Skip to main content
Normal View

Joint Sub-Committee on Mental Health debate -
Tuesday, 1 Jun 2021

Services for LGBTI+ Communities and Covid-19 Lockdown: Discussion

I welcome the witnesses to our meeting. They will be presenting virtually. We will focus on the mental health demands of LGBTI+ communities arising out of Covid-19 lockdowns. I welcome from Transgender Equality Network Ireland, Éirénne Carroll, CEO, and Vanessa Lacey, health and education manager. From BeLonG To Youth Services, I welcome Moninne Griffith, CEO, and Sinéad Keane, communications and advocacy manager. They are all very welcome to this morning's meeting.

Before we hear their opening statements, I need to point out to our witnesses that there is uncertainty if parliamentary privilege will apply to their evidence from a location outside the parliamentary precincts of Leinster House. Therefore, if they are directed by me to cease giving evidence in relation to a particular matter, they must respect that direction. I hope that is all okay. I call on Ms Lacey to make her opening remarks.

Dr. Vanessa Lacey

I thank the Chair for the invitation. I hope everyone is well and enjoying the good weather. I am a little anxious about doing this, especially via online and on television. I will give a little background. It is a brief presentation so I will not speak exactly to the presentation I sent to the committee. I will speak about the services Transgender Equality Network Ireland, TENI, provides. We provide extensive services to adults and family members of transgender people. We support adult support groups throughout the country from Donegal to the west, south west, along the coast and into Dublin. We have significantly developed supports to these groups over the years. We have developed a trans groups alliance, which encompasses quarterly meetings between representatives from all the groups. We try to bring together members of organisations to speak about their experiences and we try to develop those services in partnership and collaboration. That is what we have been about since the formation of TENI in 2006.

We currently work in many different areas, including developing training and information. We provide training for employers who have transgender people, or their family members, as staff. We provide training to the Garda. We work very closely with schools and provide training to them. We have a specific package of training and supports for family members. We have developed a family support group, TransParenCI, and a young person's group, TransFormers.

Of course, due to the pandemic situation we had to modify all our support groups and how we provided support over the last 15 months or so. All our support groups are currently online, although last summer we adapted a new model of walk and talk sessions during which people had conversations in the open air in a socially distanced way. Again, from the very beginning of this emergency, we adapted our services to suit our community especially when one considers isolation and its impact on mental health.

On the health service, we are developing a triadic model of training for health services. We are grateful to the social inclusion division in the HSE for funding our training. We have adapted our full day's training to a half day. When that training was announced through HSE communications, we were booked up for six months in the space of three weeks. That is a significant positive development in training provision over the Internet. We have developed an extensive three-day training package, called gender identity skills training, delivered in partnership with the HSE and national and international experts in the area. Although we had to postpone last November, we are endeavouring to provide online gender identity skills training in November 2021. At the moment, we are working with HSeLanD to develop a half-hour's virtual training, which will be held on the HSeLanD website. I hope we are getting across that we are always working in partnership and collaboration to develop a good system, where transgender people are included and involved, to receive services in all areas of their lives.

I will outline what we are looking for and our objectives for today's meeting. We have massive challenges in accessing healthcare for our community, including adults, adolescents and their families. We are finding many barriers to collaboration in providing adult services for transgender people. One of our wishes for today is the potential for the sub-committee to work with us in overseeing some of the recommendations in the HSE report published in December 2020. Similarly, the adolescent service is currently experiencing major challenges with no referrals to it at the moment. Last night, I received a couple of messages from families.

They have received a heartbreaking letter telling them that their children have timed out, because the overseas organisation in the UK, Gender Identity Development Service, otherwise known as Tavistock, will not be seeing them. They have been waiting on a two and half-year waiting list. Now they are being told they have to go onto a three-year waiting list. It is heart-breaking. We might have an opportunity to discuss those issues more. Again, I thank the Chairman, Senator Black, for the invitation to the Sub-Committee on Mental Health. I appreciate that from my the bottom of my heart.

I thank Ms Lacey and call on our next speaker, Ms Moninne Griffith, who is from BeLonG To.

Ms Moninne Griffith

I am CEO of BeLonG To Youth Services, Ireland’s national organisation for lesbian, gay, bisexual, trans and non-binary young people aged 14 to 23. I am joined this by my colleague, Ms Sinead Keane, who is our communications and advocacy manager.

BeLonG To has been supporting young people since we opened our doors in Dublin in 2003. Today, we provide specialist youth services in Dublin, including peer support groups, one-to-one support, and in-house counselling with our partners in Pieta House. All of this has gone online since March 2020. We also support a national network of approximately 50 LGBTI+ youth groups throughout Ireland. Our work supports LGBT young people around Ireland with where they are at right now. Many of them are in crisis or are experiencing mental health challenges. We also work to improve systems, structures and spaces in Ireland to make them safe, supportive and welcoming, so that we, as a society, can reduce the harm done to our young people in our schools, in our communities and even, unfortunately, in our homes. I have included examples of our advocacy work in the document that has been forwarded to the sub-committee, some of our campaigns, awareness raising, and our education and training work. We can talk about that later.

Last year, BeLonG To asked young LGBT people how they were getting on during lockdown. We published the results of the survey in a short report called Life in Lockdown. The findings were stark. Some 93% of LGBT young people said that they were struggling with anxiety, stress or depression during Covid-19. This was in comparison to 53% of the general youth population named in the Young Social Innovators’ Covid-19 Youth Check In survey, earlier in 2020. Prior to the Covid-19 pandemic, research such as the 2016 LGBTIreland report, highlighted the mental health struggles experienced by LGBTI+ young people in Ireland, with the group being twice more likely to self-harm, three times more like to experience suicide ideation and four times more likely to experience anxiety and depression, compared with their non-LGBT friends. Despite the great strides that we have made as a country in terms of LGBT inclusion over the past decade, this reality has been compounded since the Covid-19 pandemic began. LGBT young people are experiencing a loss of access to the spaces and supports they relied on for their well-being. Key findings in our Life in Lockdown survey carried out in May 2020 revealed that 55% of LGBT young people are struggling with suicide ideation; 45% of them are struggling with self-harm; and 60% of them are experiencing loneliness. Some 42% of respondents said they were not fully accepted in their home environments due to their sexual orientation or their gender identity and 53% of LGBT young people surveyed indicated that their home environment is not a good place to be during Covid-19 restrictions. I have listed in my document some anonymous responses to the survey. I will read one now but I can read more later. One respondent said, “Sometimes I think being dead is better than having to deal with online school, criticism from the person I live with, and the fear of the virus."

At BeLonG To, we are fearful that the devastating mental health impact of Covid-19 on the lives of LGBT young people will live long beyond the virus. Many LGBT young people experience ongoing mental health challenges. The results of our survey show that these have been exacerbated by Covid-19. LGBT young people do not stop experiencing crises during pandemics. Many feel isolated from their support networks who love and accept them for who they are. Some are experiencing emotional and physical abuse. They are alone, scared and anxious.

Now, more than ever, LGBT young people need access to a wide range of support and life-saving resources. At BeLonG To, we have rapidly responded to meet the needs of LGBT young people during Covid-19 through the provision of digital youth work, online youth groups and online training for the youth work and education sector. Through this work, we are letting LGBT young people across the country know that there is a safe space for them to come together, to be who they are, and to receive the support they need. However, we cannot do this alone. We need continued funding and support for the LGBT youth sector to combat these serious mental health challenges. In addition to Covid-19, over the past 18 months, we have seen the devastating impact of external challenges on the LGBT youth population of Ireland. There was a notable rise in transphobia and far right narratives that attempted to undermine the rights and even the existence of trans people. Incidences of hate speech targeting the LGBT community are growing, particularly across social media platforms, as we witness the rise of the far right both online and offline across Ireland.

In the first three months of this year, demand for our support services has continued to grow among young people, parents, teachers and others working with young people. As was the case last year, some young people, for a variety of reasons, including lack of privacy, not being “out” at home, or Zoom fatigue prefer one-to-one support, instead of joining one of the digital peer support youth groups.

The most common presenting issues for young people were mental health issues, followed by education and school issues, and then coming out. To date, there have been 1,290 individualised one-to-one interventions with young people this year. This is an increase of 64% compared with the same period last year, just before the first wave of Covid-19 hit. We are currently collating and analysing the data from our second iteration of the BeLonG To Youth Services Life in Lockdown survey. This survey was conducted online from 29 April 2021 to 10 May 2021, to assess the impact of the Covid-19 restrictions on LGBT young people in the Ireland. We will share this data with committee members as soon as it is ready to be published.

I have listed what needs to be done and some of the great work that has been going on. They can be broadly listed together under access to appropriate mental health services and safe spaces for LGBT young people. I am happy to go through those in more detail with members. Some of them are ongoing. There has been great flexibility and generosity across the public and private sectors, which have been funding some of these great initiatives.

I thank Ms Griffith and Dr. Lacey for two fantastic presentations. Senator Aisling Dolan has asked if it would be all right if she came in first, as she has to head off earlier. I call Senator Dolan.

I thank Dr. Lacey from the Transgender Equality Network Ireland, TENI, and Ms Moninne Griffith and Ms Sinead Keane from BeLonG To for being with us today. First, I would like to clearly say that I support them, and I support people who are LGBTI+. I recognise that the area I am in, Roscommon and east Galway, is quite a rural, regional area. We sometimes do not have as many supports as we would like to have. I speak as a public representative in that area and I am a clear advocate for the rights and equality of LGBT people. Everyone, all citizens of Ireland, deserve to have their voices heard and their rights represented. For people listening in small towns and villages, particularly in areas where it sometimes not easy to open, public representatives in those areas, although I suppose I am speaking for myself, support them.

I would like to ask a few questions based on the witnesses’ presentations. Dr. Lacey mentioned that she did much training for employers, gardaí, schools and families. I liked the names - TransParenCI and TransFormers. I refer to our family networks and how young people can feel confident about expressing their feelings or concerns. Would Dr. Lacey like to speak a little about the TransParenCI programme and the benefits she has seen from that-----

Can I stop the Senator? We are having a problem with the sound. Does she have a headset?

Yes, sorry, please give me a second.

It might be easier if she could put on her headset. I think we got the jist of that question, but she might have to repeat it.

Dr. Lacey mentioned training for employers, gardaí, schools and families. I admire her use of the term TransParenCI, which I think was focused on parents. We all need education on this. We do not know much about how to support young people who are going through this. What benefits has that programme? Are there other things we could learn and take up?

I also have questions for Ms Griffith and Ms Keane on how BeLonG To Youth Services links into the HSE. Dr. Lacey mentioned the social inclusion division. Galway and Roscommon are in the CHO2 area, which is community healthcare west. We have a specific mental health update section on which they link in with us. How does BeLonG To Youth Services link in? I know that its services may be limited to urban areas. However, I am talking about much smaller regional areas. How can we offer more supports and put in place awareness and support systems?

Ms Griffith and Ms Keane mentioned 1,290 interventions. They also referenced mymind.org which is very important for people who have been impacted by the Covid pandemic to get access to online counselling and supports. I wish to highlight the 50808 text number that is really important for young people to be able to access at any stage. How has BeLonG To Youth Services worked with primary and post primary schools? I ask the witnesses to give their comments on the parents' side of things and family.

I thank the Chairman for allowing me to make my contribution early.

Dr. Vanessa Lacey

The TransParenCI model was developed in 2011 in a Carlow hotel one cold and wet November evening when 14 parents came together. I was very privileged to facilitate that group. There were 12 parents, one aunt and a next-door neighbour. Family is family in that context. I have my personal experience of gender transitioning at 43 years of age and seeing the impact on my own family and then working with transgender people and seeing the impact on their families as well. We have developed the TransParenCI since 2011. Even though we started in Carlow back in 2011 with 14 people, we now operate in six different areas. We have two groups in Dublin, one in Waterford, one in Cork, one in Kerry and recently one in the Cavan-Monaghan area. We are working with the Donegal group to set one up in the autumn.

Our TransFormers group are young people. They are also linked in but they meet in a separate room, of course, and then they travel home together. That is all part of that dynamic. The travelling to the support group together with a young person and leaving after that support meeting together is a key part of that. Pre-pandemic we had a family residential each year. Our most recent residential before the pandemic was attended by 171 family members. On the Friday night, we hold a seminar where some of the health professionals come in and explain the background, tell them why there might be delays, what is involved in assessments and where people should go. The purpose is to inform people to decrease the anxiety and stress they might be feeling because they feel disempowered.

On Saturday we have various workshops for all the family members - for young people who are gender diverse or gender non-conforming, adolescents in a similar situation or identifying as transgender and for young adults. It also involves the child siblings because it impacts the entire family. We have family workshops, one a three-hour session based on grief and loss which I run and also a three-hour session on instrumental coping. We find that many families are engaged in trying to access services and have considerable frustration. They put much of their mental capacity into fighting a system which often distracts from their own emotional well-being. We are trying to ensure they keep well themselves.

We have workshops throughout the day and then on Saturday night we have more or less a dinner dance where we celebrate ourselves and celebrate families. That deals with the TransParenCI and TransFormers model.

The Senator asked about training. I have spent time training in Roscommon; I think I have been in every county in Ireland since 2011. I have worked with CHO2. Training is open for everybody irrespective of county. We work with all the social inclusion divisions. Our objective for healthcare is to have a hub-and-scope model, with service delivery from Roscommon, Leitrim, Donegal, Galway, Kerry, Waterford and all the counties. That is our plan for breaking down that stigma. Developing transgender health services in an integrated way in all the counties is the key part so that people can avoid the long and cumbersome waiting lists and access a service that is trans inclusive. I hope that answers the Senator's questions.

Ms Éirénne Carroll

I would like to respond to the Senator's question about the work in schools. TENI does a lot of research within the schools. Dr. Lacey and my other colleague, Hannah Solley, in collaboration with the University of Limerick last August released a great study on the experience of post primary students who are trans or gender diverse. It highlighted much of the marginalisation, the gender diversity that is in schools. It dealt with the lack of discussion that is available on gender identity, the absence of representation of trans or gender-diverse people, the lack of LGBTI+ supportive spaces in schools. We need to support those kinds of things in schools. That is the kind of work that TENI does. Ms Griffith and Ms Keane can talk about the kind of work BeLonG To does.

It is about teaching the schools how to let these students to use their preferred name and preferred pronouns, continuing to train staff on what it means to be trans in school and work, and creating those inclusive policies across the board because we believe that will decrease some of the mental stressors that our trans students experience in schools. Currently the majority of trans and gender-diverse students have a very negative experience of school and they seek to avoid school. We need to continue that training and put those supports and policies in place, and work across all of education to ensure that those students are safe and supported. I hope that gives a bit more of a flavour of the work we are doing in the education sector.

Ms Moninne Griffith

I will talk about how are work links with the HSE and then Ms Keane will talk about some of the early intervention work.

I am happy to say that we have a very positive relationship with colleagues in the HSE. Covid really showed how flexible, adaptable and realistic the HSE was when we approached it. When the fundraising climate looked pretty bleak it was very good in terms of how we could pivot and redirect funding to meet the needs of young people on the front line as quickly as possible.

We have had a long relationship with the National Office of Suicide Prevention, NOSP. It is our biggest State funder. It funds all the work we do around the country on the national network. It directly helps us support LGBT youth groups both in Galway and in Roscommon. In Galway city, shOUT! is run by Youth Work Ireland, but it also does satellite outreach around the county. It provides one-to-one support for young people throughout the county. I believe it is doing that remotely at the moment. We also work with young people from rural areas who perhaps because they are not out yet might not want to link in with their local group so they link in with us in the first place and then we refer them back to their local group where they can make friends nearby or at least in the same county when they feel comfortable being out.

Similarly, in Roscommon there are a number of different LGBT groups in Roscommon town, Boyle and online as well from Ballaghaderreen. All of those details are on our website for young people, parents or carers who want to find out how they can link in and find local support for young people. That is supported through funding from the National Office of Suicide Prevention. It also supports all our mental health work such as our work with Jigsaw to train up mental health professionals and volunteers around the country. We are providing the training online at the moment. That is very much geared towards volunteers and professionals working in the mental health sector to raise awareness about language, terminology, unconscious bias, the specific needs of LGBTI+ young people and how they can support them. There is no charge, but the courses are oversubscribed in minutes once we advertise them. There is a great appetite for it, and we need increased investment to be able to provide more of that training.

The same goes for our work with Pieta House, which gets some funding from the HSE. It has been an excellent partner and works specifically with LGBT young people who are experiencing suicide ideation or self-harm. We work with NOSP and now the National Social Inclusion Office in the HSE. We want to re-run the LGBT Ireland report. The data were collected in 2015 and the report was produced in 2016. We want to re-run it to compare the current experiences in terms of mental health and well-being for LGBT people of all ages, post-marriage equality and post-gender recognition, and really drill down into some of the groups in the LGBT community and hear from the voices that were not heard as much the last time, including transgender and intersex people, LGBT Travellers and LGBT migrants. We need to find out where the gaps are, what services are working and what needs to be improved.

The national network groups across the country link in with teams in local community healthcare organisation, CHO, areas in the HSE, the suicide resource officers and the Connecting for Life teams which are implementing the strategy. The other points of contact are with the HSE regarding the now non-existent gender identity development service for under 18s. I echo the call by our colleagues in TENI for the need for some external monitoring and evaluation to make sure that the report from the HSE published last year on services for both under 18s and over 18s is implemented as soon as possible, definitely by the end of this year, and that in the interim there would be some sort of service provided to under 18s. Dr. Lacey has already mentioned it and we hear it all the time from young people and from parents. Some young transgender people have been waiting and waiting and now there is nothing to wait for. It is very bleak. Some of them were already struggling with mental health problems and this could be the final straw. Some very distressed people have been in touch recently.

The final major piece of work we do with the HSE is with its sexual health and crisis pregnancy programmes. It partners with us and funds us for some of the sexual health work we do, in particular the work we do on MSM, men who have sex with men. We provide a personal development course that looks at everything from internalised homophobia, positive body image, positive relationships, positive sexual relationships and safer sex, among other issues. We have a very good relationship with the HSE. It has been a very good partner for us. We have evidence-based programmes that Ms Keane will speak more about. There has been an increase in funding for the training and services we provide as well as the services TENI provides. There is a lot of cross-over between the population of young trans and LGB young people that we work with.

I thank the witnesses for attending this morning. We talked a little bit about the HSE report and I would like to use my time to go through it in more detail. In December 2020 the Government published this delayed report and it probably did not get the kind of attention it merited because of the timing of its publication, which was a shame.

From my reading of it, one of the main outcomes is that the psychological support for those under the age of 18 should be provided and delivered by the Irish health service rather than in the UK. We were relying on the GIDS UK service through the National Treatment Purchase Fund. That was then removed, and people are relying on an Irish service that does not exist. It is meant to exist in Crumlin, but it simply is not there. Could the witnesses expand on the nature of its not existing? Which staff do not exist? Something that comes up again and again in the report is the creation of a multidisciplinary team. In the context of mental health, I am interested in hearing what staff members we would need for that, what a multidisciplinary team should consist of and what it would look like in a perfect world.

Dr. Vanessa Lacey

One could write a book about that. I thank Deputy Hourigan for the question about the service that was based in Crumlin. Since 2018 it had funding from the Department of Health for five positions, which included consultants in psychiatry, psychology and paediatric endocrinology as well as social care and administrative staff. The positions that were filled were part-time social care work, in administration and the paediatric endocrinologist position. Even when the Gender Identity Development Service, otherwise known as the Tavistock Clinic, was doing assessments, which were covered under the treatment abroad scheme, there was still quite a backlog. Before the pandemic there was a two-year waiting list and the clinic had to come over and back. It was not an ideal solution. It was akin to putting a plaster on a gaping wound for the clinic to come over to Ireland every month or two and do assessments with young people to try to somewhat decrease the waiting list.

In October, the paediatric endocrinologist moved on and that service collapsed. Coupled with this, there was the High Court ruling in the UK that impacted on the Gender Identity Development Service in the UK, which meant it had to pull back and it lost members of staff. The pre-pandemic two-year waiting list has grown in the meantime. There are young people who have been on a waiting list for that service for more than two years in respect of whom yesterday their parents received letters in the post stating that they are timed out and they are welcome to apply to be seen in the national gender service once they are over 17 years of age. As I mentioned, that service has, at least, a three-year waiting list. These young people have already waited two and a half years and they will now have to wait another three years for services. One can only imagine the impact of this on the mental health of the young people in that situation, and their family members.

Last night, some of the families shared stories with me. One parent said the family is already on suicide watch, but it, at least, had had hope of the young person being seen soon. We all know that when hope is taken away in terms of mental and resilience that is really problematic in regard to the risk to the young people. I agree with my colleague from BeLonG To Youth Services, Ms Griffith, that we need to have some service in the interim. We need to do something even if that means a private option. I have engaged with the treatment abroad scheme and it is open to service provision under that scheme. We have tried to link in with the European public services, but they already have waiting lists for their services and they cannot see our young people. We need to look to the private option in terms of provision for our young people in the interim. I refer to the statistics provided earlier by Ms Griffith. The suicide and self-harm risks are significantly high in the transgender community. We need to do something and we need to do it now. We have sat on this since 2018 when the positions became available. Nothing has been done in three years. I note Deputy Hourigan is indicating.

I would like to recap on what Dr. Lacey said such that everyone can be clear in that regard. As I understand it, less than half of the five positions that were funded for this service have been filled, nobody, or very few people, are receiving treatment, there is a more than two-year waiting list, if possible, we should consider reactivating the treatment purchase fund, but there will be a challenge in that other services, such as the Dutch services which might be suitable, also have a long waiting list, and we have very few options at this stage.

Dr. Vanessa Lacey

Yes, we have very few options available to us. Something needs to be done as soon as possible for these families. God help them. I am quite emotional following on from my meeting with them last night.

Dr. Vanessa Lacey

We have nobody in that service. There is nothing happening in the service. Tavistock is still somewhat involved, but it is not seeing the people who are timed out. It is really problematic. The treatment abroad scheme has tried to provide support. I have a good relationship with those involved in that scheme, as I have with the HSE. As I mentioned earlier, it is about partnering with the organisations to try to see the bigger picture. At this moment in time, service provision is really problematic and there is risk to life. I cannot over-emphasise that.

It appears there is not enough understanding of or focus on the impact of delayed treatment. One of the recommendations of the report is that a service-user forum for the NGS be developed, with advice from the HSE head of mental health engagement and recovery in regard to service-user involvement and representation. Could service provision be improved through representation and a voice for those seeking these services in the development of these services?

Dr. Vanessa Lacey

I agree 100%. The national gender service, which is the adult service, has developed in its own way. The HIQA national standard as the best and safest in terms of healthcare amplifies the need for patients to be at the centre of a service. In the national gender service, which is the adult service, there is no trans representation. We were previously invited on to the governance committee, but having attended only one governance committee meeting in which we proposed in the minutes to have a presentation to the next session in terms of the model of care that was to be developed, we were never invited back, I presume because we asked some of the difficult questions in terms of the model of care that exists. We really need to be involved in the care for both adults and adolescents. We need to be able to bring in the trans-sensitivity factor to ensure that the service is trans-sensitive and to identify if some of the questions being asked during assessments need to be modified. We want to work with the service; we do not want to be in constant attack mode with it. I prefer to work in tandem with others. There will always be differences, but we need to work in partnership to break down barriers and ensure we can provide best practice services to the transgender community and their families. I hope I have answered Deputy Hourigan's questions.

Dr. Lacey has answered my questions. It is extraordinary that no stakeholder is part of the governance structure. That is problematic. With the indulgence of the Chairman I would like to ask one more question. Another recommendation is that consideration be given to the establishment of academic partnerships to provide longitudinal evaluation of the service as it develops. I agree that the service users and stakeholders should have a voice, but I think that academic partnership is an interesting suggestion. Earlier, Dr. Lacey mentioned some interaction with academic bodies. Would she or any of the other witnesses like to comment on that, including whether they think it is an important recommendation to be pursued?

Would Ms Griffith or Ms Keane like to respond? No. Perhaps, Dr. Lacey would like to comment.

Dr. Vanessa Lacey

Academic partnerships are important. We do not have the data in that regard. We have a report from 2013 from Judge et al which provides some data. Judge et al was part of what is now known as the National Gender Service. I am aware that UCD is currently doing some research in regard to the experiences of family members and transgender people in relation to accessing trans-related healthcare services in an Irish context. I am also aware that services have a link-in, such that there is an internal connection. In terms of ethics, we need research external of the transgender community and the services, in regard to service provision, as opposed to an internal look at such services. As mentioned earlier by Ms Carroll, we have already published research with the University of Limerick. We work with universities across the board and we are delighted to be doing so. In terms of Ireland, we need to be doing much more research. In light of the number of young transgender people growing exponentially, CAMHS needs to do specific research in regard to the experiences of adolescent and children accessing services, their needs and the needs of their families. I hope I have answered the Deputy's question.

The next speaker is Deputy Mark Ward.

I thank the witnesses for submissions. It is good to see Ms Carroll and Ms Griffith again. I thank them for the crash course with which they provided me on the last occasion I met them. Like Dr. Lacey, I get nervous every time I have to speak. It is important to name it, as I always do.

There are a couple of issues that have not been touched on that I would like to focus on. I have two questions, which I will put together, allowing time for the witnesses to respond. Ms Griffith mentioned amendment of the Mental Health Act to allow under 18s to access mental health services. I have a Bill with the Bills Office relating to capacity to consent which will allow 16 and 17 year olds to have more autonomy and a right to choose in regard to the mental health treatment, which is on a par with their rights in regard to their physical health treatment.

One reason the Bill was introduced relates to the parental and other barriers that sometimes prevent people from accessing mental health supports in regard to having to disclose why they are seeking access to particular supports or treatments. This is even more problematic for young people in the LGBTI community, especially in the context of some of the parental barriers that may exist. Ms Griffith did not go into detail on why this is so important to young people that BeLonG represents. Will she elaborate on that?

When I was reading Ms Griffith's opening statement, the reference to the Prohibition of Conversion Therapies Bill 2018 jumped out at me. Senator Warfield has done a great deal of work on this issue and introduced the Bill in 2018. It is shocking that in this day and age, the practice has not been legislated against. It is draconian, harmful and inhumane, and it has no place in a modern society. I will not get onto my political soapbox. There is cross-party consensus on this, as far as I know, and we just need the political will for this to happen. What are the witnesses' thoughts on this legislation? What impact is the delay in progressing it through the Houses having on members of the LGBTI community?

Ms Moninne Griffith

I am happy to come in first but both of my colleagues, Ms Keane and Ms Carroll, have been working on the issue of conversion therapy. Ms Keane has done work on it in North America as well as here, so she will have interesting insights.

On the Mental Health Act, the Deputy is correct. For some LGBT young people who are not out, or who are out but do not have parental support at home, accessing mental healthcare is impossible because they cannot get their parents to consent to it without outing themselves or putting themselves in danger by accessing it and, perhaps, conflict happening at home because of their sexual orientation or gender identity. We have been advocating, therefore, to reduce the age of consent regarding access to mental healthcare to 16, the same as it is for other medical healthcare. We also advocate for the introduction of the Gillick principle, a judge-made principle from the UK that arose out of a woman under 17 years seeking access to contraception. In the UK, a medical professional can make a decision based on the assessment of the young person with whom he or she is working to determine whether that young person has the capacity to consent. Where he or she does, the medical professional is covered to provide the person with the healthcare required. We strongly advocate that a similar principle be applied in Ireland.

Funnily enough, the Mental Health Act also works in reverse, so it will affect conversion therapy as well. Not only are young people not allowed to consent for medical healthcare under the age of 18 without parental consent, neither can they refuse it. This relates to conversion therapy because it is very much couched in psychological or counselling language. They cannot refuse it if their parents send them for it.

I will hand over to my colleagues, Ms Keane and Ms Carroll, who can talk a bit more about conversion therapy and how, in reality, it is happening in Ireland.

Ms Sinead Keane

As Ms Griffith mentioned, conversion therapy and the Mental Health Act are linked in that young people are not able to refuse treatment if their parents wish to send them for conversion therapy. I spoke to a young man from Dublin last week who shared his experiences of conversion therapy in Dublin in the early 2000s. What is very interesting for conversion therapy is that many people who experience it are not aware of it in the moment. For example, it can be disguised as pastoral care or community supports when it is faith-based. Moreover, as Ms Griffith noted, we have seen the rise of the far right and transphobia in Ireland over the past year. Another area of concern for us relates to the rise of gender-critical therapy, a form of conversion therapy that relates to transgender identities.

In summary, our concerns include the fact that conversion therapy can be disguised as pastoral care and that people cannot refuse treatments if their parents demand they receive them.

Ms Éirénne Carroll

In the US, I grew up in a church that practised conversion therapy, so I am very aware of how it can be couched and hidden in different ways such as by presenting it as pastoral care or support. In the context of Ireland, our research at TENI, Speaking from the Margins, shows that about 70% of trans people have felt their trans identity was an embarrassment to their family, while 60% feel this continually. We look at this in the context of mental health and the lack of resources, education and support available for families and trans people widely, which feeds in to creating a vacuum where conversion therapy and gender-critical therapy can come in. These therapies prey on marginalised people who feel distress about who they are and about their family, and they are asked to submit to therapy that, according to the Office of the United Nations High Commissioner for Human Rights, is a method of torture.

That is a significant challenge that we need to continue to combat and stand against. We are asking about trans people and LGBTQ people's mental health and this is a considerable vacuum whereby conversion therapy can take away lives and freedom. We need to examine that and realise that trans people are consistently asked, essentially, to prove who they are, when in reality we are just people trying to go about our lives and live them to the fullest, yet our lives are consistently a matter of debate. There is this debate about whether we really exist as who we are. When we think about that in terms of conversion therapy, we have to stand against it because trans people, especially, are who they say they are, just as much as anyone else from the wider LGBT community.

I hope that was some help in the conversation about conversion therapy.

That was brilliant. I thank Ms Carroll. Does Deputy Ward wish to come back in?

I thank our guests for that information. The year is 2021. That it is still legally permissible in this day and age for a young person to be forced to receive conversion therapy is bonkers. It equally saddens and angers me that this practice can still happen and, as our guests said, is still happening. We have a role as legislators. There seems to be cross-party consensus that we need to start pushing the issue forward to ensure this draconian practice will be wiped off the face of society. We do not need it and there is no place for it.

It is great to see all our guests. As a member of the LGBTQ+ community, I wish them a happy first day of Pride month. I am wearing my trans Pride flag for the special occasion of this meeting. I have listened to Dr. Lacey and Ms Griffith for years and I learn something every time they speak. Even though my home community is the LGBTQ community, there is still so much I find myself learning and so much that frustrates me about the fact that we are nowhere near where we need to be or where we should be.

We have had huge wins for the LGBTQ+ community over the past couple of years with marriage equality but the knock-on effect is that people are not as aware of the community and so many needs are still not being met.

I have read the horror stories online and heard the horror stories, particularly from trans friends who have had what can really be described as the most horrific and ghastly experience of the gender services in Ireland. I do not say that every person has had that experience but there are an awful lot of these stories and they have been very difficult experiences. Not a day or week goes by where I do not see yet another trans person trying to fundraise for surgeries online and having to travel abroad. How do we get to where we need to be? I presume that the answer is we need more staff and more funding. What recommendations can we make as a committee? The experience of having to fundraise and travel abroad is having a huge impact on the mental well-being of the community. Do we need a fully funded service and to provide training to healthcare professional during college? How are we so off keel?

The witnesses have outlined the knock-on effects of the Tavistock ruling and how the waiting lists have increased. In terms of a sense of well-being, Tavistock was considered a lifeline for many people. Do the witnesses have anecdotal evidence or otherwise on the impact that the ruling has had on the well-being of individuals and their families apart from the fact that there are longer waiting lists and people may not get access to what they need?

Finally, I have done research on eating disorders over the past while and there is little information or data available around eating disorders among the LGBTQIA+ community. As we know, the treatment and services that are available in Ireland are abysmal. Do the witnesses have information on whether there is inpatient or outpatient support and on how eating disorders affect the LGBTQIA+ community?

Dr. Vanessa Lacey

I recall travelling to Cork a decade ago for the very first talk that the Senator booked me for and now she is entrenched in the Seanad. It is good to see her career take off.

I agree with her that there are horror stories about people's experience of the assessments. The sexualised nature of some of the assessments are problematic in terms of people's mental health. The service is supposed to help people's mental health but the anecdotal evidence suggest that it contributes to mental ill-health, which is a major problem.

In terms of how to fix the problem, we deliver training and hope to do more as training is the future. Certainly, I have spoken of a bespoke model of the future in the different parts of training.

The Senator asked a great question about the funding provision. We can throw all of the money in the world at services but if they are not inclusive and do not place the patient at the centre then one may as well as throw money into a well because one is not going to get anything back. To go forward we need an external review of the recommendations contained in the HSE report published in December 2020 and perhaps somebody from the sub-committee could oversee whether things move along in terms of being part of a clinical governance committee, a service-user committee or develop a multidisciplinary team based in Crumlin. I believe that it is also planned to be implemented in tandem with the Linn Dara CAMHS unit in Bluebell, Dublin, which is a positive development.

The HSE is trying to fill these positions in the NDT Before this debate I was on a call to the mental health lead so I know that the HSE is endeavouring to fill the positions but we still need an external review to see what is happening, what are the barriers and what is the breakdown. The key thing is the trans sensitivity and trans inclusion factor. That needs to happen.

In terms of Tavistock offering a lifeline, I met one of the senior clinical psychologists who has travelled to Ireland over the past three years to deliver assessments and to see the young people and their family members. The High Court ruling has impacted them in a very negative way and their system has been somewhat broken down as well so there are big changes abroad. We need to stop looking at what happens in the UK in terms of services as that is really problematic. We did not run down the pathway with Brexit or Covid responses so why should we run down the pathway in developing gender identity services for young people? We should look to Europe and see what is practised in other parts of Europe let alone the UK. The Tavistock Clinic in the UK had a good system but I do not know if that fitted exactly into what we needed here. Ultimately, we need to develop our own multidisciplinary team but we also need links and contacts with European services.

A question was asked about having collaborative research with our European partners. Massive research has been done in Belgium, Holland, Italy and Spain and Ireland needs to be part of that. We need to break down that language and ensure that we provide information to clinicians so that they can follow evidence-based practices, and not make things up as they go along which sometimes tends to happen.

I spoke earlier about the lack of hope among young people, which is very evident. For a couple of months after March 2020, I facilitated the Transformers group online and the reason for doing this was to examine the levels of anxiety that young trans people felt because of the pandemic. They felt less stressed because they did not have to go to school so did not expect to experience rejection, and forms of bullying and harassment that had happened. Covid has put a spotlight of many aspects of life and on the lives of members of the trans community and how they felt safe outside because people were told to go inside, stay inside and stay in their houses and not go out as part of guidelines. At the same time, this highlights the daily impact on their lives. Trans healthcare is a part of that but not all of it. I cannot emphasise enough that services need to be developed but we need inclusion. I know I may sound like a parrot repeating myself but inclusion is the most important aspect for us today.

The final issue concerns eating disorders. Trans young people try to control their physical development because they experience gender dysphoria. They feel that if they stop eating they might stop physical development and chest development, for example. They try to control the uncontrollable because they cannot access services. It would be great if they could access services, which does not always include medical interventions, which is only a small percentage. If trans people could link up with the CAMHS teams in the area and speak about their experiences then it might help them avoid some eating disorders.

I thank the Senator for her questions and I hope that I have not hogged all the time.

Not at all. Dr. Lacey is just very passionate, which is good to see and her contributions have been very powerful.

Ms Moninne Griffith

I support everything Dr. Lacey said. There needs to be some sort of interim service until we see the implementation of the strategy. We need some external monitoring of that. Training and education are key. There is a new LGBT lead being recruited, or who may have been recruited, within HSE social inclusion. Our hope is that we will get to work with this individual on developing an LGBT health plan within the HSE. There is lots of work going on but it just needs to happen faster. The interim service is crucial to saving lives.

On the impact on well-being, there are so many stories I could tell but two to come to mind. I am thinking of a young person who got into Tavistock just before it pulled out. His mother said he is now like a different child. He had stopped going outside. He would not go to school even when pupils went back to school after the initial lockdown because he was so self-conscious about his body. He is seeing somebody through Tavistock and is a different child. He is happier and even said to his mother that he is happy. It was the first time she heard him say that in so long. He will now leave the house and has connected with his school again. It is hard to describe the positive impact when a young person feels listened to, gets the appropriate professional supports and feels he or she is on a journey and can see the light at the end of the tunnel. As Dr. Lacey said, not seeing the light at the end of the tunnel is when the darkness comes in. That is when parents ring us terrified they are going to lose their little ones, their children.

On the question on eating disorders, recent research has brought up the issue. We will bring the results to the committee as soon as they are in a format we can share with it. The matter has definitely arisen for trans young people but also for LGB young people. I suppose it is the element of control. Eating is the one thing you can control. Emergency departments have been ringing our colleagues in Bodywise, and Bodywise has been on to us in terms of trying to develop an evidence base. This is one of the reasons we want to rerun the LGBT Ireland research. We will include in-depth questions on eating disorders so we can track the triggers and reasons and what will help with those. Again, what we really need is research that can help to inform stakeholders on the front line and policymakers.

Ms Éirénne Carroll

I want to talk a little about Senator Hoey's question on the impact of not getting the healthcare service. I always try to explain it through a bit of a thought experiment. A cisgender woman going through menopause can go to her GP and start getting the treatment. It is regionalised and easily accessible. It is more regional and one can have access. Regarding trans people, there is a belief in the model of care that we have to prove who we are consistently and constantly. Therefore, it is not just that a trans person comes out and then waits for healthcare; a trans person comes out and then, for two, three or five years, if he or she is a 17-year-old who gets referred to the adult gender clinic, has to consistently prove who he or she is. His or her first step in the system is to continue to prove who he or she is. Many mental stressors are added to people's lives when the system consistently says it does not believe they are who they say they are. That feeds into a lot of the other work in the report. I refer to the academic standards and to updating the model of care to realise that trans healthcare has to move forward with the trans community. It cannot be stagnant. It cannot just sit there in a model from the 1980s, 1990s or early 2000s. It has to meet the need. To highlight that, we can look back at the way the reports have been done here in Ireland. In 2009, the HSE produced a report on meeting the healthcare needs of LGBT people. The main issues it highlighted were isolation, fear, stigma, physical violence and family rejection, contributing to depression, anxiety, substance misuse, self-harm and suicide, multiple discriminations, the absence of a designated gender specialist to co-ordinate the delivery of trans health services, limited provision of psychological support services for trans people and their families, and limited availability of essential health services. That was 11 years ago. How much of that has changed in 11 years? That should answer the question as to how trans people are challenged with more mental health stressors. It is not that trans people are born with more mental health stressors. There has been an 11-year battle to get healthcare that is easily accessible and affirming. That should shed some light on the matter.

I thank Ms Carroll. Is Senator Hoey happy to move on?

I was going to ask another question on cisgender women being able to access hormones. It is great that Ms Carroll pre-empted my question. That is everything. Dr. Lacey has made a good point that we do not always have to look to the UK. There are turf wars happening over there that we do not need brought over here. We need to look more to continental Europe for models of care and personal engagement than to the UK.

I thank both organisations for their statements.

I will be brief because some of the questions have been asked. I do not want to be repetitive. On BeLong To's statement on the far right, it is concerning that the far right has expanded its toxic and vitriolic propaganda on the trans community. It has used it skilfully with regard to public representatives. It is used to divide people on social media. Some of the material is sickening and unacceptable. These people have an agenda, not only to sow division economically but also to do so in terms of gender. These people should have no place in society. Seeing the material in question can affect a person's well-being. Sometimes that feeds through filters in society that are not in any way influenced by the far right. It can seep into the general discourse on these issues and can be extremely toxic.

It was said that hate crime legislation should be enacted. We have been talking about this for a long time but it has never been done. What have the organisations seen, particularly in the past couple of years, regarding this narrative? Would legislation, particularly on hate crime, address some of the issues raised?

Ms Moninne Griffith

The individuals to whom the Deputy is referring do not represent the majority of Irish people. We have seen time and again in recent referenda that the values of the majority of people are based on inclusion, equality and acceptance of the diversity of people on this island.

What the people to whom the Deputy is referring are very good at is manipulating the truth, stirring up fear and making mountains out of molehills. That will move good people away from a place where they want to be inclusive and treat everyone equally to a place of fear about themselves and their own and the people around them. Several important Bills will come before the Houses, such as the hate speech legislation of which we have seen the heads. That will be really important in starting to define which hate incidents and speech can be criminalised.

It is important that enough funding goes into implementation. I know from speaking to colleagues in places such as Germany and Austria, where they have very good hate crime legislation, that the lessons they have learned relate to the implementation of such legislation. There is no point having the best legislation in the world on the Statute Book if we do not invest in the prosecution side of things, that is, in the Garda, the courts system and the DPP, to make sure that prosecutions can be successfully taken, but also to empower the communities and individuals who are targets of hate speech and hate incidents to bring those complaints. There is a significant volume of great work going on in the Garda at the moment in respect of its diversity and inclusion work around trying to work with communities such as the LGBT community to make it easier to report incidents, but we really need to do more work in that regard.

There is also the online safety and media regulation Bill that is coming before the Houses of the Oireachtas. That is connected because much of this action takes place online, so we have to make sure that platforms and individuals are held accountable and responsible for what goes on. A person said to me that the Internet is like being in a shopping centre. If something happens to a person at a shopping centre, such as a threat that the person will be murdered or raped, the shopping centre will deal with that but it will also ensure the Garda come and deal with it. That does not change just because someone is on the Internet. We are usually on the Internet as consumers of a product or as a communication platform. Those platforms owe a duty of care to us, as consumers, but the State cannot advocate all the responsibilities to the platforms. As citizens, we need to be able to regulate what happens online. We will get an opportunity to do so through the hate speech legislation, the online safety legislation and the EU Digital Services Act, which is really important for us as Irish people because so many of the data centres are located in Ireland. These three things that will happen in the coming years are all connected.

As the Deputy stated, the people to whom he is referring are very skilled at using this. Back in the days of the marriage equality referendum when Twitter was just a new baby, we on what I like to consider the more progressive side were light years ahead of those who were against progress but they have leapfrogged us and are using the online space to spread their hate and vitriol and to disrupt democracy. That is exactly what they are doing. It is not really about being anti-trans; it is about trying to break down democracy, allies and people who want to work to improve countries and societies so that we will be fighting against one another instead of working for a better society. I thank the Deputy for raising the issue.

Do Dr. Lacey, Ms Carroll or Ms Keane wish to respond to the points raised by Deputy Kenny?

Ms Éirénne Carroll

I agree that the actions of the far right and the lack of hate crime legislation are significant challenges to trans mental health. I have a really simple statement in that regard. Three weeks ago, I spent my Friday afternoon with gardaí who were assessing my flat and my apartment building as a result of a death threat that was made against me just for being visibly trans and being an immigrant. The things that are going on in the media and on Twitter are having real effects on people in their everyday lives. What would someone expect the impact on a person's mental health to be when the person spends a Friday afternoon doing an assessment of where they live as a result of a death threat? We need to continue to fight against the far right organisations that are making Ireland almost uninhabitable for people of diverse backgrounds.

Ms Sinead Keane

Members of the LGBT community, and LGBT young people in particular, spend a lot of time online, particularly before they come out, because that is where they can find a community, get information on healthcare, join forums and meet other members of the community without having to out themselves in cities or rural towns or villages. Many of the platforms frequented by the far right are also used by LGBT young people, which is creating a perfect storm. I refer to the presence of the far right on Twitter and Discord, for example. In Ireland, it is a very small but noisy group at the moment in terms of transphobia, with many of the same names coming up again and again.

In the context of well-being, when we are advising the young people with whom we work, we do not want to tell them not to go onto the platform where they get community support and information but, unfortunately, that is often the same place they are experiencing homophobia and transphobia online.

Does Dr. Lacey wish to come in on that issue?

Dr. Vanessa Lacey

No. I think the points were eloquently made by my colleagues.

The experience Ms Carroll has related, of people making death threats as a result of what she may have said, is terrible. It is unacceptable. Social media platforms in general have a responsibility to those who use their services. It is unacceptable that people can make death threats to other persons, which can have a very detrimental effect not only on the mental health of the latter, but their physical health as well. My support goes to Ms Carroll.

I thank the Chairman and our guests. I agree with the remarks of Deputy Kenny regarding the horrific story about Ms Carroll's Friday evening experience, at a time people should be unwinding after a week's work. It is shocking that she had to go through that. It just shows that we have a long way to go in society to build tolerance.

I was going to ask about conversion therapy but Deputy Ward asked the questions I was going to ask and I listened intently to the engagement on the issue. This needs to be dealt with and legislation needs to be passed to make conversion therapy illegal. One of the recommendations that should come from the committee is for that to be dealt with very quickly.

I was also going to ask about the funding of the organisations and how they have coped during Covid. I make that point in the context of Government supports and future plans because it is clear the organisations will have to be significantly resourced to try to advance their agenda.

An issue that is, to a large extent, more important relates to sex education in schools. There have recently been certain utterances from the Catholic Church on its preference for a type of sex education and a particular ethos. Sex education to build tolerance of diversity and difference and an understanding of that at a very young age is needed in the long term.

I would like to hear the witnesses' views on the present model of sex education in school. Have they had any engagement with the Department of Education on models they have seen in other parts of the world that can create the type of society we want? We have a chance of a tolerant society if we can start with very young children and instil an understanding of and a respect for diversity and difference. That can then percolate through society. That is how I would see us creating the type of equal, safe and respectful society we all strive for, dream of and hope for.

Finally, people with physical disabilities within the LGBT community have, along with the challenges of being different, the challenges of having a disability. I imagine that the pandemic created many mental health challenges for people in the witnesses' communities who have a physical disability.

Those are the points I wanted to make and maybe get our witnesses' views on.

Who would like to respond? Ms Griffith.

Ms Moninne Griffith

Yes. I thank Senator Conway for those questions. Regarding the funding, at the beginning of the pandemic we were terrified. We thought we would fall off a cliff and would have to let people go and so on. I have to commend the State funders, especially those in the National Office for Suicide Prevention and the Department of Children, Equality, Disability, Integration and Youth. We were met with great empathy and a great sense of partnership in wanting the best for young people. Some once-off funding was provided to us to build our capacity on the front line in order that we could meet the additional needs of LGBT young people during the pandemic. Reading the headlines this morning, it looks like many of the additional Covid payments will start being rolled back. That would be a worry because I think we will see the impact of the pandemic, especially on LGBT young people, for some years to come. Ideally, we would love to maintain the level of service we are providing at the moment with the additional funding that has been made available through those sources. Equally, the private sector has been really generous and rose to the challenge. It is because of its generosity and our funders in the State agencies that we were able to be so agile, move all our services online and support young people and youth workers around the country during this really difficult time.

Yes, we have engaged with the National Council for Curriculum and Assessment, NCCA, which is taking the lead on the issue of RSE. We submitted to and participated in the consultation. We support the report the NCCA published in 2019; we just need to see some action now. Some work on curriculum development is happening within the NCCA, and some interim guidelines were to be published for schools to start addressing the gaps and the problems identified in the consultation relating to RSE until the new curriculum is available. Curricula are important and teacher education is hugely important. Before I started working in BeLonG To, sexual healthcare was not my favourite subject to talk about. One needs the training and the education to feel comfortable teaching about relationships and sexuality, and teachers get very little, if any at all. That needs to be part of their initial teacher training as mandatory continuous professional development. All teachers should have a basic understanding of this, like reading and writing, but it needs to be a specialist subject in order that specialised teachers, like teachers of geography or anything else, keep up to date with what is changing. It will change all the time. By the time this new curriculum is developed it may have already aged because things keep happening with young people's relationships, including their sexual relationships. It therefore needs to be agile and be able to move with the times. LGBT inclusion is broader than that, though. We have a programme called the safe and supportive schools project, which looks at six distinct areas to effect long-term sustainable cultural change in a school to make it safe and supportive, curriculum being one of them. Another is training for the whole school staff, from the principal to the lollipop lady, with everybody in the whole school community involved. Another is support for young people and linking in with the local community supports - for example, the local LGBT group or the local LGBT-inclusive youth group. Another is the building itself being inclusive, having, for example, pride flags during Pride Month, posters from LGBT groups hanging, bathrooms that are accessible to non-binary young people and so on. We have to look at this holistically. RSE is an important piece of it but it should not be the only subject in which we see LGBT lives. We should hear about and learn about LGBT lives and experiences when we are in English or home economics classes or wherever we are in order that LGBT students feel welcome and included and that students who have LGBT siblings or LGBT parents also see their lives reflected in the school curriculum.

Lastly, our young people have just completed a project relating to inclusion of people with disabilities. It is not something I have data on in respect of the number of young people with disabilities, but we work with other disability organisations to try to make our services more inclusive. What we have found is that there has been good and bad in respect of engagement for people with disabilities during Covid. As many of our groups are now online, it makes them much more accessible to young people who may find it difficult and, again, who may not be out and who may be very dependent on parents to get them from A to B. Suddenly they are online and engaging with and making friends in the LGBT community in a way that maybe was not available to them before.

I hope that answers the Senator's questions.

I thank Ms Griffith. There is obviously a huge amount of-----

Ms Carroll has her hand up.

I do not know if Dr. Lacey or Ms Keane want to come in. Go ahead, Ms Carroll.

Ms Éirénne Carroll

Sorry. I did not want to interrupt the other speakers. I will talk a little about Senator Conway's questions about the funding. When Covid hit, our organisation was of course challenged by it and by what it could mean, but we are thankful for the support of the HSE, NOSP and the Office for Social Inclusion. They continued to fund our work. We talked about the different offerings, that is, the education, the training and the support our organisation supports. That is the key daily work of TENI. Even this year to date we are already at 987 unique contacts to our organisation of people asking for support or resources, so we know we are on pace to have one of our busiest years in respect of those support requests. That is why our organisation is continually looking to expand and to provide more direct services to trans adults and children and families. This year we have started two more adult peer support groups. We are also about to start two more TransParenCI groups. There is continual growth there in respect of the direct support that is needed for our community. That is what we are going to continue to do.

I will let Dr. Lacey talk a little more about the education side of the work she has done.

Do Dr. Lacey or Ms Keane wish to come in?

Dr. Vanessa Lacey

I agree with the last two speaker about the curriculum. I fully agree with Ms Griffith that the curriculum is key. Young gender non-conforming people in school do not have visibility in their own school books. There is diversity in other aspects of humanity reflected but there is no information around gender diversity. It is an important part. Ms Carroll mentioned the post primary research launched last year by ourselves and the University of Limerick. Similar research on primary schools was published in 2018 by Cross and Neary, which was very interesting on visibility and visibility is key for validation and who people are. It can be quite a lonely place as the Senator said, with young people tolerated - although I am not sure that I like that word - in school. Information and visibility should be in the curriculum. I look forward to seeing what comes from that process.

Our funders, the HSE National Social Inclusion Office and the National Office of Suicide Prevention have been very supportive of our work and I hope that will be ongoing. It is great to see the family support groups develop and the TransFormer groups. Undoubtedly, there will be extra challenges after Covid, not only on the lives of young trans people. We often look at the lives of young trans people but there is also older trans people, some of whom are going into their twilight years - I might include myself in that. That would include residential care, a big item in terms of Covid which no one speaks of. We really need to look at residential care and training those working in the sector about transgender identities into the future. People working in the residential care service have been incredible and do incredible work but delivering training in that sector is important work.

Ms Sinead Keane

To add to what the others have said on schools, as well as seeing themselves in the curriculum there needs to be work to create more safer, inclusive schools for LGBT young people. We published research called the School Climate Survey in 2018. We spoke to more than 700 LGBT young people in post-primary schools in Ireland. Some 73% told us they do not feel safe in school in Ireland today, 68% heard homophobic remarks from other students and 48% had heard homophobic remarks from other teachers or staff members. The data in that report was really shocking. What LGBT young people experienced at school ranged from verbal and physical harassment to sexual assault. We have done a lot of work as Ms Griffith mentioned through our safe and supportive schools project. For 11 years, we have also run a campaign called stand up awareness week. It is primarily an anti-bullying campaign to reduce the homophobic, biphobic and tranphobic bullying in schools. It also aims to create a more inclusive, safer space for students in school. The issue goes beyond RSE and the curriculum into the everyday experiences of LGBT students in their school too.

I thank everyone for their contributions. It was very enlightening. Residential care for older people is something that we might not necessarily have thought of. One thinks of younger people, but it is something that as a committee, we will look at in the round. It is certainly something that must be taken into consideration.

I agree with what is being proposed about sex education, that we need to keep on top of it and make sure that the good work being done is implemented on the ground and, more importantly, its outcomes monitored so we can be sure it is achieving what we want it to achieve. This has been a very productive engagement and I thank everyone for their time. It will feed into our report and hopefully that report can lead to some changes at Government level.

I have some questions myself. Around education, should it be a compulsory subject for all schools? Is it an area of reform for the social personal and health education?

I am really shocked and saddened to hear of those in the LGBTI+ community are twice as likely to self harm, three times more likely to experience suicide ideation and four times more likely to experience anxiety and depression compared to their non-LGBTI+ friends. The people here are doing phenomenal work. I am thinking about access to mental healthcare for members of the LGBTI+ community online. What kind of supports are online?

Everyone here is inspirational and doing brilliant work. As Senator Conway said, they have really enlightened us about everything going on and I am grateful. I would not have been aware about the impact on mental health in particular and how devastating it is. How can we as a committee support the organisations here in the phenomenal work they are doing?

Dr. Vanessa Lacey

I want to thank everyone for their really insightful and helpful questions this morning. The committee has already helped us by giving us a voice, which I really appreciate.

I mentioned the HSE report on the development of transgender identity services published in December 2020 a few times. In its report, the committee could suggest an external review of the process of meeting the needs of its nine recommendations. That would be so helpful. We work with HSE colleagues and have good relationships with them but an external view would be very useful.

As workers, we live with the matter of suicide ideation every day, and the appropriate handling of every email and phone call. Unfortunately, a few weeks ago I was aware of a family that lost their young person. It has a devastating impact. People suffer a loss of power over their lives and a loss of hope. The research highlights the impact on the quality of life on transgender people and gender affirming treatments is a main part of that. We are really lacking in that in Ireland. Everything goes back to the same thing, namely, the exclusion of trans-sensitivity in the development services which were recommended in the report.

We are aware of suicide ideation on a daily basis. We absolutely have to advocate for and fight on behalf of our young people, our older people and our families. That is what it comes down to. As much as we spent two hours on this call this morning and are very grateful for the opportunity, we can have reports until the cows come home but what we really need is action. If nothing else, we need action. That is my final point. I do not want to take any more calls from parents in that situation. We need to give them a voice and we need to move forward. We really need the committee's help.

Ms Moninne Griffith

In terms of it being a compulsory subject, in an ideal world I would love to see LGBT lives, experiences, history, culture and all the wonderful things that go along with our community, as well as some of the sad things, included on the school curriculum. However, as I said before, I believe it needs to be wider than that. The national action plan on bullying did include homophobic and transphobic bullying as issues which schools must compulsorily report and take action on but we need to go much wider than that. That action plan on bullying needs to be reviewed and updated. Schools really need to be supported with additional resources to engage with organisations like our own and the Transgender Equality Network Ireland, TENI, to upskill, build capacity and build confidence among staff so that they can address homophobic and transphobic bullying when it occurs in a school.

Of course, such bullying is going to go on in a school. Any school that says that this does not go on within it has its head in the sand. It goes on everywhere so of course it is happening in schools. The schools that say it is going on can at least do something about it. It needs to be wider than that. It is about inclusion. LGBT teachers need to feel safe in school. The Irish National Teachers Organisation carried out research earlier this year or late last year which found that thousands of LGBT teachers in Ireland do not feel safe being out in schools. That is an indication. If the teachers do not feel safe to be out, how could one hope for students, who are experiencing a very different power dynamic or situation from that of teachers, to feel safe?

With regard to access to mental healthcare, we have learned a lot from the Covid pandemic. Colleague organisations with which we work such as Jigsaw and Pieta now have all of their services online. These bodies are LGBT inclusive and that is great when services are available but, going forward, we need LGBT people to have free access to online counselling or, where necessary, face-to-face counselling, because online counselling does not suit everybody. We are about to embark on a pilot with MyMind and the National Office for Suicide Prevention with regard to providing online counselling free of charge to young people who cannot afford it. I am quite certain that this will be booked up in no time at all.

We know from our colleagues in Pieta that some young people, and especially some of our trans young people, may get over a period in which they are feeling suicidal or engaging in self-harm and finish their course before going back to their normal lives only for something else to happen that triggers that suicidal ideation again, causing them to return to Pieta. It is somewhat of a revolving door. There needs to be something in between young people getting support from peer groups and youth workers who are not clinicians to combat that isolation and feeling of being completely excluded, support which may help in dealing with bullying, and the extreme end of matters at which they need the help of Pieta. We need something in between that is accessible to these young people and which is LGBT inclusive.

Something which has been absolutely brilliant throughout the Covid pandemic is the HSE's National Office for Suicide Prevention. This office has been providing front-line workers, including youth workers, who have been impacted by Covid with counselling. That has been very important to many of the youth workers who were working in Dublin and throughout the national network across the country. These workers are experiencing vicarious trauma because they are working with young people who are experiencing extreme trauma in their lives. One youth worker who was on the phone to me said that she had lost two young people to suicide in the space of a couple of weeks. These kinds of services are beyond her budget but we were able to source something for her free of charge through our colleagues in the HSE. These are the kinds of thing that need to happen even after the Covid pandemic because we have learned that this kind of vicarious trauma, including gender identity-based trauma, existed before Covid but has been compounded. It would be a really good idea to continue those services.

Ms Éirénne Carroll

I echo what my colleagues have already said. LGBTI+ education should be part of all education. LGBTI lives are not new. They are around. Just because it is not taught in school, it does not mean it does not exist. We need to continue to move forward in supporting education that is fully inclusive of all people. With regard to mental health, we need to continue to resource our mental health professionals. We need to give them the resources to understand LGBTI+ lives and experiences to allow them to better support LGBTI+ people. The support of the committee today is very helpful. All members of the committee expressed care and compassion. I ask that each member continue to spearhead the work that needs to get done, especially with regard to including trans voices and trans organisations in the development of trans healthcare and making sure that the report is implemented rather than another report about that report being done. As we go forward, we must also continue to work against things like conversion therapy and support legislation against hate speech.

Ms Moninne Griffith

I will just refer to something which came up in recent weeks at another committee meeting with regard to bullying in schools, which I want to reiterate before this sub-committee. It relates to access to counselling in both primary and post-primary schools. Teachers are not qualified counsellors. The National Educational Psychological Service provides psychologists whose purpose is to support schools in respect of behavioural issues, bereavements in schools and lots of other things. They do a great job of that but we need counsellors. Colleagues of mine have called for this. It makes absolute sense to assign professional counsellors to groups of schools who would be available to all students, not just LGBT students, when needed.

It is 1 p.m. so we will have to finish. I thank the representatives who came in today from both organisations, BeLonG To Youth Services and TENI. We are very grateful to them. They have given us some really fantastic insight. To think that people's lives are in danger because of who they are is absolutely shocking. I thank Dr. Lacey, Ms Griffith, Ms Keane and Ms Carroll for coming before the committee today. I ask them to please keep in touch with us.

The joint sub-committee adjourned at 1 p.m. until 12.30 p.m. on Thursday, 17 June 2021.
Top
Share