Imagine if to get a flu jab, anti-depressants or a broken leg fixed you had to have 4 or 5 separate Dr appointments and at least 2 specialists confirm your diagnosis and give you a signature before you could get your prescription or any treatment.
Wouldn’t that be a waste of resources?
Waiting times would soar, costs to the NHS would rise and patients’ physical and mental health would suffer.
Decades ago being transsexual (now more commonly referred to as transgender) was very much considered a mental health issue, and required several evaluations by psychiatrists. There were many hoops to jump through because the medical profession needed to make absolutely sure that the patient was indeed transsexual before they were allowed to have their ‘sex change’. A term now very outdated and considered derogatory. Many faced being sectioned just for thinking they might be in the ‘wrong body’. After all who in their right mind would want to change gender?
These days things have moved forward. Well they have a little, but I very much feel the medical profession are strongly dragging their heals back to those times. Patients still require several assessments and signatures from trained professionals to get the go ahead for every single step of treatment and in the UK the NHS typically require more steps than the latest WPATH guidelines. This means treatment for many can take a decade or more to complete. As you can imagine the process of gender transition is all-consuming and patients lose years of their life to this process, years that could have been spent focusing on important career and social development that others just take for granted. Also the time between starting and finishing treatment can be especially challenging for trans people when trying to navigate what can be a cruel world while in a state of limbo, being physically half and half, not fully male nor fully female.
So it is any wonder that, as the BBC have stated in this article, waiting times for a first appointment are increasing and are a long way off the recommended 18 weeks? Funding is short and as society becomes more accepting more and more transgender people are finding the courage to seek treatment rather than live a life of misery, meaning the demand for gender services is rising rapidly and will continue to do so.
So what’s the answer? I personally feel it’s quite simple and is not a case of adding more recourses or more Dr’s to the teams who treat the growing numbers of transgender patients seeking help, but to reduce the number of steps required to access treatment.
Here’s a slide from a recent talk I gave to healthcare professionals on transgender care.
As a specialist who has treated hundreds, if not thousands of transgender patients Dr Lorimer is more qualified than most to understand the needs of this patient group. What I query then is why as it’s now known that transgender people are NOT mentally unstable, and we know that treatment helps people get BETTER, why are there still so many hoops to jump through to receive treatment?
In theory all that is needed is an initial diagnosis, then like most other medical issues, treatment should begin. Check ups along the way would ensure patients are coping with what can be a difficult process to navigate socially, mentally and with family members, but why the need for continual hoops for every step? Who would start the process of transition and not need to complete it? Given the old thoughts ‘they must be mad’ surely it can be seen that yes, no one in their right mind would request gender transition if they weren’t actually transgender?
How would this help? By reducing the hoops the treatment costs are reduced, as well as the overall time it takes to complete treatment. This would benefit all concerned. Waiting times would be reduced so patients are seen quicker, they would receive their treatment in a shorter space of time, which would reduce their stress and allow them to move on quicker and actually live their life in their new and more comfortable identity. It would also mean the reduced treatment costs would leave more funding for other medical conditions. So win, win, win.
BBC News: Transgender people face two-year wait for NHS appointment – http://www.bbc.co.uk/news/uk-england-42774750?ocid=wsnews.chat-apps.in-app-msg.whatsapp.trial.link1_.auin
Interview with Dr Stuart Lorimer – http://www.huffingtonpost.co.uk/2015/12/24/transgender-psychiatrist-stuart-lorimer_n_8646704.html
WPATH Standards of care (World Profesional Association for Transgender Health) – https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf