The Equality and Human Rights Commission (the Commission) Trans
Research Review published in Autumn 200913 highlights persistent
discrimination against trans people and inadequate service delivery,
both in gender reassignment treatment and other areas of health and
social care.

Accessing gender reassignment treatment
The 1999 Court of Appeal ruling in the case of R v North West
Lancashire Health Authority ex pA, D and G14 recognised that gender
reassignment is the appropriate medical response to Gender Identity
Disorder and that it would be unlawful for Health Authorities to operate
anything that amounts to a blanket ban on funding in such cases. The
gender equality duty also implies that it is unlawful for public authorities
such as Primary Care Trusts in England and Health Boards in Wales
and Scotland to operate blanket bans based solely on administrative or
financial criteria in such cir***stances.

The Human Rights Act 1998 imposed some ‘positive obligations’ on
public bodies to take proactive steps to secure people’s human rights.
Public health and social care services need to ensure that they treat all
their service users, regardless of their gender identity or what treatment
they are receiving, fairly and equally, with dignity and respect.
Yet the Equalities Review research published in 2007 found that nearly
one third of trans people surveyed had experienced problems obtaining
funding for gender reassignment treatment. Nearly one third of trans
people were refused access to even the initial assessment for gender
reassignment treatment or were made to wait longer than six months
after referral by their GP.
Furthermore, people intending to undergo or currently undergoing
gender reassignment continue to experience difficulties in accessing fair,
timely and high-quality medical assistance including counselling,
hormone therapies and surgeries to support them achieving an effective
and smooth integration into society in their new gender role.

Research carried out in Brighton and published in 2008 found that:
‘Those who identify as trans are significantly more likely to have
difficulties in the last five years with significant emotional distress,
depression, anxiety, isolation, anger management, insomnia, fears

and phobias, panic attacks, addictions and dependencies, and
suicidal thoughts… Those who identify as trans are twice as likely
to have had serious thoughts of suicide, more than three times as
likely to have attempted suicide in the past five years and over five
times as likely to have attempted suicide in the past 12 months as
non-trans people.

Although NHS Gender Identity Clinics are generally run within the remit
of NHS Mental Health Services, they are not intended to provide general
mental health support to trans people.16 Trans people experiencing
mental health problems need to be able to access mainstream mental
health services on the same basis as any other person. It is important
for general health and social care providers to ensure that their policies
and practices with regards to services such as community psychiatric
nursing care, psychiatric in-patient wards, occupational therapy,
voluntary sector mental health drop-in centres, and social work services
do not discriminate against trans people or leave them exposed to
harassment from staff or other service users.
Service provider attitudes and awareness
The research conducted for the Equalities Review in 200717 found that
many medical professionals clearly still have insufficient knowledge
about trans people and their health needs, whether mainstream or
related to gender reassignment. Indeed, service provider knowledge
and/or attitudes can be very poor. The survey found in particular that:
• Although 79% (482 of 599) of General Practitioners (GPs) were
willing to help,
of these over 60% lacked appropriate information (365 of 599).
• 17% of trans respondents had experience with a doctor or nurse who
did not approve of gender reassignment, and hence refused services.
• Only 6% of GPs were sufficiently knowledgeable, able and willing
to help.

http://www.equalityhumanrights.com/uploaded_files/PSD/psd_trans_guidance.pdf