Pathway to care – we think…

The infographic below is a first attempt to map the pathway to care for transgender/transsexual Jersey residents seeking to transition. It is based on personal testimonies of islanders who have transitioned and, due to the confusing nature of the system at present, may not match your experience. Please email us if you think you can contribute to our findings.

Apart from cost, the main difference between the public and private routes to care is choice of practitioner and speed. There are set procedures that the public system have to follow when treating trans* patients that include statutory waiting times where the patient must live as their preferred gender before being permitted hormone therapy and/or surgery. These waiting times, largely, fall away when going the private route.

Trans* Jersey is working to clarify the pathway below with the States of Jersey Health and Social Services Department. The question of funding is particularly unclear.

Video 16 May, 201416 May, 2014 Trans* Jersey

Intersex and Identity

For the first part of the show, Dr Sharon Preves, sociologist and professor, discussed her research of intersex individuals. Sharon first defined terms, such as “intersex,” “hermaphrodite,” and “transgender,” then explained how and why she became involved in this research. Sharon next explained the cause for negative stigma against intersex individuals, including the religious views of people who do not fit easily into the male/female binary. Sharon noted the strong drive that society has to pigeonhole everyone – even fetuses – into one of two genders. She discussed the evolution of outlying conditions in Western civilization: from sin, to crime, to medicalisation. Sharon then explained the excessive intrusion of the medical world and its treatment of intersexuality as an emergency requiring “correction”.

During the second half of the show, Sharon Preves, professor at Hamline University, further detailed the medicalisation of conditions that do not, normally, require medical intervention, including intersex infants and childbirth itself. Sharon compared the unnecessary interventions into intersexed individuals bodies with circumcision, and she then discussed the emotional ramifications on the patients. Many felt guilt, shame, and even fear. Some grew up convinced they had been born with a disease so terrible that no one – not even their parents or doctors – would discuss it openly. Sharon next cited recent gains in the rights of those born intersexed, and listed off ways they have found healing, such as through support groups. Sharon also provided the example of an intersex teenager who was instructed to pray that she become fully female. Sharon concluded by offering several resources, including her own book, “Intersex and Identity”.

James Zimmerman hosted.Two part interview, recorded 5/2/2013.

Minnesota Atheists practices positive, inclusive, active, friendly neighborhood atheism in order to:

– Provide a community for atheists
– Educate the public about atheism
– Promote separation of state and church

http://www.mnatheists.org/

Video 16 May, 2014 Trans* Jersey

How to be a trans* ally

Video from the “Are you an ALLY?” campaign for Health Equity at Mount Sinai Hospital in Canada: http://www.mountsinai.on.ca/about_us/… Explains how you can help trans* individuals when you encounter them.

15 May, 2014 Trans* Jersey

Summary of UK trans* issues

The following is taken from a paper produced in May 2014 by the UK charity, GIRES. It is a useful summary of the issues facing trans* citizens and the groups working with them for equality.

Introduction

The numbers of transgender people presenting for medical treatment is increasing by 20% pa. This figure rises to 50% for young people. EHRC estimates that 1% of the population fall under the protected characteristic of gender reassignment.

Transgender people are the victims of unequal treatment under the law. This sets a dreadful example and fuels the discriminatory and sometimes violent and abusive treatment experienced by many trans people.

The current government has chosen to ignore a growing cohort of younger people who do not identify with the gender binary. Many such people have no protection under the 2010 Equality Act and have no mechanism to get appropriate ID. In effect they are being excluded from Society.

Surely in 2015 equality and enjoyment of full Human Rights shouldbe an entitlement of all?

A course of action is requested to achieve the following end state:

(a) having no legislation permitting discrimination on the grounds of gender identity or non gender binary identification;

(b) truly equal marriage;

(d) education for younger people to eliminate prejudice in the longer term; and

(e) new medical treatment models to cope with the rapidly increasing numbers presenting for treatment.

Government must come to realise that people cannot be categorised into neat boxes and its obsession in trying to do so is making life very difficult for many!

A summary of requested actions is given below. [More detail on each section can be found in separate posts]:

1. Legislative revisions [More detail on this can be found here]

Equality Act 2010: Remove any rights to legally discriminate against transgender people. Grant protections to those who do not fit into the gender binary.

Gender Recognition Act 2004: Trans people find the process of having their assertions of gender incongruence checked for truth by the Gender Recognition Panel a degrading and patronising (and also expensive and protracted) process. The Act was introduced to address the lack of same sex marriage in the UK and is no longer relevant, and indeed divisive. Given that gender related discrimination is no longer permitted in the UK, a legal change of gender on birth certificates should be a self driven administrative process.

Marriage (Same Sex Couples) Act 2013: The Spousal Veto must be removed if this remains in the Act when the trans marriage regulations are passed later in 2014. The marriages of couples who were forced to annul and subsequently formed civil partnerships should be reinstated. Government assertions “that the past cannot be rewritten” are hollow given that birth certificates, and soon marriage certificates, can now be altered.

Matrimonial Causes Act 1973: Section 12(h) (non disclosure of gender history) must be withdrawn. Under this provision trans people are singled out for treatment not applied to any other group. Furthermore, as one does not have to disclose (for example) that one is a convicted murderer or married to another) before having sex, why can one be imprisoned for not doing so if one has a trans history?

Application of EU law to pension claimants: Despite very clear and well established superior European Court of Justice case law, the Department of Work and Pensions, supported by some but not all Courts, continues to act unlawfully towards some transgender pension claimants.

2. Non gender binary issues [More detail on this can be found here]

Marriage laws: Gendered language in ceremonies should be optional.

Passports: The introduction of the X marker on passports is long overdue. The conclusion of a recent Passport Office report on this topic was that there is no demand for X markers contradicted the evidence it received.

Birth Certificates: As part of the new provisions following the Gender Recognition Act a mechanism should be introduced to allow the sex classification to be removed or changed or an “X” category added.GIRES encourages direct communication with the appropriate communities.

3. Education [More detail on this can be found here]

It is the experience of GIRES that many in government do not understand the difference between sexual orientation and gender identity. This is vividly demonstrated by married trans people and their spouses “being shoehorned into arrangements for gay and lesbian people” (evidence: Commons Committee Stage, Same Sex Marriage Bill). However, the route to combating transphobia longer term is to introduce awareness training on diversity, early in the education process, in schools.

4. Medical treatment of trans people [More detail on this can be found here]

Despite some recent progress in improved treatment protocols, the growing numbers presenting for medical help are now overwhelming the specialist clinics. Although gender dysphoria is no longer accepted as a psychiatric condition, treatment generally remains under the control of specialist clinics led by psychiatrists. Inappropriate treatment and increasing delays are harming transgender people. New treatment models must be implemented to ensure timely and flexible treatment packages that make best use of the funds available.

Trans* Jersey’s response to the proposals in GIRES’ report

Because so much of Jersey’s transgender and transsexual population’s experience is as a result of having treatment in the UK or acquiring their gender recognition certificate from the UK, these issues affect us, too. Trans* Jersey, therefore, wholly supports the aims and proposals of GIRES and the other trans* organisations working to reform the law in the UK.

To find out more about how Jersey trans* individuals are affected by each of the four proposals listed above, click on the links to more detail where we outline the proposed change in greater depth and explain how we would like to see the States of Jersey tackle these issues.

15 May, 2014 Trans* Jersey

Legislative revisions

Equality Act 2010: Jersey is addressing the provisions of this law with its own anti-discrimination legislation. You can find out more about the public consultation process here.

Gender Recognition Act 2004: This Act directly affects trans islanders who wish to apply to the UK for their gender recognition certificate (GRC). Although Jersey has it own Gender Recognition (Jersey) Law 2010, it merely provides for a GRC from another jurisdiction to be registered in the Royal Court. You can find out more about this law here.

Trans* Jersey supports the calls to simplify the process of acquiring a GRC and to retain the protections afforded to trans individuals in possession of a GRC.

Marriage (Same Sex Couples) Act 2013: The Spousal Veto is the most pressing issue raised by the new legislation in England and Wales, and more information can be found about it here.

The Spousal Veto does not exist within Scotland’s legislation and Trans* Jersey are therefore advocating that, when Jersey brings in its own version of the Marriage (Same Sex Couples) Act, it follows the example of Scottish law.

Matrimonial Causes Act 1973: Under Section 12(h) (non disclosure of gender history) of this Act, a marriage can be voided on the grounds that the respondent is a person whose gender at the time of the marriage had become their acquired gender under the Gender Recognition Act 2004. The Act, however, does not state whether a marriage could be voided on the grounds that the spouse is transgender but not in possession of a GRC. There is, therefore, a discrepancy between the way that the law treats trans individuals who hold a GRC and those who do not.

Jersey has followed the UK with the Matrimonial Causes (Jersey) Law 1949, which has similar provisions to the above in paragraphs 18(h) and 18(i). Trans* Jersey would like to see these clauses removed from Jersey law.

Application of EU law to pension claimants: GIRES explains this issue as follows:

Trans women who have undergone gender reassignment surgery qualify for a Category A retirement pension under the direct effect of European Union Directive 79/7. Well established European Court of Justice (ECJ) case law indicates that once direct effect is established, it cannot be removed by a national law that introduces more burdensome conditions than in the Directive. The direct effect of Directive 79/7 has been set aside by the Department for Work and Pensions (DWP), which will only award a pension at the female pension age if the applicant holds a GRC.

Alas, for married applicants, they must currently divorce before they can receive GRC. This makes the award of a pension dependent on marital status and this is forbidden (on any grounds whatsoever) under Article 4 of the aforementioned Directive. Tribunals are unaware of their legal duty to enforce EU law and have little understanding of how EU law interacts with national law in matters of shared competence. It has not been appreciated that direct effect is by default, a part of national law and must be enforced.

Trans people are not being treated according to the law. Also, DWP is using procedural “initiatives” to delay Tribunal cases to deny justice. One such case had an appeal initiated over three years ago, has been postponed 6 times and “stayed” twice, was heard at the First-tier Tribunal nearly two years ago and has still not delivered a judgment.

Existing law should be enforced. The law firm dealing with such claims will be prepared to brief EHRC on the specific case law that has been set aside. A Judicial Review is being planned to address confidentiality issues related to trans service users of the DWP. A further case is being planned to address the use of domestic law to limit the rights to pensions awarded under EU law. The principle must be established that the law applies to trans people.

Trans* Jersey is currently undertaking research into how trans islanders are being treated with regard to pension provisions.

Trans* Jersey would also add into the legislative areas of concern for trans* people the following:

Sexual Offences Act 2003: Under Section 76 of this Act, a trans* individual can be prosecuted for obtaining sexual intimacy by fraud if they do not first declare their trans* history before intimacy occurs. The case of Chris Wilson is one such example and is explained in more detail here. It should be noted that there is no requirement for murderers, people with a history of domestic violence, soldiers with genitals that have been mutilated in the line of duty, bankrupts, etc to disclose their history before intimacy.

This is a nasty little “gotcha” that Jersey trans* people need to be aware of when dating in the UK. There is no equivalent law in Jersey.

15 May, 2014 Trans* Jersey

Non gender binary issues

Trans* Jersey supports the proposal that gendered language in marriage ceremonies should be optional and that an X marker on passports and birth certificates should be introduced. Both these issues are most important for genderqueer, androgynous, bigender and intersex individuals.

The UK charity GIRES offers further explanation of this issue as follows:

Those that are outside the gender binary are not protected under ‘gender reassignment’ as they do not intend to undergo gender reassignment or have any medical treatment.

It is accepted that those with gender dysphoria, who wish to change their social gender role on the basis on non identification with the assigned gender at birth, can do so. Those that do not identify with the birth recorded gender (or the alternative gender) and have no wish to adopt the opposite gender role have no mechanism either to gain protection under the 2010 Equality Act or obtain appropriate ID. Their often ambiguous physical appearance can cause issues when travelling. Passports can be issued to a transitioning person in their non birth recorded gender even without GRC. The Passport Office has the option of the marker “X” to denote other than male or female but refuses to use this despite it being an international convention. Alas a recent Passport Office report ignored the evidence and determined that there was no call for the X marker. The non gendered community are thus excluded from full civil participation.

The 2010 Equality Act “gender reassignment” characteristic should be widened to include those outside the gender binary. The 2004 GRA should be broadened to include an assessment of applicants who wish to have a Birth Certificate reissued with an X (or sex not recorded). Passports should be made available with the X marker irrespective of the Birth Certificate to ensure consistent treatment of all those with “gender dysphoria”.

Trans* Jersey will be responding to the States of Jersey’s consultation on the next phase of the island’s anti-discrimination legislation to ensure that trans* individuals are not excluded from the protections offered by Jersey’s equivalent of the UK’s Equality Act.

Trans* Jersey is currently undertaking research to find out whether Jersey’s passport office have the option to use the X marker as the UK passport office does, and whether it also refuses to do so.

15 May, 2014 Trans* Jersey

Education

GIRES reports that: Schools do not have proper advice on how to deal with and eliminate transphobic bullying and generally, this is not being addressed. Trans children are suffering as a result. In the new March 2014 Department of Education Guidance into Preventing and Tackling Bullying gender reassignment is mentioned but not as often as other protected categories.

Trans people in schools (pupils, staff, children of trans parents) are more likely to suffer from bullying than any other group.

The Department for Education should ensure that all schools are provided with advice on preventative and responsive action and fully informed about the information and training provided by GIRES, Mermaids and Gendered Intelligence.

Trans* Jersey echoes this call with the same request to the States of Jersey’s Department for Education, Sport and Culture to use the resources provided by trans* groups to educate. In preparation for the new anti-discrimination legislation being passed in Jersey next year, Trans* Jersey is preparing a series of courses aimed at employers, employees, teachers and students dealing with issues affecting trans* individuals.

According to GIRES in the UK, the current Department for Education curriculum for sex and relationship education (published in 2000 and referred to in a Standard Note to MPs earlier this year) includes references to sexual orientation but not to gender reassignment.Gender variant young people are thus denied equal treatment.

Trans* Jersey is currently researching the States of Jersey’s sex education curriculum.

Education about trans* issues is especially important for those working in the public sector where employees often act as gatekeepers to services that trans* individuals need to access, such as the hospital, passport office, parish hall and social security.

GIRES cites this example of where a perceived lack of education about and empathy with trans* issues is a barrier to reporting and prosecuting hate crimes:

The main issue is underreporting of transphobic hate crime due to a fear on the part of trans victims that the Police and other agencies of the Criminal Justice System will not take them seriously. Trans witnesses also fear being “outed” in Court. Hopefully we shall see some improvement following the publication of the updated the CPS Trans Management Guidance authored by GIRES and the proposed revision of the Victims Code.

Trans* Jersey firmly believes in the power of education to change people’s attitudes to and treatment of trans* individuals.

15 May, 2014 Trans* Jersey

Medical treatment of trans* people

Because there are no specialist gender healthcare professionals in Jersey, all trans* islanders have to go abroad for treatment. Most will, at least initially, go to the UK. Therefore, any issues that trans* organisations have with the UK healthcare system are shared by Jersey trans* individuals.

In addition to producing a report on the health of trans* individuals, GIRES also identifies three main areas of concern:

Multiple referral for treatment

Current treatment protocols often require two referrals before cross sex hormones, or chest reconstruction, or genital surgery, etc are authorised. This causes delays. No other medical treatment requires two referrals so why are trans people singled out for a “special” treatment protocol.

Refusal to treat

If a trans person has been treated for gender dysphoria in the private system or overseas, that person’s treatment on the NHS may be delayed. No other such patient is refused treatment on the NHS for any other condition.

Health providers must be challenged to provide the equality analysis that justifies treating trans people in a different manner from other service users.

Delays in receiving treatment for young people

A young trans person can benefit hugely from an early medical intervention to ensure that the damage done, both physically and psychologically, from an inappropriate puberty can be minimised, where there is a clear clinical need established.

Delaying treatment for young people can have a disproportionate impact. A delay of (for example) three years in treating a 30 year old gender dysphoric person will not significantly change the physical outcome on the transition as the individual will have already developed adult sexual characteristics. However, for the 11 year old, the situation is completely different. However, both patients will suffer psychological stress due to the delay.

Again, Health providers must be challenged to provide the equality analysis that justifies treating trans people in a different manner from other service users.

As we have stated elsewhere, it should be noted that Jersey trans* people can avoid some or all of the above problems if they have the resources to navigate the system privately or semi-privately. In which case, they may not find the above to be an issue in their transition.

13 May, 2014 Trans* Jersey

Press release: 13 May 2014

A new group offering support and information to transgender, transsexual, androgynous, genderqueer, bigender and intersex islanders in Jersey is starting up.

Trans* Jersey is the idea of the Jersey novelist, Vic Tanner Davy, and grew from his own experience of transitioning in Jersey and the need to respond to the States of Jersey’s consultation paper on sex discrimination legislation, the next phase in the island’s anti-discrimination laws.

(Note: “Trans*” with an asterisk encompasses transsexual, transgender, androgynous, intersex, genderqueer and bigender people, whereas “trans” only refers to transgender and transssexual people.)

The transgender population in Jersey is very small. It is estimated that about 2-5% of any given population suffers from some degree of gender dysphoria and, of them, only 1 in 12,000 natal males and 1 in 34,000 natal females will transition, although these numbers are increasing. This equates to a population in Jersey of about 2,000 to 5,000 people who might consider themselves androgynous, genderqueer or bigender and only a handful of transgender/transsexual people (i.e. those who have undergone gender reassignment), of which Mr Davy is one.

Because of the size of the population affected by trans* issues, there is very little support on the island for trans* individuals. Anyone wishing to transition has to go to the UK for the specialist treatment required. Trans* Jersey seeks to bridge that gap by providing information about the process of transitioning for trans* islanders and their healthcare professionals.

“At the moment, Jersey’s trans* population has no means to come together to share ideas about measures that directly affect them. As well as providing support for our community, Trans* Jersey is a way for us to get together online, through a blog, email and Twitter, to discuss issues that are important to us, like the States’ consultation paper on the next phase of the anti-discrimination law,” explains Mr Davy. “Anti-discrimination legislation is the first issue that Trans* Jersey is tackling but there are likely to be more coming up. Equal marriage, which affects trans* people too, is one such issue that is pressing. The UK is currently undertaking a review of its Equality Act and Gender Recognition Act in response to trans* organisations in the UK who have found a number of problems with the legislation. Trans* Jersey is working with GIRES, the UK charity, to try to ensure that Jersey’s new legislation doesn’t repeat the mistakes that the UK are currently seeking to put right.”

Trans* Jersey would like to hear from any trans* islanders before 31 May 2014 when the States of Jersey consultation closes. If you are interested in getting involved or learning more about Trans* Jersey, please email admin@transjersey.org or visit the blog www.transjersey.org or follow @transjersey on Twitter. Trans* Jersey is aware that not all transgender individuals wish to be open about their gender status and therefore all correspondence will be treated in the strictest confidence.