As we progress with the development of high quality care and treatment options in Ireland, our need to continually hone and evolve services becomes clear. Paediatric services, services to families and couples, and adjunct services, such as child and adolescent counselling, family support and speech and language therapy services, to ensure safe and successful transition, are in increasing demand. At Diamond Therapy we continue to align our service with the treatment pathways we have developed with HSE consultants over the past decade, and are committed to providing as comprehensive a service as possible to people with Gender Identity Disorder, their families, and all patients and clients requiring psychological and other services.
On the Treatment of Gender Identity Disorder (GID,302.85)
The usual treatment protocol for this condition is based on the Standards of Care, as published by the World Professional Association for Transgender Health (WPATH) and has been developed in Ireland, with this clinic and Psychiatric and Endocrine Consultants in the Health Services Executive, particularly Dr. James Lucey, and Professor Donal O’Shea.
Diagnosis is based on the criteria as published in the Diagnostic and Statistical Manual, Text Revised version, which was published by the American Psychiatric Association in 1994, and is aligned with the diagnostic criteria of the World Health Organisation’s International Classification of Mental Disorders (ICD-10).
Generally speaking, a diagnosis is made following 2-3 hours of interview, and a concurrent mental status exam is made to determine if there are other mental health issues to address. Another psychiatric diagnosis does not necessarily preclude treatment for GID. Patients discuss their plans and aspirations for full, or part-time, or partial transition, and a care-plan is developed based on patient input, and an assessment of readiness and issues that might effect a successful transition is made, such as family disclosure, acceptance, marital concerns, housing, occupational/professional or other social barriers.
Referrals are made for the medical supervision of hormone treatment, and patients who are undergoing transition with hormone therapy are given medical advice, via HSE consultants, for pre-appointment blood tests and second psychiatric opinions that are required. Speech therapy by a qualified Speech and Language Therapist is now available, and is considered to be a crucially important component for successful transition. Surgeries can be accessed privately, if preferred, and Gender Reassignment Surgery (GRS) can be accessed via the European E112 payment for Treatments Abroad scheme, under the HSE. These referrals generally follow a two-year period of successful transition.
Therapy and counselling services are also available to spouses, partners, and the children of people with GID. Additionally, we are now providing services to children with the condition, and their families, to help develop planning and give support.
Alternatives to medically-based transition
Sometimes, medical treatment is not the best plan for all patients with GID. Psychosocial, family and marital issues, age, and patient preference have created the need for the development of treatment plans that cater to part-time, partial, and non-medical expression of gender variance. Over the past decade, we have been finding ways that satisfy, at least partially, the patient's need to express their ‘alter-gender’ without upsetting or usurping family or partners, and retaining social discretion or professional privacy.
All of our treatment plans are individually developed, with the patient, and sometimes their loved ones, as partners in the process, using resources that are available to the fullest advantage. A diagnosis of GID does not mean that one must therefore undergo full transition, which may not suit all patients or situations.