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Experiences of parents and carers of young trans and gender diverse people

Child and Adolescent Mental Health Services (CAMHS)

Child and Adolescent Mental Health Services (CAMHS) are the NHS services that assess and treat young people with behavioural, emotional or mental health difficulties. In many parts of the country, CAMHS is undergoing significant changes to their services, which means that parents and young peoples’ experiences might change over time. CAMHS plays a role in referring young people to the Gender Identity Development Service (GIDS)
 
In our interviews, parents spoke about their own experiences and their trans or gender diverse children’s experiences with CAMHS. Some of the things they highlighted included:
  • Experiences with CAMHS;
  • CAMHS’ approach to trans and gender diverse young people; and
  • Lack of capacity in CAMHS.
 

Experiences with CAMHS

 

Josie talks about her daughter’s good and bad experiences of seeing CAMHS therapists.

Josie talks about her daughter’s good and bad experiences of seeing CAMHS therapists.

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We've had mixed experiences with CAMHS. We had let's see, the consultant, would it be a consultant? The psychiatrist anyway at CAMHS who prescribed Fluoxetine for [name of participant’s daughter], cause she was, had a very, very low mood. He was really helpful. And she had two different therapists who she worked with one of those, that didn't work at all. And again, he had more of a kind of let's sit and talk about all of this. Let's go over it all. And, and she found that very, very distressing and very, very annoying. But she also then had another therapist who just got the measure of her better. And would do things like [name of participant’s daughter] would bring the dog to the appointment. And they would go for a walk with the dog, in the park and just have a chat. And then the dog would come back in the office and sit on the chair while they finished off. And so she was really, I think the difference was that one of them was a very, I don't really know how to say, I don't really know how to say it, like a very sort of psychoanalytical kind of you know, wanting to talk about all these things, whereas the one that worked well was a bit more like a mum, you know, kind of a bit more down to earth, a little bit more practical. And so that, that then worked out really well. But we did find there was a couple of things with CAMHS so I don't think we ever had a letter from CAMHS that used her correct name or pronouns on it, even after we gave them the Deed Poll several times. They just didn't have anything in place for that. They still had the, they still had you know like the toilets. There was a men’s toilet and a women's toilet. There was just no need. They were single occupancy cub—do you know what I mean? There was nothing. You could tell that they didn't really, you could tell they didn't really know anything about gender diversity and it was really clear.

 
In our interviews, parents and carers spoke about good and bad experiences with CAMHS. These were sometimes put down to the different working styles CAMHS’ professionals had and how these resonated with their young person. In some instances, parents felt that the support from CAMHS was sometimes inadequate or insufficient. Still, for some young people whose parents we spoke to, CAMHS was an important source of support that at times helped them to explore and make sense of their gender identity. For example, in the case of Ross’s child, although it took the CAMHS therapists a while to ‘put a finger on it’ and identify gender issues, they felt that the referral to GIDS was helpfully made by CAMHS. Some parents, for example Kate, felt that what was available via CAMHS was not enough to ensure her son was sufficiently supported. This made Kate feel like there was nobody other than her ‘keeping an eye on him’ in what was a stressful period for the family. She also felt that she had to ‘keep fighting to get back into a service’ to get any support for her son.
 
 

There was no clear moment of coming out as trans for Ross’s child, but they first explored gender issues in CAMHS appointments.

There was no clear moment of coming out as trans for Ross’s child, but they first explored gender issues in CAMHS appointments.

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It wasn't even as black and white as that. They didn't actually, it wasn't a specific time when they came out. They just started having issues I guess really the turning point really was the bullying at school, which was because of the isolation at school, because they didn't fit into their kind of gender group. They weren't a boy, so they didn't hang with the boys. But they didn't feel they were a girl, so they didn't have a lot of friends at all. They only really had one friend at school who it turns out now has come out as a lesbian, as a gay female who could maybe relate to my child as a trans child. But I don't think they even discussed whether they were gay or trans. I don't think it ever came up in conversation. And certainly the coming out thing wasn't a big announcement, I'm coming out, it was a gradual thing which kind of started really with the CAMHS appointments, which started mainly because of the friction between mum and child. Mum looked for help via CAMHS and CAMHS couldn't put a finger on it, initially. We, certainly the first interview I went to, the therapist there one week said, my child was PTSD. The next time we went they were bipolar. The next time they went they were autistic. They were, it was kind of they were, pigeon holed, but they couldn't find the right hole. And it wasn't until my child was saying about gender issues that gender even came up. That was probably the first time I ever was aware of anything gender related at all. They brought it up at a CAMHS appointment. And eventually, CAMHS referred us onto the [Gender Identity Development Services]. And at that point, it was like the flood gates opened. Suddenly, my child knew where they were and could relate to the therapists and suddenly said, ''Finally, somebody's taken me seriously. Somebody seems to understand.'' And so it was like the flood gates, flood gates had opened. And everything then started to fall into place.

 

Kate feels support from CAMHS has been disappointing and worries her son will have no support whilst on the waiting list to the Gender Identity Development Service.

Kate feels support from CAMHS has been disappointing and worries her son will have no support whilst on the waiting list to the Gender Identity Development Service.

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It feels CAMHS has felt a bit disappointing, to be honest because the initial treatment that he was offered, the CBT, nothing to do with being trans just to do with self-harm and his suicidal thoughts. We didn’t feel ever gave him the techniques and support. I contacted them and said, you know, ‘I want to be able to help him.’ His six sessions are coming to an end. Are their techniques, is there something I can learn, something I can do? But really he was just told to do things like, ‘If you are feeling that way, watch the telly.’ And stuff like that. So, you know, really unhelpful. And we knew from the school that other people had that experience of this particular counsellor. So, nothing personal, she was a really nice lady. But just wasn’t doing what we needed. So, I think that was a poor experience. We then were told, you’re not gonna get any help. And it’s all, you feel this way just because you are trans. But actually the fact that he is trans, he does need support, even if that were all it were. I feel that he does need support, because his life is more complicated. He has the normal teenage stuff. But he has all that on top as well. So that’s been, that’s been disappointing, so far. We have been, once the GP referred us we had another assessment with CAMHS which was again really upsetting. They told him to try mindfulness colouring, which was amazing. Didn’t want to see me even though I had made the initial and I was there, I took time off work. I was there with him. And usually they’ll see me with him afterwards. And we had said how it impacts the family and everything. And that was one of our concerns. But they didn’t want to see me. So, we were expecting nothing from that. And we were like, well, we’ll wait and then we’ll complain and da, da, da. But he has been put on the waiting list. So, that’s a positive. But I am, my concern is that he’ll have his six sessions and then while he’s on the waiting list there doesn’t seem to be anything to keep an eye on him, while he’s on that waiting list.

 

CAMHS’ approach to trans and gender diverse young people

From our interviews with parents and carers, CAMHS’ professionals approached the issue of a young person being trans or gender diverse in different ways. 
 
A couple of parents felt that too much weight was given to the fact that their child was trans and as a consequence any difficulties they experienced were explained as resulting from their gender identity not of other issues. Both Lesley and Kate felt this was not always a fair or helpful thing to do because it could be ‘stigmatising’ for the young person by ‘equating’ trans with mental health problems. Kate felt that her son was not listened to carefully: ‘They [CAMHS] basically said, “Everything that he was experiencing was because he was trans. He has self-harmed… with thoughts of suicide and… they put that all down to being trans... But he [himself] doesn’t feel that it’s all down to him being trans.’ For Kate it was important to acknowledge and make a distinction between the things that her son was experiencing because he was trans and the ‘normal teenage stuff.’ She felt her son needed more support because his life was more complicated.
 
Whilst Lesley felt there were some supportive CAMHS professionals (such as the care coordinator) that helped her son, she felt that overall CAMHS’ approach to her son’s gender identity was based on the belief that her son being trans was a mental health issue. She saw that as a reflection of CAMHS’ ‘cisnormative’ approach – an approach based on the assumption that peoples’ gender identity always matches their gender assigned at birth.
 
 

Lesley felt CAMHS saw her son being trans as ‘part of a mental health difficulty.’

Lesley felt CAMHS saw her son being trans as ‘part of a mental health difficulty.’

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It was always approached from a cisnormative perspective. So there was an assumption that maybe it was a phase and he’d grow out of it. There was a perspective that the norm is to be cis. Because he had been involved with CAMHS for a long time. Their perspective was that it was part of a mental health difficulty.
So it felt this was part of a mental health issue but it’s coming from a much bigger, wider picture, the wider picture. But they couldn’t see that which maybe actually was part of the problem.

 

 
Faced with prejudice towards trans and gender diverse people, some parents and carers we spoke to chose to challenge this. Read more about parents and carers challenging prejudice and acting as advocates for their trans and gender diverse children.
 

Lack of capacity in CAMHS

Not everyone we spoke to had experiences with CAMHS, but the parents who did often felt that lack of capacity and funding within the services was a key issue in their experiences. In our interviews, many parents and carers perceived CAMHS as overstretched and therefore only able to offer support to those in the most dire circumstances. Richard felt that the thresholds of who can get help from CAMHS are ‘increasingly higher.’ Many parents and carers felt that only children who are at high risk could access help from CAMHS: E and D emphasised young people have ‘gotta be pretty suicidal to get CAMHS to take them on.’ Some parents also pointed out that the lack of capacity results in long waiting times at CAMHS.
 
 

Elijah talks about CAMHS being ‘massively inundated.’ His daughter ‘passed through there quite quickly.’

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Elijah talks about CAMHS being ‘massively inundated.’ His daughter ‘passed through there quite quickly.’

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CAMHS, I feel for CAMHS, ‘cos here we have a service which is massively, massively inundated. My daughter passed through there quite quickly. I think they just wanted, I think CAMHS, from their point of view is there no issue of suicide is there harm, is there danger here if there’s not, we have to concentrate on those. I understand where they’re coming from. The people there were perfectly nice, helpful and friendly. But when CAMHS found out my daughter was actually seeing an expert in the field, privately. I mean I’m in a fortunate position where I can do that – just popped out straight away at the other side of CAMHS and she’s on the waiting list now for [Gender Identity Development Services] and we’ll see what happens there.

When you say that she was popped out, was it?

Discharged.

Okay. And did they make it clear that it was because she was in a private?

No, they said it was a mixture of no particular danger and in private, yeah. Yeah.

 

Adele wanted continuing psychological support from Child and adolescent mental health services (CAMHS) for her son.

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Adele wanted continuing psychological support from Child and adolescent mental health services (CAMHS) for her son.

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And you mentioned CAMHS when you felt that you should get to your GP and then to CAMHS. Why were you thinking that?

Well, I’d been advised that he might, you know, would need it, the maybe for psychological support. I think this was after talking to Mermaids and they sort of said, you know, ‘If he does need any kind of psychological support.’ I mean, it was interesting actually with CAMHS, we then, the GP wrote the referral to both the [Gender Identity Development Services] and to CAMHS. And CAMHS came back and said, ‘No, we are not gonna accept him, because actually he needs to be at the [Gender Identity Development Services].’ And so, we were like, ‘Okay. Are you sure?’ So we actually went and asked again and said, ‘Can he come and see you? I think maybe that would be a useful thing.’ And then, they came wrote back again, ‘No, no, absolutely no, we are not gonna see him.’ And he can be at the [Gender Identity Development Services]. And, I mean, the thing about CAMHS is that I’ve spoken to parents since then who have children, with trans kids and I’ve actually wanted very much wanted my child, you know, later on to want to go to see CAMHS because, obviously it isn’t just transitioning, isn’t just a one moment in time thing. There are things that happen as, you know, continuously through life in the same way, you know, as anybody, things change. And I really wanted him to have some support. And I have been told by several people that the waiting list in for CAMHS particularly in this area is so long. It’s like, you know, it’s about two years long for young people. And actually they won’t see you unless your child has basically tried to take their own life. And, and several people have said that and have that kind of ratified as being reports, you know, news reports about that as well for this area, which just makes, you know, me feel kind of slightly desperate that I really would want, you know, my child to have additional support. And but there’s just no way to actually get it.

 

Okay. So you never actually ended up getting any support from CAMHS?

No. We were told twice categorically that they wouldn’t accept him. And then later on, as I say, we, you know, being kind of told that actually the waiting list is so ridiculously long in the immediacy of needing support to be there and then. There was just no point, essentially him going onto that waiting list, because you’ll be on it forever and they’ll only see you if your child, you know, literally ends up trying to take their own life with some crisis, mental health problem.

 
Whilst CAMHS see young people for a variety of issues, not everyone we spoke to felt that their child’s gender identity issues were something that CAMHS were willing to take on. Some parents, including Adele, thought that CAMHS did not offer support for children if their distress was seen as only related to their gender identity, as the services see it as the domain of the Gender Identity Development Service (GIDS). This can at times create a support vacuum for some young people and their families; in particular as the waiting time for the GIDS can be long too. One parent did not feel her daughter needed immediate input from CAMHS because she felt her daughter was doing fine and had no mental health issues. However, for Adele and Kate, they felt there was a lack of support from CAMHS because they wanted their children to be able to access it not just in relation to transitioning, but more generally, to be better equipped to deal with whatever happened in their life.
 
Even for young people who were experiencing a lot of distress, the support within CAMHS was at times limited. Ali shared that she begged CAMHS to keep supporting her daughter after a suicide attempt and self-harming incidents, but they were nonetheless ‘cut loose.’ She felt that was because of both lack of funding and the fact that her daughter’s gender identity issues had come to the fore.
 
 

After Ali’s daughter attempted suicide, she received time-limited support from CAMHS. She felt cuts in CAMHS’ funding meant her daughter was left unsupported.

After Ali’s daughter attempted suicide, she received time-limited support from CAMHS. She felt cuts in CAMHS’ funding meant her daughter was left unsupported.

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I think the difficulty with CAMHS had been partly because we hadn't come out initially and said, ''This is our problem.'' And I think because of their cuts in funding they were under time pressure to get us through and they didn't see the necessity for keeping her on. But it was, it was difficult when we were on the waiting list without support. Just desperately wanting to go through it. And at that point she was going through puberty and that was creating an awful lot of stress. I didn't know where to go. And nor did she, obviously.

 

And at that point we then got the emergency appointment with CAMHS. And at the same time as our referral came through which had basically taken from the September to just on January. It was, you know, [sighs] I'd already been flagging it up, which is a bit disappointing and saying how desperate we were, but hey ho [sighs]. And at CAMHS the therapist was very supportive. But I was very aware that they had a very limited timeframe and we did feel very much that we were on a programme of 12 weeks in and out, and you had to be sorted by then. She still hadn't told me at that point what the problem was. Although, I was starting to get a feel for it [sighs]. So, I had begged them, I literally had begged them to carry on keeping her, keeping her on until the next start of (school) year, because I knew trying to get her to go back into school at the start of that year would be horrendous. And they did agree but we were seeing a different therapist at that point. And I don't know what that after, we'd had various incidents where she'd had actually picked her up from school to go to her therapist session and she cut herself while in the classroom. So I was trying to alert school and the school were trying to help, but there wasn't very much provision in school going back. So CAMHS eventually, just before the first therapist ended, she told me what the problem was that she was trans. And but she didn't, she couldn't get the courage up to tell the therapist. And I didn't want to circumvent how she actually felt. And eventually we managed to tell the other therapist and I knew that they were supposed to do a referral to CAMHS, not to CAMHS to the (GIDS) adolescent services, but I was told at that point that they didn't handle things like that and we were just basically cut loose and left to float.

 
Suicidal behaviour and self-harming are issues that affect the whole family and can cause a lot of anguish to parents and carers of the young person. 
 
You might also like to find out what parents and carers we spoke to said about supporting their trans and gender diverse children’s mental health.
 
Learn what people we spoke to said about neurodiversity and autism.

 

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