Trans woman who died after 1,000-day NHS wait 'was failed by the system'

The mother of a trans woman who died by suicide has said her death was ‘preventable with access to the right support’.

Alice Litman, 20, from Brighton, waited almost three years for gender-affirming healthcare.

She was initially referred in 2019 to the Gender Identity Development Service (GIDS), an NHS health clinic that offers support for young trans people.

After turning 18 while still on the waiting list for the GIDS the following year, Alice was referred to its adult counterpart, the Gender Identity Clinic (GIC).

Alice died by suicide on May 26, 2022, aged 20, having waited 1,023 days for a first appointment.

She was found suffering from multiple injuries on the Undercliff Walk, near Roedean School.

Her family believe her wait for an initial assessment at an NHS gender clinic played a part in her death.

At an inquest into Alice’s death on Monday, mum Dr Caroline Litman said in a statement: ‘I do not want any other transgender person to face a future with as much despair as Alice did.

‘I do not want another parent to live the rest of their life with their child in a jar on the mantlepiece, instead of in their warm embrace.

‘I believe Alice’s death was preventable with access to the right support, and that change must happen.’

The inquest at the Sussex County Cricket Ground in Hove heard how Alice, then 16, began showing signs of low mood and anxiety in early 2018.

Seeing her GP before she came out as trans, Alice was told to play more football.

Dr Litman, a former NHS psychiatrist said: ‘When we left the appointment Alice said to me: “Please never make me see that doctor again.”‘

Alice was handed to the Child and Adolescent Mental Health Services (CAMHS)after a suicide attempt in June 2019, the inquest heard.

In August 2019, GIDS confirmed they had received the referral from CAMHS but warned: ‘Due to high demand we have found waiting times at GIDS incredibly hard to predict.

‘Currently, we are seeing young people for assessment who were referred 24 months ago.’

Despite another attempt later that year, Dr Litman says mental health services did not make her as much of a priority as she should have been.

When she turned 18 in February 2020, Alice was referred to the adult Community Mental Health Recovery Service (CMHRS) and transferred to the GIC.

Yet Alice was discharged entirely from mental health services only a month later.

‘I did not feel that CAMHS took Alice’s problems seriously enough,’ Dr Litman said.

‘The CAMHS nursing team effectively acted as gatekeepers, making it very hard for Alice to access support that she clearly needed and would not have received had it not been for intervention from her GP at our insistence.’

She added: ‘The abrupt cut-off in mental health support when Alice turned 18 also had a real impact on her.

‘It did not seem that adult services (CMHRS) took her self-harm history, and the impact of gender-affirming treatment delays on her emotional wellbeing, seriously enough.’

Dr Litman said her daughter was ‘cast out of care’ as she did not meet the adult threshold for intervention.

‘The sudden switch between services (and thresholds for support) on the day she turned 18 left her abandoned at a moment when she particularly needed help,’ she said.

The family resorted to private healthcare in an attempt to leapfrog the years-long wait list, only for the coronavirus pandemic to add further delays.

‘I felt like I was the only one who really thought she might do something,’ Dr Litman added, ‘and I felt despair at my inability to get other people to understand and support her professionally.’

Gender-affirming healthcare is an umbrella term which covers an array of different treatments, according to the NHS. What a healthcare service can provide a trans person depends on whether they are over 18.

For trans youth, it can include therapy, hormone therapy and puberty blockers – drugs which act like a pause button for puberty – among other care.

Adults are similarly offered counselling and hormone therapy alongside gender-affirming surgeries.

Gender-affirming healthcare has been linked to improved quality of life and mental health for trans adults, researchers have found.

For trans young people, studies have shown it can be ‘life-saving’.

A report from the campaign group TransActual found 86% of trans people have pointed to NHS waiting times as having a negative impact on their mental health.

The number of people on the GIC waiting list is more than 13,700, according to the service website.

Just 55 first appointments for those who were referred in July/August 2018 were offered in July.

‘The GIC clinically prioritise GIDS patients who have been transferred over to the GIC which impact our wait times,’ the website says.

The inquest, expected to last three days, continues.

Need support?

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

If you’re a young person, or concerned about a young person, you can also contact PAPYRUS Prevention of Young Suicide UK. Their HOPELINK digital support platform is open 24/7, or you can call 0800 068 4141, text 07860039967 or email: [email protected] between the hours of 9am and midnight.

Get in touch with our news team by emailing us at [email protected].

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