This Week: Susie Green, chief executive of trans-child charity Mermaids

Why she matters: Susie Green’s experience of helping her daughter change genders led her to become one of the most active champions of trans-rights, an issue which is growing in social and political salience and attracting more than its fair share of controversy as a result. She is currently involved in writing care guidelines for prepubescent children as a member of the World Professional Association for Transgender Health.

“I think that people need to remember that they’re just kids… trying to get on and live their lives. And it’s hard enough being a teenager… It feels like kids are being punished for being different rather than being supported.”

This is the fate of too many children transitioning from one gender to another in the UK, according to Mermaids chief executive Susie Green.

When Ms Green began to help her (then) son to transition at the turn of the century, she discovered there was one specialist gender dysphoria clinic in England – run by the Tavistock and Portman Foundation Trust. Nineteen years later – despite the huge increase in public awareness of trans-gender issues – that unit still stands alone and the average referral times to the clinic (assuming you can get one) stands at 20 months.

Hence the birth and expanding role of Mermaids.

Parents, she says are often “blamed” for helping a child transition on the basis that it is what they – and not their son or daughter – really wants

The charity runs a helpline and separate online support groups for parents and young people.

“The main focus is to reduce isolation,” says the charity’s chief executive, “because it’s very lonely being a trans young person [or] parenting a trans child. There’s a lot of prejudice and discrimination that’s aimed at the parents as well as at the young people.”

Parents, she says are often “blamed” for helping a child transition on the basis that it is what they – and not their son or daughter – really wants.

The helpline was launched in the middle of the last decade and, initially, says Ms Green, “it was very, very quiet. Probably about 30, 40 telephone calls in a year, [and] the same number of emails”.

At the start of this decade, she noticed an uptick in the number of calls. Intrigued, she used her skills as an IT manager of the Leeds Citizens’ Advice Bureau to install a call-logging system.

What she discovered was a “massive wake-up call” for the charity – they were answering only 7 per cent of calls.

Ms Green realised Mermaids was “letting hundreds of people down” who had found the considerable courage to take active steps to support their child.

The charity decided it needed to professionalise. It increased its fundraising, took on more call handlers and gave them formal training.

Since 2016, the charity has grown rapidly, taking on more call handlers, setting up physical support groups and providing training for public bodies, such as the NHS, police and schools. In 2018 it secured £500,000 from the National Lottery.

Even the size of the trans-gender population is ill-determined, with existing estimates putting it at between 0.6 and 2.3 per cent of the general population

The Lottery cash will be used to increase the physical support groups to 45 – therefore covering most of the country – and to place the training programme on a more sustainable footing.

The final slug of the funding will be used for research.

There remains a dearth of reliable data about trans-gender issues. Even the size of the trans-gender population is ill-determined, with existing estimates putting it at between 0.6 and 2.3 per cent of the general population.

The research that Mermaids want to contribute to is aimed at determining what good quality interventions look like and how effective they are. Ms Green says they are also very interested in discovering what makes parents want to support their child to transition and how much difference that makes to outcomes.

Screaming headlines

When Ms Green first sought help for her daughter in 2000 she discovered “just one very, very small clinic” at the Tavistock. All the patients were children who were assigned male at birth, but who identified as girls.

At that time, says Ms Green, it was Dutch clinicians who were leading the way in the treatment of trans children. Elsewhere in the world, those who wished to transition had to wait until 18 to begin treatment.

The Dutch doctors began to trial using “puberty blockers” to delay onset of what can be very distressing changes for trans-children. Young people were then given medication which began the physical transition at 16. This is now the model broadly followed by the NHS.

Tavistock is still the only service provider, although it has now opened a second clinic in Leeds. There is no service in Wales.

However, even getting on to the Tavistock’s year and a half waiting list is far from straightforward.

It is the experience of many of those contacting Mermaids that very few GPs know much about gender dysphoria in children. The charity has records of parents and children being sent away after being told that nothing can be done “until you’re 18”.

Many young people with gender dysphoria referred to CAMHS teams by their GPs are sent right back. “This is gender dysphoria, we don’t do gender dysphoria,” is often the message, says the Mermaids chief.

This is strictly accurate - gender dysphoria is no longer classed as a mental health condition, but Ms Green says this is too often a convenient excuse for struggling CAMHS services to offload anxious, depressed and, sometimes, suicidal children.

With CAMHS waiting times as they are, trans-children can find themselves back where they started after a year of wasted effort, says Ms Green.

The Mermaids CEO believes the answer is to replicate “the model that they are pursuing with adult [trans-gender] services”. This involves asking specialist services to concentrate on more complex cases – for example where there is a co-diagnosis of autism. At the same time GPs are being supported to increase their confidence in dealing with more “straightforward” trans-gender issues.

’Fast-tracking transition’

Of course, wanting to transition from one gender to another is not simply a health issue – it is one hotly debated in the media, politics and elsewhere.

In an echo of the debate around LGB issues in the 1980s , Mermaids are among those accused of “promoting” changing gender. Even the Tavistock has been accused of “fast-tracking” young adults who want to transition.

Some very active and high-profile campaigners insist that the increased number of children saying they want to transition is a result of learned behaviour, driven by social media and the “lobbying” of organisations like Mermaids. Government and opposition politicians have been dragged into the debate more than once.

Ms Green says many – including some clinicians – would still believe the right thing to say to a trans child is: “You cannot possibly know [you want to change gender], you’re too young. When you’re in your 20s, maybe we’ll start to think about this as being real.”

Many more people – again including clinicians – just want to pretend the issue does not exist as it frightens and disturbs them, she says.

As an example, she says the Royal College of GPs used to host a resource on caring for trans-children on its website. The resource was produced by the Gender Identity Research and Education Society and included mention of the Mermaids service.

Ms Green says the RCGP wanted the reference removed, but that GIRES refused and then asked for their resource to be taken down.

“I honestly think that there is such a huge amount of controversy about treating trans-children and young people,” she says, “that GPs are scared off. I don’t blame them [when there are] screaming headlines saying the Trans Lobby is pushing [treatment].”

[Addition Monday 8 April] Quite how controversial the approach championed by Mermaid is was illustrated the day after the publication of this interview. The lead story in The Times reported that five clincians had resigned from the Tavistock service because they believe: ”some gay children struggling with their sexuality are being wrongly diagnosed as transgender. The article claimed: ”All five said they believed that transgender charities such as Mermaids were having a “harmful” effect by allegedly promoting transition as a cure-all solution for confused adolescents.” [addition ends] 

The media-set agenda on trans-gender issues means that many transitioning children have an unpleasant time when being treated for unrelated issues.

Too often she says NHS staff are more interested in discussing “what genitals” a trans child has rather than focusing on providing prompt and effective treatment for whatever ails them.

She hopes that in the long run transgender issues will be addressed in the improved training of clinicians.

In the meantime, she urges NHS staff – especially decision makers – to spend time with trans children.

“People’s opinions are being formed by the media – who make an outrage out of something that is just part of a person’s identity. [But] it should be these young people having their voices heard and having their opinions listened to.”

She adds that Mermaids often facilitates meetings between trans children, their parents and those “who are making massive decisions [affecting them] without the knowledge or understanding of what [their] lives are actually like”.

Ms Green concludes: “What we find is when [the decision-makers] actually meet some of these young people and see that they are just kids, it changes their minds.”

Next week: Pollster to prime-ministers since 1997, Ipsos Mori chief executive Ben Page

If there is any political figure you would like me to interview, please email or if you are reading this on the website leave them in the comments box.

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NICE chief executive Sir Andrew Dillon

The Guardian’s Polly Tonybee

Dr Paul Williams MP

Sir Mike Penning MP

Stella Creasy MP

Paul Johnson, director of the Institute of Fiscal Studies

Neil Anderson, director of Migration Watch

Brexit expert Professor Anand Menon

Jeremy Heywood - an appreciation

Resolution Foundation director Torsten Bell

Dr Philippa Whitford MP

Johnny Mercer MP

Sarah Wollaston: part two - the role of the Commons’ health committee

Sarah Wollaston MP, part one

Luciana Berger MP

Taxpayers’ Alliance chief executive John O’Connell

Left-wing futurist Paul Mason

Spectator editor Fraser Nelson