We’re taking urgent legal advice on mental health guidance for trans youth

Good Law Project has seen an alarming leaked document from NHS England regarding children and young people’s healthcare.

The document, which does not bear the name of any NHS professional, asks providers of mental health support to children and young people (CYP) to invite those on the national waiting list for gender services for a face-to-face appointment. Providers are told: “We request all CYP who have been allocated to your service for mental health review are assessed as soon as possible.” One group is asked to be “reviewed and or assessed by… 30 June 2024.”

To enable providers to satisfy this request, they are allocated further funding for an initial face-to-face assessment – but no recurrent funding. We assume what is being sought and funded is (at best) an assessment and onward referral to already long waiting lists for mental health services or for autism/ADHD support.

As part of this process, children and young people on the waiting list for trans healthcare have been sent a “Gender Experience Summary Form”, asking them or their families whether they are receiving support from “the private sector or from abroad… such as… hormone treatment.”

The reality for all but a tiny minority of trans youth is that treatment is not available on the NHS. And regulatory harassment has diminished the pool of UK-based private providers of trans healthcare to almost nothing.

Against this background, the document recognises that many trans youth will have sourced hormone treatment from “unregulated providers or unregulated sources.” It states that the largest “unregulated provider” is a service called GenderGP, which it says is “registered overseas and is therefore outside the reach of the UK health regulators.” Good Law Project holds no brief for GenderGP but obviously “registered overseas” is not the same as “unregulated.” Nevertheless, the document seems to treat the two as one and the same.

At the assessment, providers are asked to “advise” the child or young person and their parent/carer not to take puberty blockers or gender-affirming hormones obtained through these routes without appropriate care. NHS England does not identify what “appropriate care” is and it is hard to see what available care it would describe as regulated.

Providers are told not to prescribe or to stop prescribing puberty blockers or gender-affirming hormones. They are also told that if the trans child or young person and/or their family “disregards your advice and you consider that this puts the child/young person at increased risk, then a safeguarding referral may also be appropriate in line with standard safeguarding approaches.”

It seems to us – and to those inside the NHS who have leaked the document to us – that what purports to be an “assessment” in fact an exercise in bringing very significant pressure to bear on trans youth and their families to cease private treatment, backed up with a threat of a safeguarding referral to social services if they do not.

Good Law Project has also seen a sample email sent to a parent of a young trans person. It tells a very different story to the internal NHS England guidance. It says:

“We understand it cannot be easy for [name] having to wait a long time to be seen by specialist Gender Services. Therefore, the NHS wanted to offer them some support through local Children and Young People Mental Health Services [CAMHS].”

Of course, no new funding is being made available for support – just an assessment. In the last year, the average wait time for CAMHS was over three months and more than 40,000 children had been waiting over two years for treatment.

The email goes on to suggest the provider may decide “clinical support would be best provided by your GP”. However, the NHS England document tells providers “not to continue prescribing puberty blockers or gender-affirming hormones”, so this also feels rather misleading.

We are concerned about what appears to be a misleading exercise in gathering data on which trans youth are obtaining private treatment from abroad, for the purposes of seeking to cause or compel them to stop treatment.

Good Law Project is taking urgent advice from a specialist King’s Counsel and solicitors. We do not know whether it will be possible to take legal action. In the meantime, we suggest that families receiving these emails think very carefully about whether they participate in an exercise that is not fairly described.

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