Trans teenagers are being failed

Published by The i paper (16th April, 2024)

Jason Pulman was the oldest of five children, a talented artist who ‘‘loved all the silliness in the world and using it to make all those around him smile” according to his family. He was also transgender  – and two years ago took his life at the horribly young age of 15. His mental health deteriorated during the pandemic, as with many young people, and he had a complex history including self-harm and substance misuse. His death came as he waited for an appointment with a social worker after his school made a safeguarding referral due to concerns shared by his parents. He was also on a 26-month wait list for gender affirming healthcare, which fuelled his psychological distress.

This teenager was failed by our society. The jury at his inquest in Hastings found systemic failures by all institutions involved in his care – with exception of his school – that may have contributed to his death. Jurors concluded gender dysphoria was also a contributing cause. Afterwards, his family begged for better resourcing of mental health services. “No parent should ever lose a child,” said Emily and Mark Pulman. “We just hope the lessons will be learned.”

Sadly, this seems a vain hope. Last year I spoke with the family of another trans teenager in Cambridgeshire called Danny France, who took his life aged 17 while stuck on long waiting lists for mental health and gender treatment. This resulted in his preventable death, according to an inquest. He had developed mistrust of the psychiatric system and fell into the black hole between child and adult services. His father was dismayed by the failure to learn lessons from such tragedies, rightly saying too many people were dying due to the deficit in suitable services.

Jason’s parents suspected he had autism – just like Danny’s. And just like Charlie Millers, a transgender boy whose inquest into self-inflicted death aged 17 began earlier this month.

Studies suggest autistic people are significantly more likely to be transgender or have gender diverse identities. And we know autistic young people are often alienated, bullied and excluded – and nine times more likely to die from suicide. So these fatalities should serve as cautionary tales, as pointed out by the Inquest campaign group. They are reminders that real young people are living – and sometimes dying – during the furious debate over treatment of young transgenders citizens. “Above all, we hope the Government will stop toxifying this whole issue and just look at the children,” said Jason’s parents.

Alice Litman also took her life, feeling “helpless and hopeless”. She was waiting for mental health care and an initial assessment with overloaded NHS Gender Identity services, having been referred nearly three years earlier aged 17. Her mother, a former NHS psychiatrist, spoke of feeling shame that for all her expertise she was unable to help her transgender daughter access services. She argues such long delays challenge the idea of young people being rushed through services on some kind of affirmative medical conveyer belt. Her child just wanted to live the way she wanted; instead she is dead and her bereaved family was subjected to online hate.

Jason’s inquest concluded as the Cass Review into gender care for children was published. This landmark report also condemned the toxicity swirling around these difficult issues while criticising use of puberty blockers and arguing children were let down by failures to base gender care on evidence-based research. Intriguingly, it sparked an NHS audit of 3,306 patients that found only ten “detransitioned” at point of discharge – while nothing, of course, is more irreversible than death. Dr Hilary Cass, the respected paediatrician who led the review, said rightly that children caught in this debate were a group deserving “more compassion” than being used “as a football”.

Yet some Tory ministers – with no discernible record of standing up for autistic people or defending mental health services – leapt on the report to attack political foes. One critic of transgender “ideology” denied even the existence of trans children in her triumphalism while claiming it was a “myth” youngsters denied treatment were at serious risk of suicide.

But Dr Cass indicated “rates of suicidality” were “significantly higher” than in the general adolescent population, although similar to other young people referred to mental health services, underlining complexities of overlapping psychological and neurodiversity issues in many cases. She also noted that “risk of suicidality” rose during “transition points in patient care”, which will not surprise many families with experience of bridging the chasms from child to adult care services.

No doubt this will remain a ferocious debate to the detriment of many caught in its midst. Yet there is one area where everyone could unite for betterment of society. These deaths and the Cass Review expose some of the awful holes in mental health services, which have crumbled with terrible – and often-tragic – consequences. Community services were hollowed out in a system that grew over-medicalised and over-burdened, reliant on physical and pharmaceutical restraint for troubled citizens left to spiral into crisis. Autism diagnosis, especially for girls, is shamefully sluggish – then often followed by a disturbing lack of support. These failures fuel the epidemic of eating disorders and self-harm. They also lead many autistic people to end up in prison or locked in psychiatric hellholes that only intensify their problems.

The Cass Review – welcomed by both main parties – demands improved support for the growing number of young people seeking help for “gender-related distress”. It recognises “workforce shortfalls” yet talks about the need for effective assessments, rapid access, linked services, multi-disciplinary teams, family and sibling support, continuing care into adulthood.

So imagine if everyone found a common and loud voice to demand Westminster actually fixes these floundering services by funding a humane mental health system, rapid autism diagnosis, decent social care and an end to barbarous detention. Instead, I fear the culture wars will continue, politicians will pontificate – and more young people will end their lives needlessly in despair.

Categorised in: Health, home page, Public policy