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Trans healthcare in England is insufficiently resourced, coroner says

Trans healthcare in England is insufficiently resourced, coroner says

Alice Litman’s mother said the inquest into her daughter’s death “should be a wake-up call”

Services for trans people in England are “underfunded” and “insufficiently resourced” for today’s society, a coroner said after a three-day inquest into the death of Alice Litman, a 20 year-old trans woman. 

When Alice took her own life on 22 May 2022, she had spent 1,023 days waiting for a first appointment with the country’s largest gender identity service, which falls under the Tavistock and Portman NHS Foundation Trust. 

Dr Caroline Litman, Alice’s mother and a former NHS psychiatrist, told the court that being placed on the waitlist for the Gender Identity Clinic (GIC) with “no realistic end in sight” was “a kind of torture” for her daughter. 

A month before she died, Alice told her GP she was concerned she had missed out on vital treatment waiting for an appointment with the GIC that she often felt “hopeless and helpless” and that “life is not worth living”.

The inquest heard that due to the rising number of referrals and the current pace of first appointment provision at the GIC, someone referred today would have to wait over twenty years to be seen. 

As of May 2023, there were 29,692 individuals in England waiting for a first appointment at an NHS adult gender dysphoria clinic, of whom 13,050 were on the waiting list of the GIC, according to a Freedom of Information request submitted to NHS England by Tortoise. 

Dr James Barrett, the Director of the GIC, told the court that the number of trans people needing gender-affirming healthcare in England was an “order of magnitude” greater than the service could provide.

The best way to lower the risk of suicide and serious self-harm was “actual treatment”, Dr Barrett said – but the GIC was “not in any way funded” to look after the number of patients on the waiting list. 

Alice’s father, Peter Litman, told reporters attending the inquest at the Hove County Cricket Ground that the long waiting list was an “act of aggression”. 

“If you know something’s there and you do nothing about it, it’s not a neutral act”, he said. 

Alice’s mother said transgender people were being “hung out to dry” and that the inquest “should be a wake-up call”. 

“My daughter was failed by the NHS and I don’t want other parents to lose their daughter, and for other children to lose their sister, the way that our family has done,” she said.

In June 2019, following a suicide attempt, Alice was referred to the Child and Adolescent Mental Health Services (CAMHS) in Surrey. She went on to attempt suicide again in December of that year. 

In March 2020, after Alice had turned 18, she was discharged from the Surrey Borders Partnership Mental Health Trust altogether.

Caroline Litman told the court she felt the adult mental health services available to her daughter did not take her history of self-harm and the impact of gender-affirming treatment delays seriously enough. 

The coroner, Sarah Clarke, said she would be issuing recommendations to relevant NHS bodies to prevent future deaths addressing: 

  • how people should be managed between adolescent and adult mental health care;
  • knowledge and training requirements for those offering support to the trans community;
  • access to gender-affirming healthcare; and 
  • the level of care offered to those waiting for treatment. 

Clarke said she would give a narrative conclusion in two weeks’ time.

A spokeswoman for the Tavistock Gender Identity Clinic said: “We were deeply saddened to learn of the death of a patient who was waiting to be seen at our gender identity clinic, and offer our condolences to her loved ones. It would not be appropriate to comment while the inquest is ongoing.”

A Department of Health and Social Care spokesperson said: “Every death is a tragedy and our sympathies go out to Alice Litman’s family.

“We support the action NHS England is taking to increase the capacity of specialised gender services, by investing nearly £8 million in the new gender identity pilot clinics. These new services are already having an impact, removing 3,400 patients from the waiting list between July 2020 and May 2022.

“In line with these changes, a new gender identity clinic is opening in Sussex next month, which will continue to help patients get the treatment they need sooner.”

When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.

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