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Waiting Lists

'We can't keep relying on other countries': HSE begins hiring experts to oversee service for trans youth

Teni has welcomed the fact that a consultant psychiatrist and a paediatric endocrinologist are being hired.

THE HSE IS recruiting a new Consultant Child and Adolescent Psychiatrist who will lead a multidisciplinary team within mental health services to support the delivery of the National Gender Service.

The team will oversee healthcare for transgender adolescents who currently face long waiting lists for treatment.

The recruitment plans have been welcomed by the Transgender Equality Network Ireland (Teni) who had previously raised concerns that young people were being referred to a healthcare service that doesn’t yet exist.

The psychiatry role was approved on 9 April and is now being advertised. The deadline for applications is 27 May. The salary will start at a minimum of €144,000 and serving consultants moving from permanent posts are allowed to retain their existing salary scales.

The psychiatrist will initially be based at the Linn Dara Child and Adolescent Mental Health Service (CAMHS) in Dublin for 23 hours per week and CHI (Children’s Health Ireland) at Crumlin Hospital for 16 hours per week.

Separately, CHI at Crumlin has recently appointed a Paediatric Endocrinologist who will take up the role later this year. Part of their role will be to work with the CAMHS/Gender Identity Development (GID) service and in particular with the psychiatrist once they are hired.

As previously reported by The Journal, some trans people are facing a five-year waiting list for healthcare

Currently there are two distinct waiting lists for children and adults. As a result, teenagers may spend two years waiting for treatment as an adolescent then when they reach 17 and are transferred over to the adult service, face an additional three-year wait.

Teni says up to 100 young people are currently waiting to access some form of healthcare.

Meanwhile, trans adults are travelling abroad for surgery they can’t access in Ireland.

A long-awaited report on transgender healthcare published in December made a number of recommendations including that psychological support for those under the age of 18 should be provided and delivered by the Irish health service, rather than in the UK as was previously the case.

However, until this service is up and running, Teni CEO Éirénne Carroll previously said the patients in question will “be re-referred back to the Irish new service, which does not currently exist”.

‘Good news for families’ 

Carroll has welcomed the latest development, saying it is good news for trans young people and their families after a difficult year.

She told The Journal: “It’s great news because it means that we will get the process rolling and get the child and adolescent service back to active. So, hopefully, that will mean we can start addressing the growing waitlist and offering affirming healthcare to our trans children across the country.

Since last year we’ve had such a string of bad news or disappointing news. This will come as welcome news to so many families.

Carroll said “a lot more still needs to be done” and called for the multi-disciplinary team to be established as quickly as possible, adding that Ireland can’t “keep relying” on other countries to provide certain health services.

“We need to provide a service to our children and adolescents here in Ireland. The team would allow us to have a fully functioning Irish healthcare service rather than relying on the international service.

“We need to continue to push for that, for Ireland to follow international best practice and provide a healthcare service to the many trans people here,” she said.

Sexual and gender identities

The advertisement for the psychiatry role states that the GID service “will recognise a wide diversity in sexual and gender identities”.

“The consultant will lead a highly specialist multidisciplinary team (MDT) that will be primarily community-based (Linn Dara CAMHS) with in-reach to CHI Crumlin Hospital paediatric and adolescent consultant endocrinologist-led team.”

The ad notes that the community mental health team will include a specialist consultant psychiatrist, psychologists, a social worker and a clinical nurse specialist.

The ad continues: “Children and young people who have disorders of sex development or intersex conditions and other endocrine conditions may be referred if there are associated concerns with gender identity development. If not, other services are available which local services can refer to.”

The service will be delivered in line with “emerging evidence for best practice” and “relevant national and international guidelines”.

Delays in setting up new service

In Ireland healthcare for young trans people is delivered in Crumlin Hospital, while adult services are delivered at the National Gender Service in St Columcille’s Hospital in Loughlinstown in Dublin.

In recent months Teni has been critical of delays in setting up a new model of care for young trans people.

Patients receiving treatment in Crumlin previously received psychological services via the Tavistock clinic in London, which was funded by the HSE’s Treatment Abroad Scheme. Tavistock’s contract with the HSE ended late last year and was not renewed.

Carroll said CHI and the HSE knew the contract was coming to an end so should have had measures in place to mitigate the impact on patients here, and that a recent court case in the UK is not the reason for the contract ending.

Last month Carroll told us: “According to the LGBTI+ Youth Strategy, a multi-disciplinary service for children and adolescents was meant to be established by December 2020. There was always this expectation that the contract was going to end with Tavistock, and that by 2020 we’d have our own service here.

“And yet, we got to December, and issues came up and there was no multidisciplinary team. It’s unfair to say that because of something that happened abroad the service is ending, when the people involved in the process knew the service would be ending (for other reasons).”

The LGBTI+ National Youth Strategy 2018-2020 was published by the Department of Children and Youth affairs three years ago. The document set 2020 as the year by which “appropriate resources” would be available to trans children and teenagers “in order that the HSE Service Development model of care is implemented and accessible to support trans young people”.

When asked about Teni’s concerns, a spokesperson said CHI will continue to engage with the HSE, Treatment Abroad Scheme and Tavistock “relating to any new referrals under the UK High Court ruling recommendations and following any court appeal determination”.

The spokesperson said CHI currently has no active patients under the primary care of Tavistock Gender Identity Development Service, but added: “should we have, we will continue to work with the HSE on any patients deemed suitable for assessment”.

There are currently fewer than 10 patients on puberty blockers that were assessed by Tavistock receiving treatment at Crumlin.

The Paediatric Endocrinologist will take up their post later this year, with the spokesperson adding that the appointee may request “a period of further specific training in Gender Identity”.