GIDS is a service provided by the Tavistock Clinic. Originally located at Tavistock Square in London, the clinic specialised in psychiatric care. The Tavistock Clinic treated both adults and children, with their first patient being a child. However, it mainly focused on military psychology, including shell-shock, now termed PTSD. In 1948, with the creation of the NHS, the Tavistock Clinic launched its children’s department, which developed many works by Robertson and Bowlby on attachment theory. In 1959, it opened an adolescent department and in 1967 absorbed in the London Child Guidance Clinic. Following this, in 1989 the Tavistock Clinic established GIDS, the first and only service of its kind.
provides the NHS support for children with mental health issues. However, CAMHS is organised by local government area and thus coverage varies significantly. The development of CAMHS within a four-tiered framework started in 1995. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy. GIDS takes referrals from all mental health care professionals, especially Tier 2 and 3 CAMHS specialists. GIDS is distinct from CAMHS as is it is nationally run, not by the local authority. However, in the CAMHS framework it sits in Tier 4, as a highly specialised service.
Recent history
In 2009–10, 97 patients were referred to GIDS. By 2015–16, this had increased fourteen-fold to 1419 and in 2017–18 to 2,519. Due to reduced funding and increased referrals, the average wait time is two years from referral to first appointment. In 2018, the parents of patients complained in a letter to the Trust board about the ‘fast-tracked’ nature of the services. This led to the commissioning of an internal report by Dr. David Bell, which found the service was “not fit for purpose”. Marcus Evans, a member of the Trust board resigned in February 2019. Subsequently it was revealed that 35 psychologists have resigned since 2016, including six psychologists who claimed there was “over-diagnosis” of gender dysphoria and a push for early medical intervention. Alongside this, the National Institute for Health Research announced a £1.3 million grant for a study following young people referred to GIDS, to compare mental and physical health outcomes for children referred. The study will compare the effectiveness of different interventions, including psychological, endocrinological and alternative interventions. In July 2019, the Tavistock Centre was flooded which temporarily affected the IT servers at the clinic. In October 2019, a lawsuit was launched against GIDS by a mother of a patient at GIDS and a nurse who formerly worked there.
Services
Services provided include:
Assessments, to assess primary medical aims and necessary support;
Gender development support, including access to therapy, tailored support and therapy groups;
In the financial year 2018–19, 31 referrals were made for children aged 5 or under. 30 referrals were made for adults over the age of 18. In 2018–19, there was a year-on-year increase of 6%, a relative plateau compared to previous year-on-year increases.
As the only gender identity clinic for children in the UK, the service has been the subject of much controversy related to the broader topic of gender dysphoria and transitioning in childhood.
High resignation rate
A 2019 Sky News report found that 35 psychologists resigned between 2016 and 2019. Six psychologists who resigned raised concerns about the over-diagnosis and medicalisation of young people experiencing gender identity difficulties. In February 2019, Tavistock trust member Marcus Evans resigned, citing similar concerns. In July 2019, Kirsty Entwistle wrote a public letter about the GIDS service, saying professionals were often labelled “transphobic” if they raised doubts. Clinicians have stated that concerns over children's welfare were "shut down".
Bell Report
Following a letter to the board at Tavistock, an internal report was commissioned to look at the functioning of GIDS. Dr David Bell authored the report which found that the service was “not fit for purpose”. It considered that the service could result in “damaging consequences” to children’s lives and failed to fully consider a child’s mental health background. However, it did not identify any “immediate” issues with regards to safety and in 2018 the CQC rated the effectiveness of the Trust as “outstanding”. Conversely, there is a long wait time for a first appointment at GIDS, averaging at two years as of January 2020. GIDS blame high referral numbers and low staff numbers for this wait time.
Lawsuit
In October 2019, lodged a legal complaint against GIDS at its satellite site in Leeds. The suit was brought by “Mrs. A”, a mother of a 15-year-old patient with autism, and Sue Evans, a former nurse at the Leeds GIDS satellite site. It alleges that advice around hormone therapy was “potentially misleading” and that true informed consent could not be given under such circumstances. The suit describes hormone therapy as “experimental” and that there was “robust evidence” to show long-lasting medical effects of hormone therapy.
The RCGP report on transgender healthcare in the UK found several flaws in the NHS approach. It called for a "whole system" change, including addressing waiting times and the lack of research around gender dysphoria in children.
