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Belittling psychiatric assessments are creating a storm of depression and suicide among trans patients

Belittling psychiatric assessments are creating a storm of depression and suicide among trans patients

By Christopher Inglefield, plastic surgeon and medical director at the London Transgender Clinic.  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

By
Christopher Inglefield, plastic surgeon and medical director at the London
Transgender Clinic. 

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. 

https://www.thelondontransgenderclinic.uk

Christopher Inglefield

Christopher Inglefield

Christopher Inglefield is a highly experienced Consultant Plastic and Transgender Surgeon and Medical Director of London Transgender Clinic.
He is a member of the World Professional Association for Transgender Health, the UK Association of Aesthetic Plastic Surgeons and the International Society of Aesthetic Plastic Surgeons.



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