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Gender Identity Development Service
The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with transgender and gender diverse youth, including those with gender dysphoria. Launched in 1989, GIDS was commissioned by NHS England and took referrals from across the UK, although it was operated at a Tavistock and Portman NHS Foundation Trust site. GIDS was the only gender identity clinic for people under 18 in England and Wales and was the subject of much controversy. GIDS faced significant criticism from transgender people for long delays in accessing gender-affirming healthcare and invasive assessments. It was also criticised by gender-critical people who opposed gender-affirming care for youth.[1] By 2020, a large increase in referrals led to waiting lists in excess of two years. Between 2020 and 2021, GIDS stopped offering hormonal treatments to youth following the judgement in Bell v Tavistock, until the decision was overturned on appeal. In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres, following the release of the interim report of the Cass Review, in order to reduce waiting lists and provide better quality care to young people.[1][2] The service closed in March 2024. HistoryPre-establishmentGIDS was a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. It mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children's department, which developed many works by James Robertson and John Bowlby on attachment theory.[3] In 1959, it opened an adolescent department and in 1967 it was absorbed into the London Child Guidance Clinic.[4] Early yearsGIDS[6] was founded in 1989 by Dr Domenico Di Ceglie, a child and adolescent psychiatrist.[2] It was one of the first child gender services in the world. After its opening, "it got two referrals over the whole year".[7] It was initially based at St George's Hospital before moving to the Tavistock and Portman NHS Foundation Trust in 1994.[8] The clinic saw 12 patients that year, increasing to 24 two years later.[8]  In its early years, the service took a primarily psychoanalytic approach reflecting object relations theory, drawing from Di Ceglie's training. Di Ceglie described the children referred to the clinic as suffering from "atypical gender identity organization".[1] In the early 2000s, some of Di Ceglie's colleagues at Tavistock published articles in the Guardian arguing that medical transition was a form of "mutilation" and that rights won in the European Court of Human Rights for transgender people were a "a victory of fantasy over reality".[1] Di Ceglie estimated in 1993 that only 5% of his patients would "commit themselves to a change of gender".[9][1] Puberty blockers were considered a usable option by the end of the 1990s but only for patients aged 16 or over who had first tried extensive therapy.[10] In 2000, a retrospective audit led by David Freeman looked at the records of 124 patients the service had seen since opening. The audit showed it was very rare (2.5% of the sample) for young people referred to GIDS to have no associated problems, that children do not "grow out of it" and that problems increase with the onset of puberty.[11][12] In 2009, Dr Polly Carmichael, a consultant clinical psychologist, succeeded Di Ceglie as the clinic's director.[13][7][14][15] In that same year, GIDS became a nationally commissioned NHS service.[13] Expansion in the 2010sIn 2011, in response to changing international standards for gender care, the clinic began a research study allowing a "carefully selected group of young people" to receive puberty blockers after the age of 12. In 2014, prior to the study's completion, the clinic received NHS approval to offer them without mandating enrollment in a research study.[1] In 2012, the service was extended to a satellite site in Leeds. Endocrine support was also extended to Leeds Children's Hospital at the Leeds General Infirmary site in 2013.[16] In 2011, a patient satisfaction survey found the majority were satisfied, but a quarter expressed dissatisfaction with long wait lists. Other concerns included geographic inaccessibility and the requirement for real-life experience.[17] Research and NHS consultations in 2015 found that the clinic's transgender patients considered strict assessment procedures demeaning, invasive, and disempowering. Patients also felt they had to perform their gender in ways amenable to the staff.[18]  Between 2014 and 2015, 697 youth were referred to GIDS and in 2015-2016 1,419 were. In September 2015, GIDS overshot its 18-week waiting time target for the first time. The same year, an external report by Femi Nzegwu stated that GIDS was "facing a crisis of capacity" and recommended capping referrals.[19] By 2016 average wait times rose to nine months.[7] In February 2019, it was revealed that the National Institute for Health Research (NIHR) had announced a £1.3 million grant for a voluntary study following young people referred to GIDS, to compare outcomes for those who elect to medically transition and those who do not.[20] In 2020, over 2,000 children were referred to GIDS and in 2021 this rose to more than 5,000, leading to waiting lists of over 2 years.[21][19] In January 2021, the Care Quality Commission rated GIDS as "inadequate" citing the high caseload.[19] CriticismIn the mid 2000s, gender-critical psychoanalysts and psychologists became GIDs' most prominent critics,[citation needed] opposing gender transition altogether, particularly in young people.[1] In 2018, Dr David Bell wrote a critical report of GIDS based on conversations with other GIDS staff. He suggested that transgender children who desired medical transition were suffering from other psychological factors such as internalised homophobia, intergenerational trauma, social media, and commodification of the body. He further suggested that most transgender children would desist and that medical transition should be a last resort for adults.[1] In November 2018, parents of 17- to 25-year-old patients complained in a letter to the Trust board that their children were transitioning too quickly and they felt psychosocial factors made them want to transition.[22] In December 2020 Bell reported that he now faced "disciplinary action" from the Trust though he retired later than planned in January 2021.[23] Dr Marcus Evans, a longstanding member of the Tavistock and Portman NHS Foundation Trust governance board, resigned that week in response to Bell's report, which he supported. His wife, Sue Evans, had resigned from work as a psychoanalyst a decade previously. Together, they wrote a book in 2021 sharing their views on how to help a young person overcome their wish to transition and supporting gender exploratory therapy. Reviewers noted the book was full of prejudicial value judgements about transgender people.[1] Marcus Evans went on to co-found the Society for Evidence-Based Gender Medicine, which the Southern Poverty Law Center described as a hub of anti-LGBT pseudoscience.[24][25] Subsequent to the Bell report, it was revealed that 35 psychologists had resigned since 2016, including six psychologists who claimed there was "over-diagnosis" of gender dysphoria and a push for early medical intervention,[26] because "psychologists fear being branded transphobic".[27] In July 2020, it was reported that Sonia Appleby, the "Named Professional for Safeguarding Children" at the gender identity clinic, had been in dispute with her employers since November 2019.[28] Appleby said staff had come to her in 2015-2016 with "a worry that some young children are being actively encouraged to be transgender without effective scrutiny of their circumstances". Between 2017 and 2019 she made six protected disclosures and in 2018 told a colleague that there could be a "Jimmy Savile-type situation". In 2019, she was called to an informal meeting with the Trust's medical director who said a letter was placed on her file due to the Savile comparison.[29] In September 2021, Appleby was awarded £20,000 by an employment tribunal which found the Trust's "quasi disciplinary treatment" of her had damaged her professional reputation and "prevented her from proper work on safeguarding".[30][31][29][32] In the early 2020s, The Daily Telegraph and gender-critical figures alleged that transgender youth charity Mermaids may have exerted undue influence on GIDS's clinical decisions, particularly concerning the prescription of puberty blockers and cross-sex hormones to minors.[33][34] In October 2024, an inquiry by the Charity Commission found no evidence to suggest that Mermaids had inappropriate influence or ties to GIDS.[35] Bell v TavistockIn October 2019, Sue Evans and the mother of a 15-year-old patient on the waiting list filed a lawsuit against GIDS.[36] The pair's solicitor said "the provision at the Tavistock for young people up to the age of 18 is illegal because there isn't valid consent" and that Gillick competence – a UK legal principle that those under 16 can make their own medical decisions "if and when the child achieves sufficient understanding and intelligence to fully understand what is proposed" – should not apply to gender-affirming care.[37] Later, Evans passed their role as complainant to Keira Bell, a previous service user and detransitioner. In a judgment delivered on 1 December 2020, the judges said that it was "highly unlikely that a child aged 13 or less would be competent to give consent to the administration of puberty blockers", and that it was "doubtful that 14 or 15 year olds could understand the long-term risks and consequences" of this form of treatment. Where the young person is 16 or over, the judges said "clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment."[38] Following the High Court judgement, GIDS suspended all new referrals to endocrinology. The Court granted a stay on further implementation of the judgement until 22 December 2020 or until appeals were exhausted.[39] Amnesty International and Liberty issued a joint statement emphasising their concern on "the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily autonomy."[40] Consortium issued a statement stating that the ruling "could have a potentially devastating impact on young people seeking access to medical services".[41] In 2021, the Court of Appeal overturned the judgment as "innapropriate", since it was an established legal principle that "it was for clinicians rather than the court to decide on competence".[42] ClosureIn 2020, due to a significant rise in the number of referrals to GIDS, NHS England and NHS Improvement commissioned Hilary Cass, a paediatrician and former President of the Royal College of Paediatrics and Child Health, to lead a review into gender identity services for children and young people.[43]  In March 2022, Cass published the interim report of the Cass Review. The report said the existing model was "neither safe nor viable", partly as the rise in referrals had left GIDS staff overwhelmed and led to "unacceptable" waiting times, and recommended the creation of a new network of regional centres.[44] It criticised the care at GIDS, saying that its clinical approach "has not been subjected to some of the usual control measures" expected of an innovative treatment and sidelined the patients' other mental health needs.[45][46] In July 2022, the NHS decided to close GIDS and replace it with regional healthcare centres.[47][2] The regional centres are intended to provide more "holistic care", linking to other mental health services.[48][2] After a delay,[49] GIDs closed in March 2024, and was replaced with the new NHS Children and Young People's Gender Services,[50][51][52] which initially constituted two new services at Great Ormond Street Hospital in London and Alder Hey Children's Hospital in Liverpool, intended to be the first of eight regional centres.[53] In February 2023, documentary journalist Hannah Barnes published a book on GIDS, titled Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children.[54] ServicesServices provided included:[55][56]
No surgical transition options were available through GIDS.[55] People referred to GIDS could also contribute to NIHR studies into gender dysphoria in children.[20] See also
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