open letter

Time for honest reflection, not defence

The closure of the Gender Identity Development Service (GIDS) at the Tavistock has attracted significant public and media attention.

Closure resulted from the Cass Review of children and young people’s gender services in England. The interim report recommended a new service model which acknowledges multiple routes in and out of gender dysphoria. Elevated rates of same-sex attraction, autism spectrum disorders, mental health issues, and looked after children were noted amongst the – now majority female and hugely increased – GIDS cohort. Dr. Cass reported that ‘diagnostic overshadowing’, using gender as the primary clinical lens, had led to such wider issues being relatively neglected. Inadequate records and data were highlighted, particularly on puberty blocker outcomes. The new model intends to re-centre the young person’s needs, taking a holistic view of their difficulties. 

These constitute serious criticisms of a flagship psychology-led service, resulting in its closure to protect patient safety. In this context, the statement issued by the BPS is profoundly inadequate. It offers no acknowledgement of the severity and range of these problems, or of the harm done to some children and young people. There is no reflection on mistakes made or lessons to be learnt.

Defence, not reflection, has been a theme throughout the story of GIDS. Many cliniciansparents and patients have raised repeated concerns about the practice model. Ex-patients have discussed feeling rushed into body-altering interventions which some have come to regret. Criticism has grown louder recently, following a 2018 internal report, a judicial review in 2020, damages awarded to the Trust safeguarding lead and an ‘inadequate’ CQC report in 2021, plus increasing media coverage. Concerns that GIDS was operating outside usual clinical practice were first raised, however, in 2004 critics have consistently been labelled bigots or transphobes and ostracised. 

This is a sobering moment for psychology. We need to take seriously that damaging practice was enabled for so long. Hundreds of psychologists worked at GIDS, highly trained scientist-practitioners skilled in reflective practice. Hundreds more have watched this unfold from the outside. Why did it take an external review to address the widely aired problems? Why was the service not able to reflect and change itself, instead vilifying critical voices? These are questions that psychologists should be well placed to answer, as experts in human meaning-making, embodied distress and group processes. We know that as a profession we are fallible, because we know that mistakes are made by all humans and all groups – yes, even by ‘me.’ 

We also know about recovery and redemption. Difficult things can be tolerated, made sense of and moved beyond. First, we need to acknowledge what has happened and the risks that have been taken with young lives. Some children have been badly let down and may not be forgiving. Nor should they have to be. Trust in psychology has been damaged by this episode and our collective failure to address the emerging scandal. Rebuilding trust requires accountability, honesty and reflection. We must not retreat into the comfort of defensive denial at this crucial moment. 

Dr Laura McGrath, Lecturer in Psychosocial Mental Health

Dr Anna Hutchinson, Clinical Psychologist 

Dr Sallie Baxendale, Consultant Neuropsychologist

Dr Libby Nugent, Clinical Psychologist and group work practitioner of group analysis

Dr Kirsty Entwhistle, Clinical Psychologist

Amanda Perl, Existential Psychotherapist, former Lecturer in Forensic Psychology and Counselling

Dr Jenny Paton, Consultant Clinical Psychologist

Dr Celia Sadie, Consultant Clinical Psychologist

Dr Lauren Quigley, Clinical Psychologist

Dr Russel Ayling, Clinical Psychologist, Psychoanalytic Psychotherapist

Dimitri Spiliotis, Counselling Psychologist

Anastassis Spiliadis, Systemic & Family Psychotherapist, MSc Psychology.

Dr Jenny McGillion, Clinical Psychologist

Dr John Higgon, Clinical Neuropsychologist

NOTE: This letter was first published here and reproduced with authors’ permission.