NHS and Cass Review Accused of Covering Up Trans Youth Suicides
The NHS and Hilary Cass were aware of rising deaths after withdrawal of puberty blockers but pushed ahead with further restrictions on gender-affirming care
New evidence has come to light of the tragic impact of restrictions on gender-affirming care for under-16-year-olds put in place by England’s National Health Service (NHS) following the now infamous Bell v. Tavistock case in 2020.
In that case, judges decided that under-16s were unable to consent to taking puberty blockers. This resulted in NHS England immediately ceasing new referrals and prescriptions for puberty blockers for under 16s, except via a court order.
The High Court later overturned the case, but NHS England maintained the restrictions.
Now two NHS whistleblowers working with the legal non-profit Good Law Project claim those restrictions are linked to an increase in suicides of trans youth that NHS England tried to cover up.
Jo Maugham of Good Law Project details the accusations and evidence in this Twitter thread.
According to whistleblowers, there was only one suicide of a patient at England’s youth Gender Identity Service (GIDS) at the Tavistock clinic in the seven years before the 2020 Bell v. Tavistock ruling. However, in the three years following the judgement, and subsequent restrictions on puberty blockers, there were 16 suicides.
Documents show staff directly linking the increase in suicides to the pressure that the Bell v. Tavistock ruling put on service provision and the GIDS waiting list.
Staff also highlighted the intense political scrutiny under which GIDS was operating, largely as a result of anti-trans campaigners and complicit transphobic media. This included the naming of individual staff members in the press and an onslaught of threats and harassment so severe NHS bosses involved the police.
Whistleblowers were prevented from writing an open letter detailing the shocking suicide figures after they were threatened with disciplinary action and warned they would be reported to their regulatory bodies.
Meeting minutes seem to suggest data on suicides was to be excluded from Freedom of Information requests, due to concerns about ‘reputational impact’.
The whistleblowers allege these actions were part of an attempted cover-up by NHS England.
Deadly risks ignored by Cass Review
The revelations are particularly concerning given the further restrictions on gender-affirming care imposed following the release of the much-criticised Cass Report.
Whistleblowers say they specifically alerted Dr Hilary Cass and NHS bosses to the suicides being linked to existing restrictions but were ignored.
Despite Dr Hilary Cass being made personally aware of the suicides, the Cass Report doesn’t mention the specific figures.
While the Cass Report does mention the deaths of some young patients, it obfuscates the problem and fails to mention the impact of restrictions, blaming suicides on ‘multiple comorbidities and/or complex backgrounds’ (Cass Report, S. 5.65).
Despite being warned about the risk of restrictions for patient safety the Cass Report recommends further restrictions on the use of hormones and puberty blockers for under-18s, limiting the prescription of the latter to those enrolled in an as-yet nonexistent medical trial, amounting to a de facto ban.
Cass promotes ‘conversion therapy’
In place of gender-affirming care and social or medical transition, the Cass Report recommends psychological treatments. This is despite its evidence review finding little to no support for their efficacy in treating gender dysphoria.
Cass promotes the idea that transgender identity is caused by other conditions, such as Autism or trauma — again while providing little evidence.
The idea that transgender identity is caused by trauma or other issues and that treating these issues alone will revert someone to a cisgender identity has been referred to as ‘conversion therapy’ by experts in LGBTQ+ conversion practices. Such practices are harmful to trans youth.
Conversely, there is no evidence that gender-affirming care is harmful — something Hilary Cass stated herself.
A large body of evidence demonstrates the efficacy of gender-affirming care, including for trans youth. The NHS’s own study shows the vast majority of young people who accessed the GIDS service were referred to adult services with transgender identity persisting into adulthood, as have studies in other countries.
Cass argues that mental health issues cause transgender identity and dysphoria, but ignores the possibility that dysphoria might cause mental health issues — despite evidence that mental health problems can be improved at least in part by addressing dysphoria.
Transgender young people absolutely should be given support for any other mental health issues or conditions — however, this should be in tandem with, rather than as an alternative to, gender-affirming care.
Right now the NHS is failing to provide either to transgender young people.
Lack of support for trans youth
The Tavistock GIDS was closed following the recommendations of the Cass Review in March 2024, due partly to an inability to meet demand or address long wait times.
GIDS staff also faced accusations of rushing young people onto puberty blockers and hormones — accusations which were pushed heavily by the UK’s transphobic mainstream media and anti-trans campaigners, but have never been substantiated by any formal investigation.
The Cass Review’s limited engagement with patients and their families seems to indicate the opposite: parents of young people reporting that the GIDS service engaged in ‘gatekeeping’ and that ‘counselling with GIDS went on for a long time’ before any medical treatment was provided (Cass Report, Appendix 3, pg. 6).
Other services intended to replace GIDS have yet to get up and running, raising concerns about the welfare of those on the waiting list.
The GIDS closure has left trans young people without anywhere to turn, relying on already strained child and adolescent mental health services (CAMHS) for limited support.
CAMHS isn’t equipped to support young people experiencing gender dysphoria or provide specialised transgender healthcare.
This issue was raised by the coroner’s inquest into the death of Alice Litman, a 20-year-old trans woman who tragically took her own life after spending 1023 days on the NHS Gender Identity Clinic’s waiting list from the age of 17. Alice originally asked for a referral from her GP when she was 16 but was sent away with leaflets instead.
The inquest cited delays accessing gender identity services, lack of support from mental health services, and lack of training for those in primary care and mental health services working with transgender youth as contributing factors to Alice’s death.
I spoke to Alice’s mother, Caroline Litman, who is herself a former psychiatrist, about the impact long waiting lists and a lack of care have on transgender young people like Alice:
I know firsthand how the current lack of care and respect for trans people impacts on a young person’s mental health. By failing to offer any treatment or support for young trans people the government and the NHS is effectively telling them, you are of no value to us or society, you do not matter. I know this is how Alice felt: ‘I don’t deserve to live’, she said.
Whilst the government continues to implement policies that deny access to healthcare for young trans people and continues to turn a blind eye to, or suppress information about trans suicide, they are complicit in the deaths of these vulnerable young people.
There needs to be a full public inquiry into the deaths by suicide of children and young people, whilst they are subjected to this inhumane treatment.
As an ex-doctor of psychiatry I find it particularly distressing that the profession to which I dedicated almost twenty years of my life has so little interest in listening to trans people or their families.
Dr Hilary Cass has dismissed experts, advocacy groups and members of the transgender community and their families who have criticised the Cass Review and accused them of spreading ‘misinformation’ and putting ‘young people at risk’.
But in light of these new accusations, it’s clear the NHS and Cass are the ones putting young people at risk.
Playing with young people’s lives
NHS England’s restrictions on gender-affirming care for transgender youth are dangerous and untenable — the accusations made by NHS whistleblowers about trans youth suicides demonstrate this tragic reality.
Is that why they were ignored by the Cass Review and the NHS?
In the wake of these revelations, we need a full risk assessment of the Cass Report’s recommendations and the restrictions on gender-affirming care subsequently imposed by the NHS.
We also urgently need a full investigation into allegations of bias, anti-LGBTQ ideological influences and methodological issues which have been raised around the Cass Review, which has been used to justify these dangerous restrictions on care.
Those involved in the Cass Review and the NHS decision to restrict care while ignoring these suicides must be held accountable before any more transgender young people come to harm.
Update: this article was amended on 25/06/2024 to say that Alice Litman was referred to a gender clinic at 17, not 16 as was originally stated.