Simon Harris pushed HSE to review need for psychiatric assessment for gender switches The Sunday Times 12.01.20
The original article is here.
Simon Harris, the minister for health, has asked HSE officials on a steering committee that is developing transgender services to examine the concerns of an activist campaigning against the requirement for transgender people to have a psychiatric assessment.
Meanwhile, doctors at the National Gender Service at St Columcille’s Hospital have warned that the steering committee is basing its work on an “unsafe” model of care.
At present, patients treated at St Columcille’s in Loughlinstown must undergo assessment by a psychiatrist before they can receive hormone therapy. The clinic’s 2018 model of care notes a disproportionately high prevalence of mental illness among people who identify as a different gender from their biological sex and says specialist mental healthcare can significantly improve outcomes.
However, the HSE’s quality improvement division developed a different model in 2017. It suggested that GPs could provide “initial diagnosis”, although this would require “specialist confirmation” such as by a psychiatrist. Unlike the St Columcille model, the HSE proposes that diagnosis should be “guided by” the recommendations of the World Professional Association for Transgender Health (Wpath), which places a strong emphasis on patients’ self-declaration as the basis for treatment.
Leaked minutes indicate the HSE has based the steering committee’s work on its own proposed model of care. Paul Moran, consultant psychiatrist at St Columcille’s, says this proposal is “unsound and unsafe” because it “does not enable adequate assessment of patients and does not require proper qualification of professionals”.
“Thankfully there is in place a sound and safe service which, unlike this [proposal], has qualified, highly trained people working in a well-governed service,” Moran said.
Donal O’Shea, a consultant endocrinologist, said the St Columcille model was approved by the Royal College of Physicians of Ireland and was in line with best international practice, so doctors would continue to implement it.
“My concern is that they’re almost encouraging self-declaration to equal ‘you should start treatment’ and that there is no need for a full assessment prior to that decision. A GP is not equipped to adjudicate on whether a patient can start treatment. You need a full assessment to do that,” O’Shea said.
“A person’s gender is their own decision but where that should lead you — should it lead you to hormone treatment and surgery or not — is a really complex decision.”
In May, Harris appointed to the steering committee Noah Halpin, an activist campaigning against psychiatric assessment and in favour of Wpath and a stronger role for GPs. In an email from June released under freedom of information law, the health department said Harris “wishes to ensure the concerns which Noah Halpin brought to his attention are examined”.
In particular, the minister’s “expectation” was that the committee would review implementation of the transgender model of care to “ensure compliance with Wpath is happening in practice”.
The Department of Health declined to comment this weekend. Halpin said he was unable to comment. The HSE said the committee was developing “a seamless and integrated service for those who present with gender identity issues”.