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21 September 2023

Alice Litman inquest: coroner finds that gender-affirming care is ‘underfunded and insufficiently resourced’

5 mins

Before HM Coroner Sarah Clarke
18 – 20 September 2023

Gender-affirming care services are underfunded and insufficiently resourced for the level of need that society now presents, an inquest into the death of a young transgender woman in Brighton has found today. The inquest heard that people entering the waiting list today would face a more-than 20-year wait to receive gender-affirming care unless the system changes. 

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 and 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 close-knit group of friends. In the family’s pen portrait to 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 under Surrey and Borders Partnership NHS Foundation Trust’s Child and Adolescent Mental Health Services (CAMHS). She was deemed not to meet the threshold for adult services, and a decision was made to discharge her from mental health services when she turned 18 in February 2020.

The inquest heard that although Alice was offered some mental health support, she did not receive the treatment she wanted and needed. 

A month before her death, Alice sent an e-consult form to her GP indicating that she was having thoughts of self-harm and often felt ‘hopeless and helpless’ and that life isn’t worth living.

Alice had been referred to the Gender Identity Development Service (GIDS) in August 2019, and was subsequently transferred to the Tavistock Gender Identity Clinic (GIC) after she turned 18. But she remained on the waiting list, and never received her first appointment. 

The inquest heard evidence of a lack of adequate systems in place to offer gender-affirming healthcare in England. If those on the waiting list continue to be seen at the current rate, the inquest heard, someone referred to GIC today would take twenty years and nine months before being seen. In other words, for someone to receive treatment by the GIC when they turned 18, they would have to be referred ‘in utero’. 

The coroner will deliver her full written findings in two weeks. She has indicated that she will be making reports to prevent future deaths, concerning: 

  • How a person is managed between adolescent and adult mental health care
  • Knowledge and training for those offering support to those in the trans community
  • Access to gender-affirming healthcare
  • Lack of access to mental health care for those receiving gender-affirming care
The family of Alice Litman said:

We are grateful that the coroner has agreed that the conditions of Alice’s death warrant a report to prevent future deaths. We look forward to reading her findings in two weeks’ time.

The trans healthcare system is not fit for purpose. As the inquest heard, people seeking gender-affirming care today face a twenty-year long wait for the care they want and need to live a happy life. This can’t continue – things will only get worse if they don’t change. 

Alice’s struggles are best summarised in her own words to her GP a month before she died. ‘I’ve been on the Gender Identity Clinic waitlist for over two and a half 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.’

Alice was beautiful and she made our lives better but we believe she was failed by those tasked with her care. Trans people should be able to access gender-affirming care when they need it. But as the inquest heard about Alice’s experience, trans people encounter barriers every step of the way. 

We all deserve to live in dignity with access to the healthcare we need. Accessing this care should not be a battle – it is a right.

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.

We are proud to support Alice’s family in their fight for justice for their beloved sister and daughter. Their campaign for the accessibility of trans healthcare to be recognised as a factor in Alice’s death is incredibly brave and of vital importance.

The evidence we have heard over the past three days has highlighted clear failures in the way gender-affirming and mental health care is set up and delivered in this country.

In recent years, Good Law Project has been working to challenge the extreme waiting times faced by transgender people seeking help from NHS England in a case that reached the Court of Appeal, before it was unfortunately dismissed.

During this time, we have worked with a number of individuals facing unfathomably long waits for vital healthcare services – and sadly, waiting times continue to get longer and longer.

We firmly believe this cannot go on unchecked. Alice’s case has again pushed this issue into the spotlight and we hope this will act as a wake up call for policymakers to urgently improve access to gender-affirming healthcare in England.

The family are represented by partner Anna Thwaites and consultant Helen Fry of Bindmans LLP, and Sophie Walker of One Pump Court, with support from Good Law Project

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