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Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children

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I think there was a complicating factor that, in some cases, safeguarding concerns… you know, there was a grey area between the safeguarding concern and the trans identification. And the service was very keen not to stigmatise these young people, not to pathologise. And so, there was a line to tread whereby a concern about a young person wasn't a questioning of their gender identity. But on balance, many clinicians felt that the bar was too high. Because of that… fear, if you like, in the service, the bar was too high for referring, for taking these concerns as seriously perhaps as they would in other services.

Hannah Barnes review - The Guardian Time to Think by Hannah Barnes review - The Guardian

This book contains so much more than is outlined here. It should be read carefully by everyone involved in the care and safeguarding of children, including schools and government ministers. What other institutions are in thrall to transgender activists, leaving the most thoughtful professionals afraid to speak out? Where else do we see the same failure of safeguarding demonstrated at the GIDS? Why are the same ideological groups that influenced the GIDS allowed to influence policy in schools? Medical harm may be the most extreme result, but what other harms are being caused to children in schools, social care and child agencies by the failure to put facts and evidence ahead of ideology? As numbers increased, the caseload per clinician increased beyond safety levels. In 2015, in an attempt to calm the over-worked clinicians, an organisational consultant was called in. The subsequent report warned that GIDS was “facing a crisis of capacity to deliver effectively on an ever-increasing demand for its service” and recommended immediate action to cap referrals. This was ignored by GIDS director, Polly Carmichael. The caseloads continued to rise, first 50, then 70, , 90 or 100 patients each. One clinician reported an astronomical caseload of 140 patients. With some caseloads comparative to the size of a small primary school it is little wonder that clinicians had difficulties recognising their patients when they arrived for their second appointment. MyHome.ie (Opens in new window) • Top 1000 • The Gloss (Opens in new window) • Recruit Ireland (Opens in new window) • Irish Times Training (Opens in new window) The book is not transphobic. At no point does Barnes question that many people are happier being trans and that those people should be treated well.Hannah Barnes sensibly doesn’t get in to the wider political debates on this issue; she restricts herself to factual evidence and testimony from those who were actually there, and the book is the more powerful for that. The facts speak for themselves; Barnes leaves it to the reader to gasp in horror and make the judgments and analysis for themselves. A powerful investigation … The interviews with staff and children — some who have happily transitioned and some who have not — show how complex the issues are. Not a comfortable read but meticulous and thought-provoking’ – Camilla Cavendish, Financial Times, Best Summer Books of 2023 The book charts the course of concerns being raise about the service. This started in 2005 with an internal review. There were then recommendations that the number of people who could be seen be capped in 2014. After that in 2018 the Bell Report was written that deemed GIDS ‘not fit for purpose’. In 2021 the Care Quality Commision (CQC) rated GIDS as ‘Inadequate’, the lowest rating. Finally GIDS was closed in 2022 and that regional centres in children’s hospitals would be used that emphasized mental health more. GIDS began seeing Irish children in 2012 under the Treatment Abroad Scheme. Three years later, as demand increased, staff started holding monthly clinics in Crumlin hospital. Between 2011 and 2021, 238 young people in Ireland were referred to GIDS. As in the UK, the Irish referrals were overwhelmingly female and had multiple other “difficulties”.

book by Hannah Barnes: ‘Time to Think: The Inside Review of book by Hannah Barnes: ‘Time to Think: The Inside

To raise safeguarding concerns about children and young people who happen to be experiencing gender related distress should be viewed in the same way as it should be about anybody. It's not transphobic. Sonia was accused of being transphobic. But for what? For asking for data and for relaying concerns about some of the young people under GIDS’s care. It's striking. And some of those young people did seem to be in desperately difficult situations. And it seems that really anybody who raised concerns about the safeguarding of children was dismissed in some form or another. Paul Cullen, of the The Irish Times calls the book "forensic and sombre" and "scrupulously non-judgemental". [8] Cordelia Fine describes the book as an "exhaustively researched account" of "a textbook organizational scandal". Fine notes that Barnes "repeatedly relays clinicians’ support for young people’s access to a medical pathway [and] offers no grist for prejudice-fuelled mills." Fine explains what she regards as "[s]ocially just medicine" and says "Barnes’s book is replete with examples of how far short the gender service fell from this ideal." [9] Some studies have asserted the mental health benefits of these drugs, but Barnes says these have been heavily critiqued and shown to have flaws. “The science is not settled, and this field of healthcare is overpopulated with small, poor-quality studies,” she concludes. “It’s often not possible to draw definitive conclusions on the benefits or harms of these treatments.” When things are sensitive, it is always difficult to persuade people to talk to you. And really often in journalism, there's not much in it for them to do so. To put your head above the parapet is difficult. And especially, as you will know from reading the book, there are people who have put their head above the parapet, who have been named, who are prepared to say ‘I got things wrong’ as well. And that's incredibly rare.FiLiA: It sounds like these clinicians were put in almost an impossible position and in certain cases, definitely the empathy that you have for the participants in your book shines through. Even though sometimes it's infuriating. Because you kind of wish that you can have a more clear-cut story, of heroes and villains, and so on and so forth. So in that sense, it can sometimes be a slightly frustrating read. But I wondered if you would mind talking to us a little bit about what your discoveries were about the child safeguarding aspects in particular. Because I think one of the other things that this book has that's really important is discussion with Sonia Appleby after she had won her case. about 70 per cent of the sample had more than five ‘associated features’ – a long list that includes those already mentioned as well as physical abuse, anxiety, school attendance issues and many more” Hannah Barnes’s well-researched book delves into how this situation arose. She speaks to over 60 clinicians: psychologists, psychotherapists, nurses, social workers. It is this forensic approach that makes her findings so devastating. Barnes is not coming at this from an ideological viewpoint. Some of her interviewees are happily transitioned. Others are not. They feel that the risks of the medical pathway they were put on were never explained to them or that they were too young to understand the full implications. One girl asked if when given testosterone she would be able to produce sperm. So I don't use that phrase, for the very reason I don't think we know yet. I think we know that some people say they've been helped by GIDS, and some of those stories are in the book. And we also know that some people have been harmed by GIDS, and some of those stories are in the book as well. And I think what we don't know yet is the numbers on either side, because we don't have that data. GIDS haven't been collecting data on outcomes. Ever. They've been running since 1989. So we don't know. And hopefully, Dr Cass and her team can start to answer some of those questions. So I personally don't describe it in those terms. But I think it's very striking that a number of the clinicians who were there and were trying to help these young people fear that it may end up being a serious medical scandal because of their experiences. But I think at the moment, everybody would like some certainty, but I don't think we have it. The pair started a new service, identifying people who were ready for transition by assessing them before they started hormones. This approach, involving an assessment by a psychiatrist, was criticised as pathologising by the trans community, but they say it has resulted in dramatically better outcomes.

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