National Gender Service in crisis as Ireland fails to meet WHO obligation

Dr Karl Neff defends the National Gender Service as Ireland fails to meet the deadline on WHO guidelines.

Split screen. On the Right Dr Karl Neff, cinical lead with the National Gender Service, on the left WHO flag.
Image: @karljneff/wikicommons

According to endocrinologist and clinical lead at the National Gender Service (NGS), Dr Karl Neff, the NGS “is facing multiple complex challenges, and is facing them with insufficient resources.”

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

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

In the article, Dr Neff explained that when the NGS began, almost 20 years ago, it saw an annual referral rate of fewer than 10 people per year. This number rose to 12 in 2008 and continued to escalate gradually until 2014. By 2017 the service was receiving more than 200 referrals per year. 

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

Dr Neff states, “Without sufficient staff, we are unable to see people for their initial assessment as quickly as we would like, and waiting times continue to increase. Similarly, we are unable to offer the wide range of support services for people as they move through their medical transition.”

He suggests that issues are also compounded by an increase in the complexity of clinical needs. He explains,  “When we reviewed the care needs of people attending the service in 2014, social care needs were hardly mentioned. Now, social care needs are common and often complex. 

“This is partially a reflection of the change in age demographics. Up to 2014, people seen in the service were usually aged 30 or older. Now the majority of people referred to the service are in their late teens or early 20s, and at this age are often dependent on others for fundamental 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 daily chores or more complex such as engaging in the world of work or education.

“For an increasing number of people attending the service, engaging in these tasks can be difficult. There are many potential reasons for this. Autistic spectrum disorder (ASD) is only one, but is increasingly common in our service. In 2014 the prevalence of ASD was less than 3 per cent whereas now more than 30 per cent of people attending have clinical features of autism or ASD.”

However, in an article for GCN, Lilith Ferreya-Carroll, National Community Development Officer at Transgender Equality Network Ireland (TENI), wrote, “Patients have stated publicly or reported to TENI that they are being denied or delayed treatment for reasons such as suspected autism, ADHD, unsatisfactorily answering overtly sexual questions or for not bringing family members into assessments which community members continue to report to us, despite public statements by the HSE to the contrary.

“Assessments include questions about masturbation, porn habits, sexual history, thoughts during oral sex, detailed genital descriptions of themselves and sexual partners and even racial preferences. GP referral forms now require details of patients’ education, employment and housing situation.”

In the Irish Times article, Dr Neff defends this assessment process citing, “common complications of medical transition relate to a decline in mental health or social function that occurs when a person’s needs have not been met prior to and during their medical transition. In severe cases, the complications of medical transition include homelessness, disability, acute psychiatric illness and suicide.”

This “comprehensive psychosocial assessment”, as Dr Neff refers to it, contravenes the World Professional Association for Transgender Health’s (WPATH) best practice model of care and pathologises people seeking gender affirmation treatment. 

Since May 2019, the World Health Organisation (WHO) has formally depathologised Trans people. As part of this process, countries are obliged to implement the ICD-11 guidelines from January 1 this year. 

As Noah Halpin, Health Care Officer with TENI (Transgender Equality Network Ireland), highlighted in a series of recent tweets, Ireland has not met this obligation. “Ireland have not yet done this & it doesn’t look like we will be doing this any time soon. We’re in direct violation of the guidelines of the very global organisation that we signify to follow in all of their global health recommendations. But not those that include trans people?

He goes on, “The trans community in Ireland are still being pathologised when trying to access gender affirming healthcare, the trans community are still being abused in our healthcare system. Why are we signatories to an global organisation of which we follow almost all of their guidance, other than when it comes to trans healthcare?”

TENI continue to advocate for an accessible healthcare system in Ireland, one that will practice international best practice standards of care.

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