Tragic suicide

[Ramblingnamechanger]

Channel four news spent long time talking about the suicide of a young person ( male ) who killed themself because of not receiving gender affirming surgery when they wanted it. Obviously distraught parents seemed to think that that should have had whatever it was, affirming their son was their daughter and interviewer calling them she throughout.nothing about treating the depression which was underlying. Did not touch the area of what exactly GAS is. I have no idea what they meant…the only thing that was interesting was that they were discharged at 18 from the gender identity clinic, because of depression ( I think that was stated), Would this now be a counter indication for surgeries I wonder?

Ah OK. I hadn't picked that bit up from all the info.
In which case it's even more clear cut.
If this inquest picks up on all of the nuances that led to Alice taking Alice's own life, this family is in for a lot more pain 😔😔😔

In their grief, the family is looking for answers. They are being surrounded by lots of people and organisations (the Fox Killer, the press) who are telling them exactly what they need to hear to process their grief: you did the right thing by affirming Alice's gender identity and this all went wrong because Alice was waiting for too long to transition (and the fact that Alice had access to gender affirming care privately, while on the waiting list, is irrelevant). To echo your words @ArabeIIaScott it really is abhorrent that they are being used in this way.

It is really hard to work out exactly what happened with NHS mental health services because the newspaper reports are all incomplete and sometimes contradict one another. However, everyone already knows that they have been seriously under-resourced for a very long time.

I thought I had read in one report that Alice had received support from Adult Mental Health Services (CMHRS) but I can't find it and the detailed account in the Metro suggests otherwise:

"Alice was handed to the Child and Adolescent Mental Health Services (CAMHS)after a suicide attempt in June 2019, the inquest heard.

In August 2019, GIDS confirmed they had received the referral from CAMHS but warned: ‘Due to high demand we have found waiting times at GIDS incredibly hard to predict.

‘Currently, we are seeing young people for assessment who were referred 24 months ago.’

Despite another attempt later that year, Dr Litman says mental health services did not make her as much of a priority as she should have been.

When she turned 18 in February 2020, Alice was referred to the adult Community Mental Health Recovery Service (CMHRS) and transferred to the GIC.

Yet Alice was discharged entirely from mental health services only a month later.

‘I did not feel that CAMHS took Alice’s problems seriously enough,’ Dr Litman said.

‘The CAMHS nursing team effectively acted as gatekeepers, making it very hard for Alice to access support that she clearly needed and would not have received had it not been for intervention from her GP at our insistence.’

She added: ‘The abrupt cut-off in mental health support when Alice turned 18 also had a real impact on her.

‘It did not seem that adult services (CMHRS) took her self-harm history, and the impact of gender-affirming treatment delays on her emotional wellbeing, seriously enough.’

Dr Litman said her daughter was ‘cast out of care’ as she did not meet the adult threshold for intervention."

https://metro.co.uk/2023/09/19/trans-woman-who-died-after-1000-day-nhs-wait-failed-by-system-19520026/

In The Times (and some other papers) it seems that Alice received support from CAMHS in 2017 then consulted a GP some time in 2018 before disclosing issues with gender identity to a different GP in September 2018.

"In a statement she said: “There were significant and ongoing delays in accessing gender affirming care. My daughter could have lived a happy and healthy life if she had not been failed by the healthcare systems that were meant to support her.

“I felt that I was repeatedly unable to get my daughter past the gatekeepers for mental health treatment and gender-affirming care. I felt and continue to feel immense shame and responsibility that, as a mother who used to work as a psychiatrist for the NHS, I struggled to get the help for my child that she so obviously needed.”

Alice first came to the attention of the Child and Adolescent Mental Health Services in 2017 when she began suffering from severe anxiety and low moods.

She received group therapy which was helpful but her low moods continued and in early 2018 she went to see a GP in her home town of Leatherhead, Surrey.

Her mother criticised the GP who failed to take her daughter’s requests for help seriously.

She said: “We both found the appointment totally unhelpful. He suggested that Alice needed to play more football and told me that he made his daughters go for a walk every day and that I should do the same. No other treatment was offered.

“When we left the appointment, Alice said to me, ‘Please never make me see that doctor again’. She felt she was not being taken seriously and the doctors did not understand her.”

In September 2018 Alice told her sister that she felt she wanted to live her life as a woman and went for an appointment with another GP where she told the doctor about her gender identity problems.

Litman said that this doctor suggested a “watch and wait” approach and did not make a referral to the Gender Identity Development Service.

She said: “In my view this demonstrated a lack of understanding on the doctor’s part, both in her assumption that transgender people are likely to change their minds about transition, and in her failure to consider that the waiting list to access treatment was already years long.”

It was not until after her first suicide attempt in June 2019 that Alice was finally referred for treatment at the Gender Identity Development Service.

In August 2019 the service said that “due to high demand we have found waiting times at the Gender Identity Development Service incredibly hard to predict. Currently we are seeing young people for assessment who were referred 24 months ago”.

That month, Alice began wearing make-up and changing her name, which helped with her low mood, but this declined again when she realised there was a long waiting list for gender identity treatment.

When she was 18 in February 2020, the referral was transferred to the adult Gender Identity Clinic at the Tavistock Clinic.

Due to the severe delays in referral, her family paid for private counselling to help support her mentally. They also sought help from GenderGP, a private service aimed at supporting transgender patients, and Alice began taking cross-sex hormone therapy.

The outbreak of the Covid pandemic made seeking further treatment or surgery impossible.

Litman said: “Lockdown was another barrier to Alice getting appropriate care.”
In September 2021 Alice moved from her family home in Surrey to Brighton where she lived with a friend.

The family continued to try and find private gender care for Alice but on a visit home in Easter 2022 Litman told Alice that even waiting lists at the private London Transgender Clinic were long because of a rapid rise in referrals due to the increasing NHS backlogs with the Gender Identity Clinic.

During the same visit Alice confessed to her mother that she was having thoughts of suicide."

https://www.thetimes.co.uk/article/0cf50618-566c-11ee-9ad7-7384b2f230c5?shareToken=11685d7ef5bc8e26332f1d94f0c2a36c

The repeated use of the term "gatekeeping" by Alice's mother is emotive and also incongruous because Dr Litman worked for many years as an NHS psychiatrist. It would be more usual to talk of "referral acceptance criteria" and "prioritisation criteria".

The inquest might find that NHS mental health services, in particular the adult CMHRS, got it wrong and should have accepted and prioritised Alice.

However, Alice did receive both private mental health care as an adult and private "gender affirming care" (a prescription for cross-sex hormones from GenderGP).

The eventual outcome is heartbreaking and tragic but as all the experts in suicide stress, there is never just one reason.

Thanks, Bosky.

there is never just one reason

that's vital to convey, and I think something that most of the coverage has failed to make clear.

Gatekeeping is a familiar word among frustrated parents of distressed children: trying to get an appointment, and for that to be a meaningful, helpful appointment that leads to helpful action is very, very difficult. Worsened by covid but the system was broken before that; I remember a CAMHS worker telling me in frustration that she was now seeing mostly only teens referred from A&E after direct attempts at self harm, and she had maybe forty minutes in a secondary school corner with them, and that was it, and that was ten years ago.

A massive proportion of the children waiting years for a paediatrician's appointment or an assessment or for CAMHS help are those with diagnosed or suspected Autism, ADHD, anxiety, many too distressed to get to school any more. It is awful, the distress and suffering is high - and I count parents and siblings in this, not just the child themselves - and it is a failing. And the criteria to access any services gets ever higher because the services are so overwhelmed. Boundaries are being shifted constantly to try and put the responsibility for provision and care back on parents and schools to reduce the weight of referrals coming in. And anecdotally, what is offered if children do manage to access the services does not seem to be leading to many families reporting much success.

But I am very wary about one population of these children being painted as in greater distress and suffering more/in more danger than other populations, or this being a more simplified situation than it really is. I am also wary about the focus being on endlessly creating faster referrals and more services rather than a broader focus looking at why we are being increasingly swamped with so very many very distressed children.

It's terrifying, Frood. When are we going to get a grip on this problem? All these poor children and families.

there is never just one reason

And, sadly, no magic bullet cure either.

My brave Dd has had brain surgery to take out part of her brain but there’s at least a 18 month wait to see a neurologist because she’s been transferred to adults. It’s bizarre to have just had such major surgery and no follow-up from the neurologist now. Just been told to keep on the same strength of strong meds.

The problem is that all patients coming up to 18 are having messy transfers and new wait lists. For mental and physical health.

Great sleuthing and analysis @Bosky

And yes, exactly this re the press coverage @ArabeIIaScott
If they were going to report on it at all, the only way to do it any just would have been to Do A Boksy and turn over every stone. Even with underfunding in the press, there is no excuse when reporting on a suicide. The risks of copycat ideations are just too great, particularly so when we already know that anyone on a GIDS or similar waiting list is highly likely to have co-morbiditities which may be contributing to low mental health.

I consider our family very fortunate that we're still navigating the CAMHS system successfully, albeit at a frustratingly slow pace - sadly private psychiatric mental health care is overwhelmed ATM. Everywhere I phoned said they weren't taking on new referrals.
On a further positive note, the main contact overseeing my daughter's case has assessed that autistim, and the distress that it is leading to in regards to puberty (body changing, sensory etc), is what is driving my daughter's mental health issues, coupled with the bullying distress. Even more positively, a multi-disciplinary team also agrees with this. Looping back to something earlier on in the CAMHS journey, I remember the senior person who called me back (after we had taken the difficult decision to put her CAMHS support on hold), after all my letters and escalations, telling me that "You've been to cause of lots of conversations here. I think that's what you wanted". She was a phenomenal and formidable lady, and the tone in which this was said with was collaborative and supportive. Things are changing. Slowly, but they are.
Sadly not in time for Alice or her family 😞 But hopefully in time for others to get the mental health support that they need.

(to add context: the conversations that had kicked off in CAMHS were about gender identity and autistim conflating when a young person is distressed during puberty)

I'm glad that things are moving forward for your daughter and you, Bonfire. I hope you all find a way through. And positive to hear that things are changing. I'd be very surprised if most in the mental health world weren't aware of the Cass Report and Hannah Barnes' book, for a start.

Thank you.
TBH I don't think so. I know a few people in autism and mental health now (professionals and volunteers) and it's the same story each time: they are so in their bubble that gender identity comes across as an accepted coincidence (e.g. similar to a coincidence that some autistic people are gay) rather than something to be looked in to further. The Cass Review isn't routinely landing in their laps.
In every single case without exception so far, when I open up the conversation something interesting happens and the professional/volunteer pulls it all together very quickly (a rapid peaking experience!). I think the main issue is the silos.
I'm always very careful in how I frame the conversation when I open it. This is why I think of it in terms of belief: some people believe in gender identity and that's OK. What's not OK at all is the impact that this belief has when it is taken onboard as fact by vulnerable children and adolescents, and then becomes the "answer".

Wow, really?

I guess that's me being in a bubble. I had the impression everyone in a related field would be aware of the Cass Report, at least. But then, HCPs often don't have time to keep up with the latest developments.

I think this is typical in today’s separated-out NHS, where patients are referred for specific diseases of specific parts of the body. Where once we’d just stroll over to the opposite side of outpatients and ask a colleague what they thought of [this particular symptom/phenomenon], now a letter goes back to the GP saying “refer to so-and-so instead”, there’s little seeing the patient as a whole.

40 years ago we had general physicians who might specialise in respiratory, gastrointestinal, cardiology etc. but they still saw and treated the whole gamut of patients, they had to be up to date with everything medical. Now everyone is so specialised, and the “internal market” means nobody wants to treat anything they won’t be paid for, so while junior docs are far more broad in their knowledge, consultants are usually experts in a small area.

As an ICU nurse and medical ward sister, I knew a lot about a lot, but then I went into HIV/Aids nursing , followed by cancer/palliative care, and all of my former knowledge went out of my head because I didn’t need to know it. I forgot it. I read only the stuff - and there was an awful lot of it - that pertained to my specialty.

So yes, it’s not too surprising that people who aren’t in the very small and specialised field of gender medicine would be aware of the Cass report or Hannah Barnes’ book. When referring patients to other services, it’s often with a sense of relief to have got someone off one’s enormous unmanageable caseload - pretty sure this was the case with over-stretched CAMHS who referred to GIDS.

This makes a lot of sense.
I had to kick up quite a fuss in two CAMHS teams to get myself heard (the hospital one and the receiving team), including multiple letters and a SAR. Had I not done, we were on a straight pathway to the GIDS queue because of the incorrect statement from the hospital team that she "identified as male". After much back and forth they acknowledged she never did and that this had come in as nurse's observation. I don't blame the CAMHS teams at all. They were following protocol (when I finally had a meeting with the head of the hospital team and the original crisis counsellor they said this protocol would change - I have every faith that it did) and the receiving team, who would have referred her on, were simply doing the same. Despite how stressful it was to go through it, once conversations opened up (and people intentionally and deliberately stepped outside their bubble - I think pretty much everyone at CAMHS wants to do a good job) it was amazing. A true collaboration to support my daughter, even with the limitations and snail like speed of it all.

Ps I'm not trying to centre this thread around me.
This is about Alice and her family.
But I think my own experience does shed a relevant angle on what happens when the mental health and co-morbiditity pathway is no longer front and centre.. and the effort someone might have to go to to get it re-centred.
This is why I'm so angry at the current circumventing of the Cass Review. The 16/17 year old acceleration to adult services (the Anna Castle and Mrs C judicial review), the current draft Interim Specification (better... but still written in gender identity language), GOSH being the main London hospital (and their recent Global Butterflies training.. and clear bias from the top down), the idea of trans mentors for 16/17 year olds, the latest announcement that Gendered Intelligence will partner with the NHS in the accelerated 16/17 pathway. All of it is so so so wrong.

Worth remembering as was pointed out up thread that clearly the media coverage is heavily influenced by the Good Law Project taking it up because ????

So their slant on the story is probably filtering what has and what hasn't been reported.

And, although I suspect some will think this isn't right to say, it is also filtered through how the parents reacted / responded to what was happening with Alice. They were so sure what was the right treatment that they are looking for an inquest decision that confirms their actions were correct.

Again as said up thread, it appears the parents were able to pay for treatment they felt the NHS was not making available (not necessarily gatekeepipng, but an overwhelmed service) and and they are presuming it was the right treatment, but it could have been that the private treatment didn't address underlying issues. And rather than look at that they are asserting it is the failure of the NHS.

These are current waiting times according a website by queers for queers!
https://genderkit.org.uk/resources/wait-times/

Wow! 4-5 years on average! No wonder desperate parents turn to private services, although the tragedy is that those 5 years waiting to be seen could have been the “cure” for their gender dysphoria.

The problem seems to be parents and (both NHS and private) doctors yielding to young people’s demands for puberty blockers and cross-sex hormones. I can think of no other field of healthcare where patients can demand and receive experimental medical treatments when they’re too young to appreciate the long-term effects on their bodies, or understand what they’re potentially giving up, like future fertility and ability to orgasm. It shocks me that doctors can agree to this, it’s simply scandalous.

I can think of no other field of healthcare where patients can demand and receive experimental medical treatments when they’re too young to appreciate the long-term effects on their bodies

This, although more dangerous, seems to be part of a pattern of parenting where the mere hint that you challenge what your child has said or thought as being totally unacceptable.

I am not arguing for children to be told to accept what parents say, but in some families, it seems to have gone the other way. This whole narrative that children are so fragile that you musn't traumatise them by saying anything that might imply they dont know what they are talking about or that they shouldn't do something.

And there are very major ethical concerns about providing rapid extreme surgical and hormonal intervention to a child in the hope that it might. Removing their fertility and creating major lifelong health issues on the way.

You cannot undo it if it doesn't help, and the child discovers that this was not in fact the answer and they are now in a worse situation than before.

I also wonder how much the gender issues get in the way of any genuine therapy - if you can state that you are suicidal because of gender dysphoria, you have a concrete reason & then don’t have to explore anything else about your relationships, behaviour etc. - & there is no evidence that gender affirming care will reduce the risk of suicidal behaviour

This is very important. I get the impression some are trying to suggest that co-morbidities such as depression, anxiety, other mental health issues, will be somehow 'solved' by surgery and hormones and therefore any kind of mental health support or exploration is unnecessary.

I don't think there's even any reliable, solid evidence that even dysphoria will be alleviated in the long term with these treatments, yet it's all got smooshed in together and is being presented in a hugely crude, skewed, oversimplified and unevidenced package.

In the worst cases this oversimplification gets chopped down to 'better a live trans child than a dead one'. And I apologise for even using that phrase, I find it utterly abhorrent that anyone would try to reduce a sensitive, complex issue to such an emotionally manipulative and ghastly suggestion. But people do. And parents trying to navigate what must be an incredibly difficult and upsetting situation have it thrust upon them, as a challenge to any questions.

Yes to all the above that is between my last message and this one.

This is a really good article that I saw earlier today which is very relevant:

https://www.spiked-online.com/2023/09/20/how-trans-ideology-is-undermining-the-family/

Ps I should add: I'm not blaming or judging Alice's parents here.
There are a whole raft of reasons, some mentioned above, as to why parents affirm a child's identity.
The suicide emotive push "better an alive daughter than a dead son" is probably the most powerful of all.
Even now, knowing what I do about the harms being done to children, when I hear that said directly to me (I'm in a parent group), it still cuts right through to my emotions and fear. I don't dwell on it because I know how to process it but the visceral reaction is to a) stop for a moment and b) really, really understand the pain that a parent is feeling on knowing what to do. I've heard a few parents say in the group that they don't believe their child would be alive if they hadn't transitioned. They mean it from a place of kindness, possibly also from a need for validation that others think they've done the right thing (Helen Joyce talks about this too). Irrespective of the motive, it's bound to have an effect on the parents who are listening whose children haven't yet had hormones or surgery'.

I'd also imagined the Cass report would land in the laps of everyone doing any kind of mental health care for young people because gender dysphoria has become such a common comorbidity. Well silly me

I get what you mean about silos though. My adult DC (who has a diagnosed ASC, and is transitioning) is also wondering if they might also have ADHD or even bipolar. (I know, diagnosis chasing, but they are adult so it's not my decision) Anyway everything is so silo'd that DC has two separate referrals to two separate clinics, one for ADHD one for bipolar. There's no-one in DC's bit of the NHS whose job is to be holistic, to do a differential diagnosis and ask "which of these many labels is really the nearest, the best, the most useful?"