GenderJam NI met with Knowing Our Identity, the Gender Identity Development Service for Northern Ireland, which is a service commissioned through Child & Adolescent Mental Health Services, at the Beechcroft facility in Forster Green Hospital, Belfast on Thursday 16th of April 2015.
Several questions were asked of KOI, most of which were raised by GenderJam NI members throughout the previous couple of months privately. Some of the questions were asked by other individuals.
- Throughout, the Brackenburn Clinic, which is the adult Gender Identity Service for Northern Ireland, is referred to simply as the Brackenburn Clinic.
- The answers provided are the stance of Knowing Our Identity and do not necessarily reflect the opinions of GenderJam NI.
1: Are service users being referred for hormone blockers required to consent to a genital exam prior to prescription?
Due to the requirements of regional paediatric endocrinology services, service users accessing hormone blockers through KOI are required to undergo a full physical examination, which involves a non-contact visual genital examination. There is no expectation that this policy will change in the near future, and any changes will be dependent on the Royal College of Endocrinology changing their stance on genital examinations for endocrine interventions in adolescents.
A genital examination may be refused by service users at the Brackenburn Clinic.
2: At what age can service users access hormone blockers and cross-sex hormones?
Service users can access hormone blockers at age 15 and older, after an initial assessment process. Cross-sex hormones can be accessed after one year of hormone blockers, which in practice means a lower age limit of 16 applies.
KOI do not currently offer an Early Intervention Scheme similar to that offered by the Tavistock & Portman clinic in London, but younger patients may be referred to Tavistock & Portman for assessment and treatment separately if appropriate. They will not be treated through KOI.
3: Will older service users be able to access cross-sex hormones concurrently, or instead of, a period of hormone blockers?
No, service users, from age 16 and up, will be required to undergo a year of hormone blockers prior to access to cross-sex hormones. This is to allow a period of reflection and adjustment.
4: Is there a procedure in place for service users to transition effectively to the Brackenburn Clinic?
Yes, KOI meets regularly with the Brackenburn Clinic, and a smooth transition is handled by staff, including offering first appointments at the Brackenburn Clinic to be attended by KOI staff members for support.
Assessments undergone by KOI are generally taken into account by the Brackenburn Clinic to new service users to avail of services quickly.
5: Are non-binary people eligible for treatment at KOI?
Yes, all non-binary people are eligible to access services offered by KOI. There is no set care pathway for service users.
6: Are service users able to access physical interventions without parental consent?
Although KOI aims to involve parents or guardians wherever possible, it is recognised that in some situations this is not possible. Patients aged 16 or over are able to consent to treatment, and patients aged under 16 will be assessed using the Gillick competence principles to ascertain their ability to make informed decisions about their healthcare.
Each service user is assessed on a case-by-case basis.
7: Are service users who referred to KOI at age 17 able to access physical interventions, or is it more useful to wait until they turn 18 for a referral to the Brackenburn Clinic?
All patients are required to undergo a full assessment period prior to access to physical interventions including endocrine services. In the interim, support services including talking therapies, family support and peer support groups are offered to all service users.
Unless a young person is about to turn 18, it is useful to be referred to KOI for support.
8: Are autistic young people eligible for treatment at KOI?
Autistic people are eligible for treatment at KOI. Around 20-30% of current service users are autistic.
Generally, KOI attempt to make sure services are accessible with sensory and communication issues, and shape social groups and appointments around the access needs of autistic people among others in terms of sensory environments and physical accessibility.
As long as a person holds competency to make informed decisions about their healthcare, they are eligible to access treatment offered by KOI. This includes people with learning disabilities.
9: Are other physical interventions (laser hair removal, speech & language therapy etc) available through KOI?
There is an ongoing effort to secure commissioning for these services, but at present, neither hair removal nor speech and language therapy are available through KOI.
- If you would like to respond to this or ask a question to KOI yourself, please get in touch.