National Gender Service is in crisis as Ireland fails to meet WHO obligations • GCN


According to the endocrinologist and clinical manager of the National Gender Service (NGS), Dr Karl Neff, the NGS “faces multiple complex challenges and is coping with them with insufficient resources”.

Writing for the Irish Times, Dr Neff described the diabolical state of trans healthcare in Ireland and highlighted a number of issues facing the NGS.

The National Gender Service, based at St Columcille’s Hospital in Loughlinstown in Dublin, is the only service in Ireland to provide specialist support to people seeking medical interventions to help them assert their gender.

In the articleDr Neff explained that when NGS started almost 20 years ago, it had an annual benchmark rate of less than 10 people per year. This number increased to 12 in 2008 and continued to increase gradually until 2014. In 2017, the service received more than 200 referrals per year.

To date, the National Gender Service currently receives over 300 referrals per year. Despite an expansion of services, the NGS is still overwhelmed as demand continues to exceed capacity.

Dr Neff says: “Without sufficient staff, we cannot see people for their initial assessment as quickly as we would like, and wait times continue to increase. Likewise, we are unable to offer a wide range of support services to people throughout their medical transition. “

He suggests that the problems are also compounded by an increase in the complexity of clinical needs. He explains: “When we looked at the care needs of people attending the service in 2014, social care needs were barely mentioned. Today, social care needs are common and often complex.

“This partly reflects the change in demographics by age. Until 2014, people seen in the service were generally 30 years of age or older. Today, the majority of those referred to the service are in their late teens or early twenties, and at that age, they often depend on others for basic needs such as housing and income.

He maintains: “Another key emerging clinical need is functional impairment, which was not recorded as a requirement in 2014. Functional impairment refers to the ability to engage in necessary or meaningful tasks. These tasks can be as simple as everyday tasks or more complex such as getting involved in the world of work or education.

“For a growing number of people attending the service, engaging in these tasks can be difficult. There are many potential reasons for this. Autism Spectrum Disorders (ASD) are only one, but they are more and more frequent in our department. In 2014, the prevalence of ASD was less than 3%, while today more than 30% of those present have clinical features of autism or ASD.

However, in an article for GCN, Lilith Ferreya-Carroll, national community development manager at Transgender Equality Network Ireland (TENI), wrote: “Patients have publicly declared Where reported to TENI that treatment is refused or delayed for reasons such as a suspicion of autism, ADHD, unsatisfactory answers to overtly sexual questions or for not having provided family members in the assessments that community members continue to report to us, despite HSE’s public statements to the contrary.

“The assessments include questions about masturbation, pornographic habits, sexual history, thoughts during oral sex, detailed genital descriptions of themselves and their sexual partners, and even racial preferences. Referral forms for general practitioners now require details about the education, employment and housing situation of patients.

In the Irish Times article, Dr Neff defends this assessment process, citing: “Common complications of medical transition are linked to a decline in mental health or social function that occurs when needed. of a person were not satisfied before and during their medical transition. In severe cases, complications of medical transition include homelessness, disability, acute psychiatric illness, and suicide.

This “comprehensive psychosocial assessment ‘, as Dr Neff calls it, contravenes the World Professional Association for Transgender Health (WPATH) best practice model of care and pathologizes people seeking gender-affirming treatment.

Since May 2019, the World Health Organization (WHO) officially depathologized trans people. As part of this process, countries are required to implement the ICD-11 guidelines from January 1 of this year.

As Noah Halpin, head of healthcare at TENI (Transgender Equality Network Ireland), pointed out in a series of recent tweets, Ireland has failed to meet this obligation. “Ireland hasn’t done it yet and it doesn’t look like we’ll be doing it anytime soon. We are in direct violation of the guidelines of the very global organization that we pledge to follow in all of their health recommendations. global But not those that include trans people?

He continues, “The trans community in Ireland is always pathologized when trying to access gender-affirming health care, the trans community is always abused in our health system. Why are we a signatory to a global organization that we follow almost all of their advice except when it comes to trans health care?

TENI continues to advocate for an accessible healthcare system in Ireland, which will apply international best practice in healthcare.

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