Professor Donal O'Shea:

To reply to Deputy Ó Snodaigh's question about the age of 16, the really important time is puberty, and in the ideal management of this condition that is when treatment would start. In such circumstances, if there is a change of mind, puberty has still begun. In 20% of cases in which there is a diagnosis before puberty there is a change of mind. One needs access to paediatric treatment for this condition, but that is rudimentary in this country. The service we provide for adults is inadequate but the service for children is really minimal. Other people here today are agitating for such a service to be developed. The definition used would be the definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, by the American Psychiatric Association, which is newly revised as of August of this year. This definition separates adults from children and adolescents for the first time. That needs to happen so that treatment pathways can be put in place for both.

On the issue of forced divorce, we have very happily married couples who are expecting children or who have young children and who are very committed to each other. This will force change, because one cannot force divorce. The Constitution will have to be changed to reflect that.

The labelling of the condition as a mental health issue is significant and contentious. The fact that homosexuality was only removed from the DSM in the 1970s is a very good yardstick of how offensive that whole area is and can be. The situation with gender dysphoria is that a lot of medical input is required and that needs to be facilitative rather than a barrier. For a medical condition to access treatment it has to exist as a medical condition. If the condition is taken out of the medical arena completely and one asks the HSE to please treat this thing that does not exist as a condition, the treatment will not be given. The only way we will get traction with the health service is if it is a condition with an internationally recognised treatment pathway which is not adequately provided in this country for adults and is barely being provided at paediatric level. Therefore, we need to do better in the medical sphere. I believe that in 20 years' time we will be talking about the removal of gender from the DSM-5 classification, because it very nearly came out this time. It is in the classification, however, and we will have to work within that system.