How we got from there to here in 83 years
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Transcript of How we got from there to here in 83 years
What I’ll Cover
Some historical context
NHS Context
International definitions
What trans people need and want
Challenges to service design
Challenges for today
Historical Context
Trans people have been transitioning for centuries, if not millennia
The modern world brings opportunities but also challenges
Clinical imperialism and voluntary services
Gatekeeping
The UK Clinical Landscape
NHS Care for people with gender identity problems confirmed judicially in 1998/9
GPs -- CMHTs -- Tertiary services
Commissioning until now by 152 PCTs taking policy guidance from 10 Specialist Commissioning Groups
Tertiary services will be commissioned by the NHS Commissioning Board in England after 1st April 2013
Clinical Definitions
The International Classification of Diseases and Health Conditions (ICD)
The Diagnostic and Statistical Manual
Both subject to revision at present
The ICD
The ICD is published by the World Health Organisation, a specialised agency of the United Nations
Ratified by the World Health Assembly(the health ministers of 193 countries)
Always a product of its time
Next edition (ICD-11) 2015/6. Will be part of clinical practice for 15-25 years
The ICD and trans people
Transvestism first added in 1965 (ICD-8) under ‘sexual deviations’
Transsexualism first added in 1975 (ICD-9) under ‘sexual deviations’
And then there was ICD-10...
ICD-10 (1990)F 64.0 - Transsexualism
F 66.1 - Egodystonic Sexual Orientation
F 66.2 - Sexual Relationship Disorder
F 64.2 - Gender Identity of Childhood
F 66.0 - Sexual Maturation Disorder
F 64.8 – Other Gender Identity Disorders
F 64.9 – Gender Identity Disorder, unspecified
F 66.8 – Other Psychosexual Development Disorders
F 66.9 – Psychosexual Development Disorder, Unspecified
F 65.1 – Fetishistic Transvestism
F 64.1 – Dual – Role Transvestism
WPATH DiscussionsF 64.0 - Transsexualism RENAME / MOVE
F 66.1 - Egodystonic Sexual Orientation DELETE
F 66.2 - Sexual Relationship Disorder DELETE
F 64.2 - Gender Identity of Childhood RENAME / KEEP?
F 66.0 - Sexual Maturation Disorder DELETE
F 64.8 – Other Gender Identity Disorders DELETE
F 64.9 – Gender Identity Disorder, unspecified DELETE
F 66.8 – Other Psychosexual Development Disorders DEL
F 66.9 – Psychosexual Development Disorder, Unspecified
F 65.1 – Fetishistic Transvestism DELETE
F 64.1 – Dual – Role Transvestism DELETE
WPATH Don’t Decide
WPATH is a global professional association, involving over 800 clinicians dealing with people with gender identity conditions
Their process is about reaching a consensus recommendation of their own to present to the World Health Organisation
WHO will consult others too
Process takes 2-3 years to secure global consensus for World Health Assembly
Current Thinking
Delete all but two classifications
Rename the adolescent / adult category (“Gender Incongruence?”) and remove from mental health section
Rename the child category (“Gender Incongruence of Children?”) or remove it altogether and use Z-codes
Uses of the ICD
Clinical utility - A common language to describe symptoms and anchor treatments
Common taxonomy for research
Health statistics and funding
Public health and policy
What trans people need and want
In transition
For lifelong wellbeing
In other services
As relatives and carers
In their own old age or disability
Trans care challenges service design
Intensely multidisciplinary. Needs joined up working at a time when NHS is fragmenting
Massive variation in needs
A legacy of stigma and ignorance to be overcome