The Cass report – An empty gesture
After four years work, the Cass report on gender identity services for children and young people emerged last week. And it was pretty damming: according to the Guardian it ‘laid bare the devastating scale of NHS failures of a vulnerable group of children and young people, buoyed by adult activists bullying anyone who dared question a treatment model so clearly based on ideology rather than evidence’.[1] That’s the Guardian! As you’d expect, views expressed in papers like the Telegraph and Spectator were even stronger.
And the main criticism Cass made of the field was that it had been dominated by an ideological, toxic debate in a more or less complete absence of meaningful research and reliable evidence: ‘This is an area of remarkably weak evidence…Results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress’.[2] Absolutely, bang on, she’s right, thank God, someone’s said it.
Which is why it’s so intensely disappointing that the main thrust of her recommendations was to kick the can over to mainstream mental healthcare, as if that was any different. It isn’t; the criticisms she makes of gender identity services belong equally to the mental health services she wants to pass the buck to. Where does she think the self-serving drivel she’s identified in gender identity came from and was championed if not mainstream mental health services?
This is what she had to say: ‘The systematic review of psychosocial interventions found that the low quality of the studies, the poor reporting of the intervention details, and the wide variation in the types of interventions investigated, meant it was not possible to determine how effective different interventions were for children and young people experiencing gender distress. Despite this, we know that many psychological therapies have a good evidence base for the treatment in the general population of conditions that are common in this group, such as depression and anxiety. This is why it is so important to understand the full range of needs and ensure that these young people have access to the same helpful evidence-based interventions as others’.
That isn’t true: NHS figures show that only around 1-in-4 people who are provided with therapy recover (and much of that may be down to regression to the mean) and ‘recovery’ often appears fairly illusory as research suggests around 85% will become ill again. There are not many studies that have done the laborious work of tracking children who receive mental health care into adult life to see how effective that treatment appears to have been. Those that exist were gathered together in a 2022 review at Groningen University. The conclusion was that there ‘is no convincing evidence that interventions for the most common childhood disorders are beneficial in the long term’ and ‘the scientific literature cannot answer the important policy and health care question regarding the long-term effectiveness and safety of treatment of childhood mental disorders with any confidence’.[3] That’s remarkably similar to language Cass was using to criticise the research on gender identity related distress.
No-one wants to hear that mental healthcare doesn’t work and is busy pretending that it does. That’s the whole problem: no-one wants to hear it – it’s the same delusional, wishful thinking and failure to engage with reality that underlies mental illness in the first place. To be fair to Cass, it wasn’t her remit to review the competence of mental healthcare services as a whole but you don’t get to be the kind of person that writes reports for Governments by telling people what they don’t want to know.
When she makes ‘Recommendation 3: Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions. This should include support for parents/carers and siblings as appropriate’, she is part of a much larger, much more damaging problem than gender identity services. She is indulging in the same shoddy, lazy thinking she accused gender identity services of. And gender identity services is just one tip of an iceberg: what Cass is going along with has allowed mental healthcare to sponsor and promote ideas about the self and the world around you which have come to pervade mainstream society and are making people ill.
What Cass seems to be saying is that gender identity issues sit alongside a whole range of recognised mental health conditions so let’s focus on those. Agreed, but then what?
If we really ‘know that many psychological therapies have a good evidence base for the treatment in the general population of conditions that are common in this group, such as depression and anxiety’, how come the kids are so sick these days?
[1] https://www.theguardian.com/commentisfree/2024/apr/14/hilary-cass-review-gender-trans-young-people-children-nhs-evidence
[2] https://cass.independent-review.uk/home/publications/final-report/
[3] https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13677