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

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Feminists who protect the sex-based rights of girls and women have long challenged the social and medical interventions done on children who express unhappiness with their body or strongly resist their ‘expected’ social role. Women ask: why are doctors physically intervening in children’s natural development with powerful drugs, for no defined medical pathology? How can clinicians justify this practice despite such poor scientific evidence? How does the rise in teenage girls going to gender clinics around the world relate to issues like misogyny, lesbophobia, porn-culture and the objectification of women and girls? Why are women being called ‘transphobic’ for questioning whether young girls who might otherwise grow up to be lesbians are being inappropriately medicalised for life? How is a mother trying to safeguard her child from possible medical harms acting in a ‘hateful’ way? To begin with, the extent of the GIDS’ involvement with the pressure groups Mermaids, GIRES and Gendered Intelligence right from the start is staggering. These are political campaign groups, two of which are run by parents, with very set ideas and beliefs based on the unscientific concept of innate gender identity. They are not politically impartial. As Mermaids became more politicised and extreme in their belief in gender identity ideology, so did the GIDS. FiLiA: I just wondered, for example, I think you say in the book, it's quite difficult to get psychologists to speak about something. And in this case, you had a certain cohort of people who are really quite desperate to get their story out. And then you had others who perhaps weren't so happy to have their name on the record, but would also want to be discussing things. And then others who, at least it looked like in the footnotes, there were some people who just didn't want to be participating in the book. And so I suppose from that sort of perspective, was this atypical? Is this what normally happens?

Time to Think, The Inside Story of the Collapse of the

A therapist called Matt Bristow relates what happened when people tried to raise concerns, which suggests the place had a cult-like atmosphere: 'He and others recount how executive members of staff would become teary when criticisms of the service were raised. It would then be made known among the team that "this has made Polly cry", Bristow says. 'I don't think that's appropriate as a management style."' This refers to GIDS director Dr Polly Carmichael, a person many of the sources in the book seem to have been afraid of crossing.

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It was only when the first referrals were old enough to have their care transferred to the adult service at St Colmcille’s Hospital in Loughlinstown that concerns were raised. The book has a narrow focus on GIDS and does not comment about the way in which the number of children with gender dysphoria increased so dramatically. This is to the book’s credit. The narrow focus on the exposition of events at GIDS in such a careful way is very impressive. This was a time when two thirds of referrals were boys, average age 11 at referral. Over 25% had spent time in care (compared to a rate of 0.67% for the general children’s population (2021)). 42% had experienced the loss of one or both parents through bereavement or separation. Only 2.5% had no associated problems; about 70% had more than five ‘associated features’ such as physical abuse, anxiety and school attendance issues. 42% suffered from ‘depression/misery.’ Close to a quarter of those aged 12 and over had a history of self-harming and the same percentage exhibited ‘inappropriately sexualised behaviour.’ FiLiA: Yeah, that was a line that actually I wrote down because I thought it was such a striking line from one who's working within the medical sphere to even be contemplating it like that. Because obviously from an outsider's perspective, you want to just be able to say, well, of course, you're always going to put the patients first. This shouldn't even be a question. But then it comes to those sorts of human factors and the relationships. I think you at one point characterise the feeling of being within GIDS as being almost like a start-up.

Time to Think: The Inside Story of the Collapse of the

Katy Hayes of the Irish Independent called the book "meticulously academic, thoroughly footnoted and referenced", though it is "a dense, clotted read". Hayes notes that interviews were "almost exclusively" with former GIDS employees who "dissented" from the direction the leadership took. Therefore, while "Barnes has her well-argued position, and the questions she raises are legitimate", "the result makes the book feel very one-sided. All the clinicians talk about how they harmed children. There is very little mention of how any clinician might have ever helped anyone." Hayes complains that the "book occasionally slides into innuendo" (such as about funding), which Hayes says is "a pity, because they make Barnes sound biased", and that "the overall tone of the book is so hostile that it is likely to become another weapon in the unfortunately loud and bitter war over this subject." [10] Barnes speaks to many former employees including Sonia Appleby, who was the ‘professional for safeguarding children’ at the centre for before she was dismissed. She was awarded compensation for wrongful dismissal. Interestingly some of the other people Barnes talks to were gay and believed that there was homophobia at GIDS. Some parents were also described as homophobic. To make this clear, we are not referring to anyone who is in the least bit “transphobic.” Rather, these clinicians feel the insane increase in referral numbers of trans children over the years needs to be examined more closely as to , rather than simply ignoring the problem. It’s unbelievable to me that the most vulnerable members of our population, children (sometimes as young as 3 or 4!) are being put onto a pathway which clearly isn’t right for them and at times when they clearly aren’t struggling with gender identity itself, but rather homosexuality, and often puberty and the awkwardness that EVERY child goes through at its onset.Actually, there isn't agreement amongst frontline clinicians working with this group of young people about how best to care for them, and how there may be different ways to care for different people. And I wondered a little bit about, do you think that there's something about, like you were saying, we're not really sure if it's a disease, we're not really sure if it's a condition or if it's just a state of identity, but is there something that is almost inherently troublesome with the condition or the question of gender dysphoria and paediatrics itself? That is causing perhaps, less of a focus on child safeguarding? As in, is this a problem with the idea itself? Or is this an issue of different practices locally that seem to be going beyond the scope of what is considered to be reasonable medical practice? Given that these sorts of issues are cropping up in lots of different places? 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. It traces various reports made by clinicians raising concerns: the David Taylor review (2005), David Bell report (2018), Dinesh Sinha's GIDS review (2019), Helen Roberts report (2021), and Hilary Cass review (2022).

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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. 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. Camilla Cavendish of the Financial Times described it as a "meticulously researched, sensitive and cautionary chronicle" and a "powerful and disturbing book" that reminded them of other NHS scandals. [6] Rachel Cooke, writing in The Observer called her work "scrupulous and fair-minded" and, with regard to GIDS, "far more disturbing than anything I’ve read before". Cooke says the account is of a "medical scandal" and "isn't a culture war story", concluding: "This is what journalism is for." [7]Some had been sexually abused, she says, some were struggling with their sexuality, and some had suffered early traumas in their lives. Others were autistic or were being bullied in school.” Time to Think goes behind the headlines to reveal the truth about the NHS’s flagship gender service for children. As Barnes makes perfectly clear, this isn’t a culture war story. This is a medical scandal, the full consequences of which may only be understood in many years’ time. Among her interviewees is Dr Paul Moran, a consultant psychiatrist who now works in Ireland. A long career in gender medicine has taught Moran that, for some adults, transition can be a “fantastic thing”. Yet in 2019, he called for Gids’ assessments of Irish children (the country does not have its own clinic for young people) to be immediately terminated, so convinced was he that its processes were “unsafe”. The be-kind brigade might also like to consider the role money played in the rise of Gids. By 2020-21, the clinic accounted for a quarter of the trust’s income. 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.

Hannah Barnes | Book review | The TLS Time to Think by Hannah Barnes | Book review | The TLS

Clinicians Paul Moran and Donal O’Shea have helped hundreds of people transition successfully. “For people who are ready, have a clear, stable understanding of their gender, social supports, and are physically and mentally healthy, I see it as a fantastic thing,” Moran is quoted as saying. But this isn’t to say that ideology wasn’t also in the air. Another of Barnes’s interviewees is Dr Kirsty Entwistle, an experienced clinical psychologist. When she got a job at Gids’ Leeds outpost, she told her new colleagues she didn’t have a gender identity. “I’m just female,” she said. This, she was informed, was transphobic. Barnes is rightly reluctant to ascribe the Gids culture primarily to ideology, but nevertheless, many of the clinicians she interviewed used the same word to describe it: mad. An exemplary and detailed analysis of a place whose doctors, Barnes writes, most commonly describe it as “mad”. This is a powerful and disturbing book’ – Financial Times At times, the world Barnes describes feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for’ – ObserverBarnes sent the book proposal to 22 publishers. Several publishers praised the proposal, but declined to publish it; one of them on the basis that it was too controversial. On 13 April 2021, the independent publisher Swift Press made Barnes an offer. [5] Reception [ edit ] Hannah Barnes lays bare the whole appalling business in a clinical and forensic fashion. She is fair-minded - she speaks to young people who avow that they were helped by the service, as well as those who were irretrievably damaged. She uncovers a truly appalling management culture, and lays the blame very much with the leadership, although she does not impugn motive (there's some speculation here but no conclusion). Yeah. And Sonia had not spoken before to anybody, so I was very grateful to her. Well, this was another aspect, if you like, of exceptionalism within GIDS. So you had clinicians saying what clinical concerns were not being reacted to in the same way that you'd expect in other services. And clinicians say safeguarding concerns weren't responded to in the same way that you would expect in other services dealing with children either. They say that in all other services they worked in if you were concerned, then you referred on, that's what you did. It didn't matter if that concern was true or not, because often you don't know. But you refer on. And they said that that didn't happen in GIDS, or not to the same level. Many children referred to the service had suffered trauma, had mental health problems or had experienced ‘deprived or injurious upbringings.’”