Before HM Assistant Coroner Sarah Clarke
13th October 2023

Alice Litman was left feeling ‘hopeless and helpless’ after facing an extremely long wait for gender affirming healthcare, with ‘sporadic’ mental health support, the coroner concluded today as the inquest into her death closed. The coroner said that the most commonly asked question during the inquest had been ‘If not your service, then where should Alice have gone?’, with Alice ‘told that she was on her own until she was able to access the gender affirming healthcare which was potentially years away.’ In a statement following the hearing, Alice’s family said, ‘We will continue to fight for Alice, and for all the young trans people who are still being denied the care they need.’

The coroner confirmed that she will make a prevention of future death report addressing:

• The knowledge and training for those in the mental health setting for managing and offering care to those in the transgender community.
• The delays in access to gender affirming healthcare.
• The lack of provision of mental health care for those waiting for gender affirming treatment.
• The lack of clarity for clinicians who are in place to support young transgender individuals in primary care.
• The lack of clarity for clinicians who are in place to support young transgender individuals in the Mental Health setting.

The report will be sent to the Surrey and Borders NHS Partnership Trust, which was responsible for Alice’s mental health treatment, and to the Gender Identity Clinic (‘GIC’) at the Tavistock. Recognising that tackling the GIC’s waiting list will also require changes at a national level, the coroner will also send the report to NHS England and the Royal College of General Practitioners (‘RCGP’).

Alice Litman, 20, died on 26 May 2022. She had been on the NHS waiting list to receive gender affirming healthcare for 1,023 days at the time of her death. She was referred in August 2019 to the Gender Identity Development Service (‘GIDS’) and transferred to the adult GIC when she turned 18; she never received her first appointment.

Alice was from Surrey, and moved to Brighton a year before her death. She was much loved by her parents, two siblings, broader family and a close knit group of friends. In the family’s pen portrait for the inquest, they described her as a caring and sensitive young woman, who had a knack for making other people feel comfortable and welcome.

In her teens, Alice began to struggle with her mental health. She had been treated for depression and anxiety by Surrey & Borders Child and Adolescent Mental Health Services (‘CAMHS’). She was deemed not to meet the threshold for adult services, however, and a decision was made to discharge her from mental health services when she turned 18 in February 2020.

The inquest heard that Alice did not receive the mental health treatment she wanted and needed, particularly in relation to the distress she experienced as a result of not being able to progress her transition. The coroner concluded today that the mental health support Alice was offered after she turned 18 was ‘quite frankly half-hearted’, with Alice ‘told that she was on her own until she was able to access the gender affirming healthcare which was potentially years away.’

A month before her death, Alice expressed concerns that her hormone treatment was not being managed effectively and said she often felt ‘hopeless and helpless’ and that ‘life is not worth living’, having been on the waiting list for vital gender-affirming care for two and half years ‘with no end in sight’.

The inquest heard evidence of a lack of adequate systems in place to offer gender-affirming healthcare in England, and the coroner concluded that gender-affirming care is ‘underfunded and insufficiently resourced’. If those on the waiting list continue to be seen at the current rate, the inquest heard, someone referred to GIC today would wait twenty years and nine months before being seen. The inquest heard evidence that part of the problem is a lack of clarity about GPs’ role in providing bridging hormone prescriptions to patients on GIC waiting lists, and a lack of training.

The family of Alice Litman said:

‘We are relieved to hear that the coroner will be sending prevention of future deaths reports to NHS England, the Royal College of General Practitioners, the Gender Identity Clinic and Surrey and Borders Partnership NHS Trust, and look forward to reading them in full. It is our hope that these unprecedented reports will help to achieve urgent change.

We can never bring Alice back, but we will keep campaigning to ensure that all trans people are able to live in dignity and receive the healthcare they need and deserve.

The trans healthcare system is not fit for purpose. As the inquest heard, at the current rate that the Gender Identity Clinic is seeing new patients, someone referred today would have to wait twenty years before receiving their first appointment.

We believe that if Alice had been able to access gender-affirming care when she first went to her GP in 2018, she could still be with us today.’

Instead, Alice was left to languish on the GIC waiting list for 1,023 days. A month before she died Alice told her GP:

“I’ve been on the Gender Identity Clinic waitlist for over 2 1/2 years with no end in sight. I need an appointment. I am struggling. I am concerned that I have missed out on vital treatment. I often feel hopeless and helpless and feel life is not worth living.”

Trans people should not have to wait years to access essential care through inaccessible specialist services. We believe most trans healthcare could be provided through primary care. We are asking NHS England to ensure that GPs have the resources, training and guidelines they need to deliver trans healthcare .

The inquest is not the end of our fight for Alice – it is the beginning. We will continue to fight for Alice, and for all the young trans people who are still being denied the care they need.’

Jo Maugham, Executive Director of Good Law Project said:

‘We have been incredibly proud to support Alice’s family throughout this inquest. No family should lose someone they love after being left for too long on a waiting list for healthcare.

This coroner’s conclusions should sound alarm bells around the abysmal state of gender-affirming and mental health care in this country – which are chronically underfunded and being outstripped by demand. Urgent change is needed.

The real problem here is that treatment which should be led by medical expertise is instead led by politics. The victims of this tendency – which leaves medical professionals afraid to treat – are the trans community who do not get the healthcare they need.

We welcome the fact that the Coroner has published her reports to prevent future deaths. Policymakers must take immediate action on the back of the inquest’s findings, so no other families ever have to go through this.’

NOTES TO EDITORS

• For further information, photos, interview requests and to note your interest, please contact press@goodlawproject.org, BindmansLLPPressTeam@bindmans.com or 07907 296156.
• The family are represented by Partner Anna Thwaites and Consultant Helen Fry of Bindmans LLP, and Counsel Sophie Walker of One Pump Court, with support from Good Law Project.
• Others recognised as Interested Persons were Tavistock and Portman NHS Foundation Trust (Gender Identity Development Service and Gender Identity Clinic), Surrey & Borders Partnership NHS Foundation Trust (Child and Adolescent Mental Health Services), and WellBN (Alice’s GP when she died).
• Journalists should refer to the Samaritans Media Guidelines for reporting suicide and self-harm and guidance for reporting on inquests.
• Journalists may also find the Trans Media Watch guidance on reporting on trans people useful.
• Alice’s sister, Kate Litman, previously wrote this opinion piece about her experiences and concerns.