My daughter took her own life after waiting 1,023 days for a gender identity clinic appointment

Caroline (R) and her daughter Alice (L) (Picture: Caroline Litman)

My daughter Alice was a bright, bubbly child. 

She loved to be outside, toasting marshmallows on a campfire, running around with the dog. She enjoyed Dungeons and Dragons, and dancing and snuggling up with a good book. 

Her friends described her as witty, gentle and kind. She held so much potential and I felt blessed to know her.

But almost two years ago on May 26, 2022, Alice took her own life. She was just 20 years old.

At the inquest into Alice’s death, the coroner issued a prevention of future deaths (PFD) report. She listed five main matters of concern.  

One was the delays in access to gender affirming healthcare. At the time of her death, Alice had languished on the waitlist for 1,023 days. I know she would still be waiting today as clinics are only just offering first appointments to those referred in December 2018 .

We hoped that going public with Alice’s suicide, and drawing attention to the lengthy waitlists and lack of mental health support for vulnerable young people during this period of limbo, might help change things for the better. 

Eight months later, with the publication of the Cass Review, these hopes are in tatters.

I sat at my kitchen table on Wednesday and wept. For all the young people waiting to be seen – and for their parents – in their helplessness at being unable to get their children ‘the support they need to thrive’.

The report’s recommendations aim to rectify this but I don’t believe they will.  

Alice died by suicide at 20 years old (Picture: Caroline Litman)

Cass makes 32 recommendations – which will be argued over in the coming months – and, in my opinion, fails to address how any of them, in her new vision for child and youth gender services, will be adequately funded and delivered. 

She wants ‘specialists’ and ‘experts’, but who are these people? Where are they coming from?  

Cass recognises ‘workforce shortfalls are one of the most challenging aspects of delivering this service’ then recommends a service with an extraordinary level of specialism that requires ‘every case considered for medical treatment should be discussed at a national Multi Disciplinary Team [meeting]’. 

A dystopian level of control. 

And without an adequate workforce there cannot be an adequate service. Meanwhile trans people wait. 

The common notion that children are being rushed through gender affirmative care is, in my experience, abject nonsense. Alice waited and waited. 

Her dysphoria was dramatically exacerbated by the bodily changes of puberty that could have been avoided with appropriate timely care. She waited some more, until she couldn’t wait any longer.

In Cass’s report she acknowledges in the sub section on suicide that ‘risk of suicidality was heightened at transition points in patient care’ before giving the example of the period of time between moving between child and adult services.

I have to ask whether that includes those waiting to be seen in the first place? Those, like Alice, who were waiting for care to begin. 

There has been much talk online about how reversible puberty blockers are. By contrast nothing is more irreversible than death. 

While I commend Cass for speaking to some (but not enough) service users and their families, and to some elders in the trans community – who were once children themselves – but I’ve talked with some who took part in her focus groups and they did not feel listened to. 

Meanwhile, I’ve been disheartened that those on the other side of the debate have trumpeted their delight at the review. It seems as if they feel entirely heard and as such, this has fed the ‘toxic’ conversation that the author made such a big deal of in the opening pages of her review. 

Alice was still waiting for care to begin (Picture: Caroline Litman)

Much will be made of Cass’s decision to disregard ‘weak evidence’ from her review of trans healthcare. In my view, hormones seem to be under more scrutiny than other childhood medicines, which are swerving such intense investigation.

She recommends that those prescribing the hormones to those over 16 but under 18 should do so with ‘extreme caution’. And children hoping to get access to puberty blockers, as of March this year, will only be able to do so through clinical trials.

It’s a level of gate-keeping not seen anywhere else in paediatric medicine, as far as I’m aware.

The possibility of more robust evidence in the future from these trials is no reassurance for parents and those young people whose mental health is reliant on them receiving treatment now.

The biggest problem with trans healthcare remains its rationing and I believe that Cass’s recommendations only make this worse. 

While it feels positive to read, ‘a compassionate and kind society remembers that there are real children (and) families… behind the headlines’, Cass seems to entirely forget her own words. 

Her hints at rationing trans healthcare until someone turns 25 look like a mission creep that’s leaving many in the adult trans community anxious for their future.

If only Alice had been born just a few years earlier in 1998, as her brother was. Why? A child that went to nursery with my son now lives a rather ordinary settled life after completing her gender reassignment pathway. 

Isn’t this all any parent wants for their child; the opportunity for a settled life? 

It’s what I wanted for Alice. Lack of care denied her that chance. 

My family will never stop speaking up for trans people like her, who need the healthcare they deserve, today, not in 10 or 20 years time. 

Do you have a story you’d like to share? Get in touch by emailing jess.austin@metro.co.uk. 

Share your views in the comments below.