Mermaids

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Regarding the Charity Commission and Cass Review

I was relieved to see today that the Charity Commission’s investigation into Mermaids has finally concluded. The Commission’s published decision found that Mermaids was mismanaged in several respects, but did not find evidence of misconduct, especially in terms of safeguarding young people or providing medical advice.

This is great news in that Mermaids can now continue to operate as a charity and seek funding from relevant agencies to do so. The organisation clearly faced an enormous squeeze during this time, that significantly affected service provision.

However, I am concerned by the language used around the Cass Review in the Commission’s report and accompanying press release. I feel much of this language is deeply misleading and demonstrates considerable ignorance regarding the Review. At the same time, I feel there are some good, practical recommendations in there for charities which face potential harassment from media reporting and on social media.

Logo for the Charity Commission for England and Wales




Binders

The most concerning statement can be found in the Charity Commission’s press release, concerning Mermaids’ former provision of binders to young people as a harm reduction measure:

The Commission has issued statutory advice to the charity requiring that, should it ever resume this service, its future policy and controls should reflect the recent Cass Review, or any future NHS guidelines on parental involvement.

The Cass Review does not, of course, actually make any formal recommendations for non-medical service providers – moreover, its commentary on social transition is not well-evidenced.

However, the Charity Commission decision quotes the final report of the Cass Review, which states that “parents should be actively involved in decision making unless there are strong grounds to believe that this may put the child or young person at risk“. This would appear to align with Mermaids’ actual policy, which was to work with parents, families, or carers unless a young person was not directly supported. The issue, of course, is that the Charity Commission (and, indeed, the Cass Review team) do not fully interrogate or understand the considerable risks posed to young trans people by unsupportive parents.

I am increasingly of the impression that policymakers are taking all kinds of decisions without having read the Cass Report in any detail, let alone with a critical eye. This would appear to be another example of this.


Having “regard” to the Cass Review

Similarly, in a sub-section of the decision report titled “Implementing the findings of the Cass Review”, the Charity Commission recommends that trustees working with “children and young people who are questioning their gender identity or experiencing gender dysphoria” need to “ensure that they have regard to the findings, conclusions and recommendations of the Cass Review and ensure that they have reviewed their charity’s literature, website and guidance in light of them“.

This statement is, I believe, being wilfully misinterpreted on social media and in media commentary. For example, the Standard’s report on the decision leads with the headline “Charities should follow Cass Review recommendations, say watchdog”. However, that is not what the decision actually says.

In the UK, “have regard” means that organisations should take account of guidance and carefully consider it. An example of this can be found in the Charity Commission’s rules for charities on public benefit:

As a charity trustee, ‘having regard’ to the commission’s public benefit guidance means being able to show that:

  • you are aware of the guidance
  • you have taken it into account when making a decision to which the guidance is relevant
  • if you have decided to depart from the guidance, you have a good reason for doing so

In the current political climate, this strikes me as an eminently sensible approach to the Cass Review. I would expect all service providers and researchers to be aware of the Review’s final report, to take it into account, and (for the purpose of defending against bad faith actors) be able to provide good evidence for acting otherwise.

Going by a statement from Mermaids Chair Kathryn Downs for Third Sector, this appears to the charity’s planned approach to having regard:

“The Cass Review final report is the highest-profile review of youth healthcare in the world and has influenced NHS England’s policies. However, it is not legislation or guidance.“

She then goes on to emphasise that Mermaids’ advocacy and policy work will continue to be “driven by and give a platform to the voices of young trans people“.


We deserve better from the Charity Commission

Overall, I feel this is good news for Mermaids, and for trans organisations more generally. However, the language used by the Charity Commission, especially in their press release, really muddies the water by providing considerable grounds for bad faith interpretation.

It’s also deeply frustrating to see the Cass Review continually upheld as a paragon of policy advice. Trans people know that the Review was conducted by non-experts and involved individuals hugely hostile to our very existence. As a researcher, when I open the final report I see a methodological and ethical nightmare. The Cass Review is an example of runaway bad science, treated as an article of faith by mainstream decision-makers, many of whom haven’t actually read it.

I don’t think it’s unreasonable to speculate that the Charity Commission’s final decision reflects the influence of transphobic actors. Two years is an extraordinarily long time for an investigation to take place, and surely does not serve the interests of the young people Mermaids work with. Earlier this year the Commission’s Twitter account “accidentally” shared a transphobic post claiming (without evidence) that the charity had caused “so much harm”, calling into question the independence of the investigation.

I’ve been critical of Mermaids myself in the past, especially given I did not feel appropriately supported by them when I came out as a teenager. I am sure I will continue to be critical in the future. However, I hope this criticism can always be both constructive and grounded in reality, recognising our shared interest and care in building a better future for young people.

I’ll end this post, then, by amplifying Mermaids’ demand for better:

…the time taken to publish this report has been frustrating, significantly affecting Mermaids’ fundraising and ability to deliver on our charitable objectives. We call on the Charity Commission to ensure that organisations serving groups facing rising hostility are supported and protected, whilst being held to account where this is necessary.

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13 days to defend trans and queer kids

On 12 March 2024, the UK Department of Education consultation on draft guidance on “gender questioning children” for schools and colleges will close. Until that date, we have our best possible chance to fight for the safety and wellbeing of young people.

Last month I wrote a long blog post and zine about this draft guidance: New Year’s Resolution: Smash the New Section 28. I argued that the guidance resembles the notorious anti-gay law Section 28, in that it aims to both directly oppress LGBTIQ+ young people, and create an atmosphere of fear and uncertainty around supporting them. This is to be done by reinforcing a strict sex binary. The guidance directly targets young trans people, but also threatens to enforce sexist and homophobic standards on all students, e.g. through stating that school uniforms should be allocated on the basis of “biological sex”.

I also argued that there are important reasons for hope, and many routes to resistance. One possible option is to take part in the consultation itself, but there are other approaches too, including noncompliance and resistance in schools, contacting politicians and unions to raise the alarm, supporting trans youth groups, and creative forms of protest.

Since I wrote Smash the New Section 28, the situation for young trans people has continued to deteriorate. In the UK, the Government has very quietly introduced a second consultation on proposals to segregate trans college students who are on trips or who would otherwise be sharing accommodation with other students. In the US, the murder of trans student Nex Benedict in a school bathroom shows just how dangerous the UK proposals would be in practice. I have updated my original post to reflect both of these events. Moreover, it’s emerged that the Royal College of GPs are hosting a conference for conversion therapy advocates in London, and the British public are more openly prejudiced towards trans people than they were just five years ago.

However, it’s also been really heartening to see how many people have read the blog post and shared the zine over the last month. I have particularly appreciated the support from the amazing independent Leeds book shop The Bookish Type, who have been giving away loads of free copies of the zine. I have heard from parents and bureaucrats who say they are using what I have written to argue for independent guidance that actually supports trans and gender non-conforming young people in schools and college.

Importantly, my writing is just one piece among many. Important critiques and consultation guides have been published by people and groups including The Diversity Trust, Just Like Us, Nancy Kelley, Gendered Intelligence, LGBT Foundation, Mermaids, Stonewall, and the Trans Learning Partnership. If you’re aware of any good writing or resources, please share in the comments and I will add it to this post.

You and the people you know have the resources to take action against the new Section 28. If the guidance is implemented, this will not be our only opportunity to fight back, but it is the best opportunity. Think about what you can do before 12 March: whether it’s writing to school governors or an MP, agitating in your workplace or union, or sharing information with others.

As ever, we can never win freedom alone, but have so much power when we act with others.

Photograph of a women holding a zine titled Smash The New Section 28. The woman is white and has shoulder-length brown hair, and is wearing glasses and a grey t-shirt. She stands in front of a large book shelf.
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NHS England proposals put young people in danger

NHS England logo

Three weeks ago, I wrote to the NHS England Gender Programme Board (of which I am a former “patient public voice” member) to raise urgent concerns about their consultation on a new interim service specification for children and adolescents.

The proposed service specification is deeply transphobic on numerous levels – from the dearth of relevant treatment pathways, to the assertion that being trans is likely a “phase”.

It is also probable that if implemented, this service specification will impact other young people more widely – especially girls and LGBTIQ+ youth – by undermining principles of autonomy and respect.

You can read more about the service specification here.

The proposals have been condemned by UK and international experts including Dr Natacha Kennedy, Cal Horton, and the Australian Professional Association for Transgender Health. Their well-evidenced critiques are well worth a read, especially if you might consider participating in the consultation. Edit 26/11: the proposals have now also been condemned in a strongly-worded and well-evidenced statement from world professional bodies WPATH, ASIAPATH, EPATH, PATHA, and USPATH.

The consultation is open to anyone. If you have the time and energy, there is a guide to participating in the consultation here, prepared jointly by Gendered Intelligence, Stonewall, Mermaids, and the Trans Learning Partnership. If you are a community member, a healthcare practitioner, a researcher, or work with a relevant charity, it would be particularly useful for NHS England to hear from you.

Other things you could do to oppose the proposals include: organising a demonstration, raising awareness of this issue on social media, and/or writing to your MP or trade union and asking them to place pressure on NHS England to reconsider.

To date, I have not received a reply from NHS England. Given the danger the proposed service specification poses to the safety of young people, I have now decided to make my letter to them public.

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Dear all,

I am emailing to share my great alarm at the proposed service specifications for child and adolescent gender dysphoria services. It is my expert opinion that, if implemented, these proposals will cause great harm to young people. Moreover, in opening such poorly designed and unevidenced specifications to consultation and media commentary, NHS England has already caused harm.

The fact that this consultation is happening at all represents an enormous failure on the part of every professional involved.

I stepped down from the Gender Programme Board earlier this month due to clashes with my teaching schedule. However, given the severity of this situation, I would be remiss in my ethical duties if I did not also email you directly to share my concerns.

My three main areas of concern are:

  1. Social transition should not be subject to medical oversight. This would represent a gross abuse of power on the part of commissioners and practitioners. Choosing to wear different clothes, and possibly use a different name and/or pronouns – is a personal, non-medical decision related to a person exploring their identity and/or coming out. Preventing a young person from choosing a social transition amounts to an attempted conversion practice.

  2. Punishing young people and their families by subjecting them to investigation if they access private services will not help them access healthcare. Young trans people who access private healthcare in the UK or abroad generally due so due to the severity of NHS failures.  It will increase the likelihood of young people hiding the fact they are accessing external treatment from NHS clinicians, and of people turning to black-market hormone providers rather than private doctors. I am not sure that members of the Gender Programme Board are fully aware of how prevalent and dangerous the home-made substances already in circulation can be.

  3. Requiring that young people become research subjects as a condition of accessing treatment is completely unethical. This is a well-established principle in the trans health literature. There is no way in which you can truly obtain informed consent for research participation from individuals who will be denied healthcare if they refuse to participate. I fully support the expansion of NHS-funded research into trans healthcare, but participants must not be recruited through coercion.

I will end by inviting all recipients of this email to reflect on what they do not experience, and what they do not know.

Most members of the Gender Programme Board have not experienced gender incongruence or gender dysphoria.

Most members of the Gender Programme Board are not members of a trans community. It is likely therefore that you – even if you are a clinician – have never found yourself in a position where you are confronted with the true impact of NHS failings on young trans people who rely on community support. You do not know what it is like to be trying to look after many extremely damaged members of your community dealing with complex trauma and self-harm from people who have been repeatedly abused by NHS clinicians and processes. We, in the community, are the ones left picking up the pieces of your failings, finding ourselves on constant suicide watch and scrabbling to keep people alive. Invitations onto bodies such as the Gender Programme Board, where we are expected to be polite while fighting for scraps – only to be ignored – do not right these overwhelming wrongs.

It is now on you to rebuild trust.

Sincerely,

Ruth

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New job with the Trans Learning Partnership

I am very excited to announce that I will soon begin work on a new project. From the beginning of April I will be working full-time with Spectra as Research Coordinator for the Trans Learning Partnership.

The Trans Learning Partnership is a groundbreaking collaboration between trans and non-binary community representatives, academics, and four organisations who work to directly provide community services: Spectra, Gendered Intelligence, Mermaids, and the LGBT Foundation. The aim of the Partnership is to drive the development of a robust service and advocacy-oriented evidence base, enabling trans services and their service users to have needs-based, impactful services.

This also means that I will be leaving the Trans Pregnancy Project at the University of Leeds, but rest assured that I plan to continue supporting my colleagues from that project in writing up and publishing our findings. We have a number of academic articles currently in the pipeline, along with a themed special issue of the International Journal of Transgender Health.

I will of course continue to update this website periodically with information and reflections on all of my ongoing research.

The Trans Learning Partnership feels like such an important opportunity to design and undertake research intended to directly improve people’s lives. I can’t wait to get started!