The official version of this document can be found via the PDF button.
The below content has been automatically generated from the original PDF and some formatting may have been lost, therefore it should not be relied upon to extract citations or propose amendments.
Deputy Kevin Pamplin
Health and Social Security Panel k.pamplin@gov.je
5 November 2018
Dear Kevin
Assessment of mental health services
I am writing regarding the work that the Health and Social Security Panel are doing around the Mental Health Strategy. I am not entirely sure that the issue I would like to bring to your attention sits within the current review you are conducting, but it would be helpful for you and your fellow members on the panel to have knowledge of it.
The problem
There is currently a lack of gender therapy skills in Jersey, which means that the pathway to care for someone with gender dysphoria (a transgender person) who is seeking hormone therapy to transition is –
- An appointment with your GP in Jersey, who then refer to...
- Child and Adolescent Mental Health Services (CAMHS) or Adult Mental Health Services (AMHS) in Jersey, who then refer to...
- The NHS Gender Identity Clinic (GIC) in the UK.
The above process currently takes on average 18 months for the first appointment at the GIC in the UK. It is highly unlikely that any hormone therapy would be prescribed at a first appointment, so it is likely that at least two appointments in the UK would be required for a patient, lengthening the time further before any treatment commences.
For someone who is clear about their gender identity and has no underlying mental health conditions the process of sending them via Mental Health Services is inappropriate, complicated, lengthy, costly to the States of Jersey and could be delivered on-island by a GP with some skills in gender identity issues in consultation with the States of Jersey Endocrinology Department.
For someone who would like to talk to a therapist about their gender identity before taking any steps to transition and has no complicating mental health conditions the process could also be delivered on-island without referral to the critical care of CAMHS or AMHS by a local psychotherapist/psychologist with an understanding of gender identity issues in consultation with the patient's GP and the States of Jersey Endocrinology Department.
In a small proportion of cases where there is a serious mental health issue in addition to a desire to undertake a gender transition, the current pathway to care may be appropriate. For the majority of cases, it is not and is placing an unnecessary burden on over-stretched critical care mental health services in Jersey.
The World Health Organisation declassified gender incongruence as a mental health condition in June this year - https://youtu.be/kyCgz0z05Ik
Due to the distress caused by the long waiting times for transgender patients for their first appointment with someone who can actually assist them with hormone therapy we know that there are GPs in Jersey who are prescribing hormones as an interim measure to alleviate the patient's distress until they can access the GIC in the UK.
Background note: the gender therapists working in the GIC (or privately) in the UK are not trained as such. There is no qualification that a medical professional can get to qualify them as a gender therapist. Gender therapists are trained psychotherapists/psychologists who have experience of dealing with or written research papers regarding or otherwise have an interest in gender issues.
The solution
We need to provide the island's GPs and psychotherapists/psychologists with the skills to service transgender clients in Jersey. This would remove the burden of transgender patients automatically being seen by Mental Health Services, releasing those professionals for critical cases that need them.
GPs particularly need support so, where they are prescribing hormones to alleviate distress, they are doing so with an understanding of gender issues. They also then have the skills to know whether to refer to a therapist or whether the patient is clear about their gender identity and desire to transition and that transition can be managed at primary care level.
Work is being done by Liberate and others within the Jersey Health Service to provide this training. Liberate delivered a two day course in 2017 to a number of Jersey mental health professionals in partnership with the UK non-profit organisation Gendered Intelligence, which provides training by mental health professionals for medical professionals on gender identity issues.
Having up-skilled GPs and psychotherapists/psychologists, there should be no barrier to Jersey being able to provide hormone therapy to transgender patients without recourse to the NHS, saving the cross-charges associated with that referral and relieving a stretched service in the NHS of a burden.
Surgery
Having achieved self-sufficiency with regard to hormone therapy, it is unlikely that the island would be able to do the same for most of the specialist surgical procedures required by transgender patients.
The States of Jersey would need to agree a new cross-charging model with the NHS for this part of a transgender patient's treatment, specifically an agreement regarding who can refer into the NHS for surgery.
Currently, referrals for transgender surgeries within the NHS come from the GIC in the UK. However, if Jersey is able to standalone for the (usual) first part of a person's transition (hormone therapy), Jersey patients would not necessarily access the GIC any longer, so a new referral model would be required, such as the NHS accepting referrals from a central Jersey point that, in turn, accepts referrals from a Jersey GP or psychotherapist/psychologist.
I hope that the above information is of interest/helpful to you and your panel members, although it may not be directly of use to your current work.
Please let me know if you or your colleagues would like to understand more about the current pathway to care for transgender islanders further and our thoughts on how it needs to adapt for the increasing numbers accessing it in Jersey and in the UK.
ITV Channel recently covered this issue with Liberate's input and you can see their reports here: https://www.itv.com/news/channel/2018-11-01/calls-for-more-on-island-support-for- people-who-want-to-change-gender/ and https://www.itv.com/news/channel/2018-11- 02/waiting-times-for-gender-therapy-could-be-the-difference-between-life-or-death/
I look forward to hearing from you. Kind regards.
Yours sincerely,
Vic Tanner Davy
Chief Executive Officer