C: HSE (L) and Priscilla Du Preez via Unsplash (R)

Up to 90% of those who used HSE’s gender service in 2022 may have been autistic, audit finds

The National Gender Service (NGS), which is operated by the HSE, has seen an increase in the number of people attending their service with Autistic Spectrum Disorder (ASD).

The fully public service, which “provides specialist support to people who are seeking medical and surgical interventions to help them affirm their gender” operates at St. Columcille’s Hospital, Loughlinstown, and is provided by the Health Services Executive (HSE) and St John of God Services based at St Columcille’s Hospital.

The NGS conducts an annual service audit of all their service users, through which they found an increase in users who may have been autistic. 

In a statement shared with Gript, the NGS said:  “Based on these Audits the National Gender Service has seen an increase in the number of people attending their service with Autistic Spectrum Disorder (ASD)”.

The NGS said that a repeat audit is ongoing, and it anticipates that those using the service with ASD “will increase significantly and may reach as high as 90%” for 2022:

“This number was as low as 3% in 2014. The last time a full-service audit looking at the prevalence of ASD was in 2019. At that stage, the number was 34%. A repeat audit is ongoing and the expectation for 2022 is that figure will increase significantly and may reach as high as 90%. This will be confirmed at the end of this year when the audit is finalised”, a spokesperson said.

They added: “The HSE has not been sent any of this year’s preliminary data or observations yet.  

“Being autistic does not mean that a person cannot go on to start hormones or have gender affirming surgery.  However, it is important to understand a person’s autism as part of a broader clinical assessment that includes assessment of social and occupational function, mental health and communication needs, as all of these can be affected by autism”. 

In the statement, the NGS also said it had identified the “fact that they have insufficient resources to meet current and future demand for their services”. 

“Over the past two years, the NGS have highlighted the urgent need for funding via various channels within the HSE including the HSE Acute Operation Division via Ireland East Hospital Group (IEHG) and HSE Mental Health Division,” an NGS spokesperson shared.

The service said it has submitted a number of business cases, including business cases for new premises and “most importantly additional staff”. It said that a decision on funding approval for new premises is currently pending, adding that this decision “rests with the HSE Acute Operation Division and IEHG”. 

The NGS said it has requested business cases for new staff, with two posts so far approved from a total of 11. 

“Decisions on the other posts are pending and these decisions will be made by the leads in HSE Acute Operations Division and the HSE Mental Health Division,” it said.

One of the posts it has requested is for a consultant psychiatrist with a special interest in autism. It said that it has also requested two administrative posts, with a separate business case for a Consultant Surgeon in development with IEHG but not yet submitted. 

The NGS also said that it will see “waiting lists continue to grow in Ireland” without the additional resources it has requested.

As reported by Gript in January of this year, the clinical lead of the NGS made headlines for calling for the immediate provision of all major  ‘gender affirming surgical options’ including chest surgery, mastectomy or breast removal and mammoplasty or breast enhancement, as well as genital surgery including reconstructive surgery of the genitals to form a vagina or phallus. 

Endocrinologist Dr Karl Neff made the call after the HSE confirmed the Service is seeing more than 300 new referrals each year with a current waiting list of up to two and a half years for 800 people over the age of 17.

According to The Chief Director of Nursing and Midwifery for the HSE, Paul Gallagher, “referrals received per year continue to exceed capacity.”

“The HSE had previously confirmed to Independent TD for Laois-Offaly Carol Nolan that the existing pathway in Ireland for pre-pubertal children generally begins with an approach by the child and family to their General Practitioner who may then refer to the local Child and Adolescent Mental Health Service (CAMHS).

“At that stage, a social transition may be advised with management between the family, GP, CAMHS team and school services as well as an assessment and management of any co existing mental health or developmental disorders,” David Mullins reported in January 2022.

At present those who wish to pursue a surgical option usually travel to the UK or further afield with funding support from the Cross Border Directive for chest surgery or the Treatment Abroad Scheme for genital surgery. 

As reported by Gript this summer, at least 129 Irish children were referred to the unsafe Tavistock gender clinic in the U.K, which was forced to shut due to multiple health and safety failings. Up to 1,000 families in the U.K. are expected to sue the controversial gender clinic.

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