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

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When things are sensitive, it is always difficult to persuade people to talk to you. And really often in journalism, there's not much in it for them to do so. To put your head above the parapet is difficult. And especially, as you will know from reading the book, there are people who have put their head above the parapet, who have been named, who are prepared to say ‘I got things wrong’ as well. And that's incredibly rare. 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. Those discussions are taking place in gender clinics across the world. They took place at GIDS. They're taking place in Europe, and in the United States we're hearing as well. So it was really trying to bring this out of the gender clinics and into wider society because of course, of course, this is an issue for the trans community, but it's also an issue more generally about children and young people. It's really, really difficult. So I have experienced those issues before, but I think perhaps not to the scale here.

Time to Think by Hannah Barnes review - The Guardian

Cultural Influences and Debate Wider cultural influences, indoctrination in “gender identity” and debate/argument What is most inexcusable in this story is the fact that the failures of the early days of the service have simply been repeated down the years. The GIDS not only failed to take account of its own data, learn from it and put in place structures to ensure a safe service for children, it doubled down, allowing pressure from activists to dictate. The service became increasingly ideological, not less. 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. Time to Think shows what happens when the exponents of an ideology, so certain of its righteousness, capture a field of medicine, silencing critics, refusing even to collect follow-up data on whether its treatments actually work’– The Times Best Books of 2023 So FarActually, 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. The evidence of the book shows that the grip of the ideology underpinning the demands of these groups only strengthened at the GIDS over the years. Language changed from ‘natal female’ to ‘assigned female.’ The clinic promoted Gendered Intelligence and the Genderbread Person (the GIDS conferences we attended over the years also reflected a service increasingly in thrall to gender identity ideology, with organisations like Gendered Intelligence, Allsorts and Intercom Trust given platforms to present their business models, and audience members invited to introduce themselves with their pronouns). In referral figures for 2021/22 the biological sex of 22% of children was not even recorded. So it is always difficult to persuade people to go on the record, especially when there's an emotional attachment to the story as well. I can think of other stories where people have wanted to be granted anonymity because they still work in the field. Not necessarily medicine, but perhaps politics or the charity sector or what have you. It's difficult speaking out against your peers, and that was certainly an issue here. And it was more, it's not just your peers, it's people that you really like and you got on with and I think that was really striking about GIDS as I wrote the book. As distinct from those who would have been genetically female, but were instead born male due to a problem occurring in the endocrine system during their sex development. Is that by the time puberty arrives, almost a decade will have passed, making social contagion an unknown factor that cannot be ignored? Many children referred to the service had suffered trauma, had mental health problems or had experienced ‘deprived or injurious upbringings.’”

Time to Think by Hannah Barnes | Waterstones

Cooke, Rachel (19 Feb 2023). "Time to Think by Hannah Barnes review – what went wrong at Gids?". The Guardian. Archived from the original on Feb 19, 2023. 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? Time to Think” goes behind the headlines to reveal the truth about the NHS’s flagship gender service for children. The book is centred around Barnes' over 100 hours of interviews with close to 60 former clinicians who worked at GIDS. All but two of the interviews were taken before the decision was made to close GIDS. The results were not good; “the children’s gender-related distress and general mental health – when based on clinical measures of things like self-harm, suicidal ideation and body image – had either plateaued or worsened.” Moreover, “Researchers reported a statistically significant increase in those answering the statement ‘I deliberately try to hurt or kill myself ’ as well as a significant increase in behavioural and emotional problems for natal girls.” Even though there was no clinically measurable positive impact on psychological well-being, GIDS chose instead to focus on the children’s self-reports of being “highly satisfied with the treatment”.

FiLiA: I suppose this is beyond the scope of the book and perhaps something you don't want to comment on, but there is that sort of tension. Like you said, this is a question that's being grappled with in different countries. Different places are starting to look at their own sort of services. So notably, for example, Sweden had Uppdrag Granskning that looked at, in a series of documentaries, what was going on in Sweden on the subject. And that actually ended up changing practice. In a similar way that I think the BBC and other news outlets reporting here in the UK are also now affecting practice in an English context. I don't really know necessarily what's happening up in Scotland.

Swift Press | Time to Think

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. A one sided view which fails to take sufficient account of the voices of transgender people. It is purely looking to follow an anti transgender and gender critical view point. The story begins in 1989 when a psychoanalyst called Dr Domenico di Ceglie became convinced there was a need for a clinic that focused on gender identity issues in children. . Whether GIDS operated within the framework of gender identity theory or a more developmental understanding of gender dysphoria never seemed to be properly clarified. This ambiguity seems to be a fatal flaw in the service as clinicians operated from different theoretical perspectives. I think the clinical dilemmas stem from the fact that the evidence base is weak and that the existing weak evidence base has been used on a very different group of young people from that for whom it was designed. So, GIDS have actually been open about the fact that they extended the so-called Dutch protocol, which was designed for a group of young people who were psychologically stable, who had gender incongruence from childhood, who had stable supportive living environments. They extended that medical pathway and the evidence for it, if you like, to a group of young people who didn't fit those criteria, whose gender incongruence started in adolescence, who had multiple other difficulties that they were contending with, and who sometimes had quite chaotic living arrangements. And we've seen that shift in the people presenting to gender clinics across the western world. So, I think it's the uncertainty surrounding the evidence base and the fact that the one-size-fits-all approach doesn't seem to be working. I don't know if that's answering your question. Sorry! An absolute must read for anyone who has heard anything or been involved in the transgender debate.In 1994 GIDS became part of The “Tavi” and by 2009 had a new director, Dr Polly Carmichael. Yet by July 2022, following Dr Hilary Cass’s report, GIDS was deemed neither a safe nor viable option for young people with gender-related stress and it was closed down. FiLiA: You include lots of different perspectives and lots of different voices from people who were actually there, who were actually involved, and had direct experience. So it's not a sort of commentary from folks on the side lines. Dr Anna Hutchinson, in particular, plays quite a large role in the book. She kind of opens and closes the work with that question: ‘Are we harming children?’ You do seem to be quite careful about choosing a range of different stories with a range of different outcomes in terms of kids who've actually been through GIDS themselves and have different perspectives, and some of them seem quite positive. So do you think it's fair then to characterise what happened at GIDS as a “serious medical scandal”? And in that case, why? 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. Paul Cullen, of the The Irish Times calls the book "forensic and sombre" and "scrupulously non-judgemental". [8] Cordelia Fine describes the book as an "exhaustively researched account" of "a textbook organizational scandal". Fine notes that Barnes "repeatedly relays clinicians’ support for young people’s access to a medical pathway [and] offers no grist for prejudice-fuelled mills." Fine explains what she regards as "[s]ocially just medicine" and says "Barnes’s book is replete with examples of how far short the gender service fell from this ideal." [9]

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

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. Unsurprisingly, it's always the principled few who push against the current and take all kinds of risks to get the word out. 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 Barnes mixes the stories of people working at GIDS with stories of children who have been through the clinic. There are some de-transitioners and some who had issues with the clinic.

FiLiA: I think one of the difficulties, is that it’s at every level. At the individual, when there's the two clinicians in the room, looking at the patient. Then beyond that, it's in that team meeting where you're allowed to speak but nothing seems to then happen. And then it's going to the more senior people, and having these secret meetings with, for example, Dr Bell or someone and creating this report. Then making those reports and then nothing happens from the reports. And then you have this top safeguarding lead [Sonia], who you're then not allowed to speak to because that's apparently going to be perceived as a hostile act. And so, I think is one of the questions that, I was thinking was: ‘Well, what is it about child safeguarding that provokes this idea that it’s being transphobic? Or vice versa?’ Gender identity activism and social transition in schools – a 15-year-old girl’s account September 7, 2023 Some studies have asserted the mental health benefits of these drugs, but Barnes says these have been heavily critiqued and shown to have flaws. “The science is not settled, and this field of healthcare is overpopulated with small, poor-quality studies,” she concludes. “It’s often not possible to draw definitive conclusions on the benefits or harms of these treatments.” It's also striking that it took till 2019 for GIDS to have a standard operating procedure around safeguarding. And that was one of the results of the review. But to have operated for 30 years without seemingly the feeling that there needed to be one, I think is interesting. And then not to include your safeguarding lead for children, so Sonia says, in the drafting of it is also rather striking.