Ms Vanessa Lacey:

It is getting worse than "Countdown" here, I am like Carol Vorderman.

I thank the members, particularly the Chairman, Deputy Jerry Buttimer, for arranging this meeting. The idea for it emerged from a conference we had in Waterford in February. I appreciate this opportunity and also thank Paul for all his help.

To introduce myself, my name is Vanessa Lacey and I am the health and education office for Transgender Equality Network Ireland or TENI. I also sit on the committee for transgender health care in association with the HSE as well as other voluntary organisations of which I am a part, including Integration Waterford which includes all marginalised communities in our area of Waterford city - it looks at diversity and bringing that forward.

I want to say a little bit about language and differences. I am talking about gender identity. This is a deeply rooted feeling of being male or female whereas the term "transgender" is an umbrella term and refers to those people whose gender identity is different from what was recorded at birth.

In regard to myself, I appear before the committee today a very proud Waterford woman and a proud Irish woman. However, I am not a stereotypical Waterford woman or Irish woman. At the end of this month I will be 49 years of age. I was born in Waterford city. At birth I was identified as male. My parents and the midwives did not know my gender identity and the hospital staff or GPs could not have known my gender identity. However, my gender identity for as long as I can remember is female and always was. I do not get any prizes for that, that is the way it is, it is human diversity. It is nobody's fault, it is how life was for me.

As a young child growing up, I did not think there was anything wrong until my expression of my gender was either frowned upon or I was punished for it. In the 1960s and early 1970s in Waterford, being the way I am and being way I have grown up to be was not the run-of-the-mill. It was frowned upon so I conformed to my parents' and society's expectations. I went to a Catholic boys school and then I went into secondary school. I left school at 14 years of age after failing every examination I could possibly sit because I could not concentrate on what was going on. I conformed again and I was lucky enough to have two wonderful relationships with people, both of them female, and I was married and I have two wonderful children. My wonderful children have supported me through this process and this process has taken six years.

However, I have lost contact with most of my family members. My mother died two and a half years ago and prior to that she did not talk to me. Coming back to what I am going to speak about and to make the matters plain for everyone, I would point out that two and a half years ago my mother died and three years before she died my brother asked me if I was wishing to carry Mam's coffin. I said, "No. Not really, I have not really thought about it". He said, "That is good because I cannot imagine any member of this family wanting to put their arms around you".

It is estimated that 1% of the population experience some form of gender variance. That equates to around 50,000 people in Ireland. However, a small percentage of people transition to a new gender role or seek medical help for transgender-related experiences. As a country we are only coming to understand gender identity and the needs of our transgender community. I will highlight some of the issues. The World Health Organization defines health as not simply the absence of illness but the presence of wellness. Ireland's transgender population does not enjoy good health. In a recent survey carried out in Ireland it was found that 78% of transgender people had seriously considered ending their lives and, believe it or not, a startling 40% of people attempted to take their life at least once. The national average for suicide is 1.6% and this begs the question, how many transgender people are included in this 1.6% and how many people today are planning to take their own lives due to feelings of despair with regard to their gender identity?

I also seriously considered taking my life because I was afraid of the shame I would bring on my family. This is the impact of the lack of awareness of this issue in society. The high rates of depression, anxiety and suicidality are exacerbated by the fact that transgender issues have historically been doused in stigma, stereotyping and discrimination. The term used for this is "transphobia". This will take many years to combat and eradicate, allowing transgender people and their families to seek necessary treatments, procedures and legal documentation and move on with their lives in safety and inclusivity.

Access to health care is one of the most urgent issues facing the transgender community. Some transgender people feel so desperate and trapped in another gender that they need to undergo a transition from one gender to another in an effort to lessen the deleterious factors on their mental health. This may include accessing mental health services, hormone therapies and surgical procedures. Up to December 2012, transgender people received hormone therapy through St. Colmcille's Hospital in Loughlinstown, which is the major centre for endocrinology in Ireland. The patient figure in this regard has tripled since 2006. Currently, 160 transgender people are receiving this therapy. There is anecdotal evidence that some transgender people seek hormone therapy in the UK and other EU countries and that some purchase hormones through the online black market. Hormone treatments have been proven to alleviate stress and anxiety and are a medical necessity. It is vital that individuals are able to access these services in a safe and timely manner.

There is no doubt that this service needs to be expanded. The case for vibrant and healthy services is clear, as the long-term financial effects of the treatment can potentially be cost effective, allowing the person to return to the workplace or school environment, free to be himself or herself, in a society that is growing in awareness and accepting of diversity. Under the instruction of Dr. Philip Crowley, the HSE has made positive steps to develop pathways and provide a service to transgender people and their families. A transgender health working group was developed in 2011. This group consists of members of the HSE, Dr. Crowley, Ms Mullen, Ms Gleeson, Mr. Perry, Mr. Giambrone, myself and a member of GLEN. We appreciate everyone's services.

In 2012, research was carried out to ascertain the level of transgender awareness within the HSE, the statistics on which are interesting and are included in the packs which members have received. Following this, a series of events was arranged in the first half of 2013. As I mentioned earlier, a conference was held in February, to which we invited the president elect of the World Professional Association for Transgender Health. We have since developed and are delivering training to HSE staff and members of other organisations throughout the country who are in touch with transgender people. We are happy to be working in collaboration with Dr. Crowley's office.

TENI's objective is the development of a safe and accessible health service for transgender people. However, serious barriers remain. These can be overcome without huge financial strain. It may only take willingness to engage and collaborate. The key is engagement and collaboration. We have a good relationship with the HSE and welcome that we can meet with and discuss issues with it. Collaboration and engagement is key in this area.

In regard to children and young people, members will be aware from the press conference on Tuesday at which Senator Zappone's Private Members' Bill was launched that there has been an increase in the number of children coming out as transgender. For example, in 2012, TENI was contacted 80 times by families whose children and teenagers were exploring their gender identity. There is currently only one support for families of transgender people. It is called TransParenCI. It is a fantastic group which connects families with others with similar experiences. It was developed 18 months ago and has during that time become one of the biggest transgender family support groups in Europe. It is a positive development.

For some children, access to age-appropriate treatment is a medical necessity. For young people under the age of 16 years who have been diagnosed with gender dysphoria and are supported by family members, it is indicated that treatment with hormone blockers and cross-sex hormones can substantially relieve the negative symptoms of their condition and allow the young transgender person and his or her family to continue with their lives. Unfortunately, these services are not yet available in Ireland. This saddens me.

In some instances, young people go through child and adolescent mental health services, CAMS, and, if lucky, they are referred to the Tavistock clinic in the UK. I was informed three weeks ago that three cases were recently referred to that clinic. In other cases, clinicians are unaware of what actions to take and the child's life is put on hold, often with drastic consequences. Deputy Buttimer will recall that at the conference in February, a parent spoke of how her daughter had attempted suicide on a number of occasions, the last attempt being almost fatal. Luckily, the girl was saved and referred to the programme in the UK. Some parents take their children abroad at substantial cost to them. Others take the initiative and access treatments from overseas or on the Internet, which treatments can be dangerous if the chid is not medically monitored. These drastic measures are taken when the family's primary focus is to keep the child alive until the age of 16, when they can access medical treatment as an adult. This treatment has been researched and proven. It is important it is made available, even if this means experts training others in this area. We have contact with these experts and this can happen. Again, it is a matter of collaboration and engagement.

The medical treatment of young transgender people is often seen as controversial. However, research carried out to date suggests that these treatments and procedures are safe, that hormone blockers are reversible and that psychologically the patient does not suffer further dysphoria. There is clear preliminary data from the EU and US which indicates that young people have positive mental health outcomes following access to this treatment. These supervised treatments have many benefits. The child can develop and comfortably live in the desired gender and ultimately will be able to move on with his or her life and education. As human beings, we perform much better if we can be ourselves.

How can the committee help? As the rates of transgender people coming out are rising throughout the world, Ireland's health service must be competent in addressing the needs of its communities and families. Developing and rolling out training is key to enabling health care workers gain skills and feel confident in this area. As this training becomes widespread, it has the potential to upskill service providers, enabling them to provide a service locally. This can have the benefit of easing the bottleneck that currently exists in the endocrinology unit in St. Colmcille's Hospital. Expanding this service can have enormous benefits for all. In this regard, we would certainly require the collaboration - I apologise for my continued use of the word "collaboration" - of Professor O'Shea and his team. However, this is about more than Dr. O'Shea and his specialist team. Various departments within the HSE need to be involved as, collaboratively, we can provide this service with little impact on the economy.

In the longer term, education is key to decreasing and eradicating transphobia. TENI is engaging with educators in this regard with a view to developing educational tools that explain gender identity to all ages. I recently with a member of St. Patrick's College in regard to the provision of age-appropriate books on this issue to its students. It is hoped the students will have access to these books from next year. Education is the future.

If this issue is addressed holistically, it will certainly contribute to the welfare of the transgender person, and the education and support will contribute to decreasing and eradicating transphobia. I urge the committee to help us to facilitate this process and bring trans-related health care into line with that of other European states.

As I stated earlier, there is no service provision for younger transgender people in Ireland. However, and I will conclude on a positive note as I do not like to leave anything on a negative note, we are addressing this issue at present and there have been talks with CAMS and also with the paediatric endocrinology department of an Irish hospital. I cannot give any confidential information or I would probably be shot. If these talks lead to a reality, Ireland will be in a position to deliver a safe and quality service to transgender people using an informed consent model. There is a long way to go in these talks and that is why I did not mention the hospital, but I am positive that this will happen. Again, it comes down to the engagement and collaboration but I am very confident this will happen. These young people are our future and supporting them to be themselves will reap benefits for this generation and the next. It will allow families and people to move on with their lives. If we remove the stigma from this issue, people will realise there is no threat and there will be no fear of this. We can provide the health care and educate people and just move forward. This matter should not be an issue. We must move forward with this.

I thank the committee again and apologise if I took too much time.