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# Crumlin
Trans children being referred to healthcare service that 'doesn't exist yet'
The Transgender Equality Network of Ireland said the situation is “very concerning” and will impact up to 100 people.
THE GENDER IDENTITY adolescent service that was situated in Crumlin children’s hospital is no longer receiving further referrals, according to the Transgender Equality Network of Ireland (Teni).
Teni has been informed that CHI at Crumlin is no longer receiving referrals from either the Child and Adolescent Mental Health Service (CAMHS), or the Gender Identity Development Service UK (GIDS UK/Tavistock clinic in London).
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.
Teni CEO Éirénne Carroll told TheJournal.ie that Teni has been informed that the patients in question will now “be re-referred back to the Irish new service, which does not currently exist”.
“This would mean that young people and their families that have already suffered a two-year wait to be seen by GIDS/UK, will potentially be waiting in limbo for a service that does not exist.
“This waitlist will impact between 70 to 100 families that have now been dropped by the failure of the HSE to implement a supportive and functioning gender identity service within the HSE child and adolescent care service.”
Carroll said “this very concerning situation has transpired due mainly to the failure of the HSE, to develop and implement a proper Multi-Disciplinary Team (MDT) to support the provision of care for young trans people in Ireland”.
“This MDT was highlighted as a key requirement in extending proper child and adolescent care to trans children in a recently published HSE report in December 2020,” she added.
Previously the service provided in Crumlin relied on GIDS/UK to provide psychological assessments, which were funded by the Treatment Abroad Scheme (TAS).
‘No path forward’
The report published in December was submitted by the National Trans Healthcare Steering Committee in February 2020 but only published on Christmas Eve, as previously reported by TheJournal.ie.
Similar recommendations were also made in the LGBT+ National Youth Strategy 2018-2020 and the National LGBTI+ Inclusion Strategy 2019-2021.
“Despite all of this work, and these reports, none of the goals (in the strategies) have been achieved or undertaken,” Carroll said.
“With the ceasing of the Crumlin Children’s Hospital Child and Adolescent Care programme, transgender young people and their families are left with no Irish support, and no path forward.
“The care provided to transgender people, and transgender children has regressed over the last two years, despite numerous reports recommending the development and delivery of essential services for these young vulnerable and at-risk group.
“These developments raise serious questions that remain unanswered by the Department of Health and the Minister.”
Carroll has called on Health Minister Stephen Donnelly to clarify how his department “plans to ensure these young people and their families can immediately access the care they need.”
Teni wrote to parents this afternoon to make them aware of the situation. The organisation plans to organise an online meeting for families affected to discuss their concerns.
TheJournal.ie has contacted the HSE, CHI at Crumlin and the Department of Health for comment.
Tavistock
Patients receiving treatment in Crumlin previously received psychological services via the Tavistock clinic in London, which was funded by the TAS.
Tavistock’s contract with the HSE recently ended and is not due to be renewed.
A recent UK High Court case involving Tavistock, which runs the UK’s only gender-identity development service, does not affect Irish people.
Fewer than five patients in Ireland were referred to Tavistock in 2020, down from 20 in 2019, 46 in 2018, and 40 in 2017.
Healthcare services for trans adults are based in St Columcille’s Hospital (SCH) in Loughlinstown in Co Dublin.
Recommendations
In December the HSE told TheJournal.ie that most of the recommendations in the steering committee’s report were in progress, and that it was considering updating the current model of care.
The report by the National Trans Healthcare Steering Committee recommended the following:
- Move from the current system of psychological support provided by Tavistock Clinic (in London) for those under the age of 18 to ensure services are provided and delivered by the Irish health service.
- Develop a full multidisciplinary team within mental health services to support the delivery of the National Gender Service (NGS), led by the new CAMHS Consultant Psychiatrist.
- Develop terms of reference of a Clinical Governance Committee for the NGS (to include representation from adult and paediatric services, as well as service users) that will operate across all services delivering transgender care to ensure clear clinical and corporate governance structures are in place.
- Develop a Service User Forum for the NGS, with advice from the HSE Head of Mental Health Engagement & Recovery in relation to service user involvement and representation.
- Consider revisiting the current Model of Care, as developed by Dr Philip Crowley (National Director of the HSE Quality Improvement Division) under the auspices of new guidelines published by the Department of Health, noting that additional resources are now available to deliver more comprehensive programme of care.
- Continue to rollout Gender Identity Skills Training (GIST) nationally to all relevant staff members across the continuum of care, through primary care, secondary care and tertiary care, including Jigsaw and Counselling in Primary Care (CIPC) staff providing services at a local level.
- Consider the establishment of academic partnerships to provide longitudinal evaluation of the service as it develops, and appropriate key performance indicator (KPIs) for ongoing monitoring of the service, to best ensure service provision develops along with need.
