Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank the Senator for raising this important issue for transgender persons in Ireland. I recognise the deficits in the service provision to the transgender community and the unprecedented increase in the demand for services, particularly among children and adolescents. To address this, the HSE has developed a model of care for transgender children, adolescents and adults. The model was developed in consultation with the key treating clinicians, planners, policy-makers, advocates and service users. The model outlines the key services required to address the needs of the transgender population, including children and adolescents. It builds on the current service provision and identifies emerging service demand. It also draws on evidence-based international best practice.

I understand actions are under way to resource and support health care services at hospital, community and primary care levels in order to develop a national service for adults, adolescents and children in the transgender community. Eight key posts will be recruited in 2018 for adult services, including a consultant endocrinologist, a consultant psychiatrist, two senior psychologists, a clinical nurse specialist, a social worker and a speech and language therapist. A further three key posts in child and adolescent service will be filled, including a consultant endocrinologist, a senior psychologist and a clinical nurse specialist. These actions will address the waiting times and immediate service needs of children, adolescents and adults in transition.

The HSE, across mental health, acute hospitals, primary care and social inclusion programmes, is committed to building services for the transgender community in accordance with international best practice. The issues raised by the Senator are very important if she thinks the model being used is not the accurate or correct one. We have had that debate in the disability sector for many years. People were trying to use the medical model instead of a social care model to deal with people with disabilities. I would be interested to hear the Senator develop that point.

An undertaken has been given to building services for the transgender community in accordance with best international practice.Further work will be undertaken to identify additional priorities to be developed and resourced in 2018. In addition, the Health Service Executive has supported Transgender Equality Network Ireland, the national advocacy service for the transgender community. It provides funding for the posts of training and education manager and family support worker. These posts have provided education and training for staff across the HSE. Furthermore, the HSE has supported a training programme for speech and language therapists to develop the skills to support transgender people.

Transgender-specific guidelines have been developed by the World Professional Association for Transgender Health and the Endocrine Society. The guidelines recommend a comprehensive multi-disciplinary psycho-social assessment prior to commencement of hormone therapy by endocrinology services. They highlight several criteria which must be met prior to referral for hormonal intervention. It is important that co-occurring conditions be identified and addressed, including mental health difficulties, self-harming behaviour, suicidality and autistic spectrum disorders. Accessing supports to manage co-occurring difficulties can impact on the response to medical transition. I believe informed consent is essential whereby the benefits and risks of hormone treatment and surgery are discussed with individuals seeking these interventions. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on the use of a multi-disciplinary psycho-social assessment, the fulfilment of criteria for hormones and ongoing psychological support throughout the process.

The Department of Health and the HSE are committed to providing health care services to meet the complex needs of transgender people and ensuring adequate levels of knowledge and awareness among health professionals to meet these needs.