not me, guv".

This is an interim report. Almost by definition, you can't expect it to contain conclusions.

I believe this is presenting the evidence they've gathered and giving parties a chance to point out anything they've got wrong or missed before they proceed to the completed report, which I would expect to have firmer views and recommendations.

Mermaids are not trying to let their patients down gently, they’re trying to delicately extricate themselves from any potential legal fallout.

Mermaids are not trying to let their patients down gently, they’re trying to delicately extricate themselves from any potential legal fallout.

Yes they do it every time there’s some kind of review/enquiry. When the Education dept said that no child was born in the wrong body, Mermaids did a complete reverse ferret. It would be funny to watch if it wasn’t children's lives they are experimenting with.

Did anyone click the link 'best practice'?

It takes you to these New Zealand Guidelines!

Yes, I did. And it left me somewhat in admiration of Mermaid's chutzpah in declaring something is best practice because they've decided it ought to be, on the basis of no evidentiary or clinical standing that they've shared with the public.

which simply means supporting a young person’s understanding of who they are while taking an exploratory approach.

What are they defining as an exploratory approach?

Because I seem to remember Susie Green saying that you 'cannot make a child trans, and cannot make a trans child not trans.'

No room for any kind of exploration in that statement.