Mental Health · Psychology

The Tavistock Clinic: (Paediatric) Gender identity development service (GIDS) and Mermaids

The Gender Identity Development Service (GIDS) is for children and young people, and their families, who experience difficulties in the development of their gender identity. It’s a national specialised service, based in London and Leeds, and is the only one of its kind in Great Britain.

A number of serious concerns about the service have arisen over past years, and GIDS has been the subject of an inquiry led by Dr Hilary Cass. Her draft report has now become available. In late April 2022 the Director and Chair of the Tavistock Clinic, from where GIDS operates, said that they are ‘disappointed’ at the gender-critical position of some parents.

The repercussions of the enquiry are likely to be important for future Child and Adolescent Mental Health Services (CAMHS).

Some background: (19 Sept. 2022)


Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice (2022)






Trans children turn to dark web for puberty blockers claims Mermaids charity

Embattled organisation produces report assessing impact of the landmark Bell versus Tavistock court case in 2020 (3 Dec 2022)


Sweden cuts ties with leading trans health group over guidelines for child sex changes

Sweden has broken ranks with WPATH, announcing that gender clinics will no longer attempt experimental sex changes on under-18s but will instead offer “psychological support to help youth live with the healthy body they were born with.” (20 Dec 2022) 


Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice
In the last decade, there has been a rapid increase in the numbers of young people with gender dysphoria (GD youth) presenting to health services (Kaltiala et al., 2020). There has also been a marked change in the treatment approach. The previous “common practice” of providing psychosocial care only to those under 18 or 21 years (Smith et al., 2001) has largely been replaced by the gender affirmative treatment approach (GAT), which for adolescents includes hormonal and surgical interventions (Coleman et al., 2022). However, as a recent review concluded, evidence on the appropriate management of youth with gender incongruence and dysphoria is inconclusive and has major knowledge gaps (Cass, 2022). Previous papers have discussed that the weaknesses of the studies investigating the efficacy of GAT for GD youth mean they are at high risk of bias and confounding and, thus, provide very low certainty evidence (Clayton, 2022ab; Levine et al., 2022). To date, however, there has been little discussion of the inability of these studies to differentiate specific treatment effects from placebo effects. Of note, the term “placebo effect” is no longer used to just simply refer to the clinical response following inert medication; rather, it describes the beneficial effects attributable to the brain-mind responses evoked by the treatment context rather than the specific intervention (Wager & Atlas, 2015). This Letter argues that the current treatment approach for GD youth presents a perfect storm environment for the placebo effect. This raises complex clinical and research issues that require attention and debate.

Mermaids trustee quits over paedophile-group links  (4 October 2022)


NHS Trust taking over trans children care from Tavistock ‘being trained by Mermaids’

The Telegraph has learned the charity, currently under investigation, will provide sessions for South London and Maudsley staff this month (13 January 2023)


The Tavistock:  Inside the gender clinic

In a few months, the Tavistock – the only NHS clinic in England and Wales which treats children suffering from gender dysphoria – will close. This is the story of what happened: (6 episodes)


Interim Report – Cass Review (of Tavistock paediatrcic services)

Interim report


The Cass Review has submitted an interim report to NHS England, which sets out our work to date, what has been learnt so far and the approach going forward. The report does not set out final recommendations at this stage.

At present there is a single specialist service providing gender identity services for children and young people – the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust.

In recent years GIDS has experienced a significant increase in referrals which has contributed to long waiting lists and growing concern about how the NHS should most appropriately assess, diagnose and care for this population of children and young people.

Key points – context

  • The rapid increase in the number of children requiring support and the complex case-mix means that the current clinical model, with a single national provider, is not sustainable in the longer term. 
  •  We need to know more about the population being referred and outcomes. There has not been routine and consistent data collection, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.  
  •  There is lack of consensus and open discussion about the nature of gender dysphoria and therefore about the appropriate clinical response. 
  •  Because the specialist service has evolved rapidly and organically in response to demand, the clinical approach and overall service design has not been subjected to some of the normal quality controls that are typically applied when new or innovative treatments are introduced.   

Key points – moving forward

  • Children and young people with gender incongruence or dysphoria must receive the same standards of clinical care, assessment and treatment as every other child or young person accessing health services.  
  • The care of this group of children and young people is everyone’s business. Our initial work indicates that clinicians at all levels feel they have the transferable skills and commitment to support these children and young people, but there needs to be agreement and guidance about the appropriate clinical assessment process that should take place at primary, secondary and tertiary level, underpinned by better data and evidence.  
  • Addressing the challenges will require service transformation, with support offered at different levels of the health service.
  • The Review’s research programme will not just build the evidence base in the UK but will also contribute to the global evidence base, meaning that young people, their families, carers and the clinicians supporting them can make more informed decisions about the right path for them.    

A fundamentally different service model is needed which is more in line with other paediatric provision, to provide timely and appropriate care for children and young people needing support around their gender identity. This must include support for any other clinical presentations that they may have.

It is essential that these children and young people can access the same level of psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service.

The Review team will work with NHS England, providers and the broader stakeholder community to further define the service model and workforce implications.

At this stage the Review is not able to provide advice on the use of hormone treatments due to gaps in the evidence base. Recommendations will be developed as our research programme progresses.