PROJECT EVIDENCE for Prevention of Mental Disorders. The project coordinator is Dr Allan Mawdsley. The version can be amended by consent. If you wish to contribute to the project, please email admin@mhyfvic.org
[3] Indicated Programs are those for young people who will inevitably develop mental disorders unless there is preventive intervention.
[3 a ] Biological factors
i Brain injury
ii Chronic illnesses
iii Substance abuse
iv Psychosexual and gender dysphoria
[3 a iv ] Psychosexual and Gender dysphoria
Childhood and adolescence is a time of rapid physical and psycho-social growth and profound personal development. It is characterised by examining many aspects of identity, including sexual orientation and gender. As the child matures and progresses through puberty this questioning usually transforms and resolves and the young person, in the majority of cases, accepts his/her biological sex and adult body.
A small proportion of young people feel that their sexual identity is different to their biological sex and wish to change. This gender dysphoria/incongruence may, in some instances, be a manifestation of complex pre-existing family, social, psychological or psychiatric conditions. A holistic approach includes a comprehensive exploration for these potential conditions in order to more fully understand a child presenting with gender dysphoria/incongruence.
Assessment of family, social, psychological and psychiatric factors is an essential step in the effective and safe management of children and adolescents presenting with gender dysphoria/incongruence. It is proposed that psychotherapy should be a first-line treatment for young people with gender dysphoria/incongruence.
This intervention should be undertaken before medical interventions (puberty-blocking drugs, cross-sex hormones, sex reassignment surgery) are planned. Such interventions are not fully reversible. A few individuals who have undergone hormonal treatment and surgical interventions subsequently report experiencing regret and a wish to de-transition.
Avoidance of such failures highlights the reasons for careful assessment prior to undertaking any irreversible medical interventions. This precautionary statement is the basis for a policy that gender transition programs should only be offered in multidisciplinary specialist settings that have established expertise in this field.
The goal of intervention is to improve the physical and mental health and wellbeing outcomes for trans and gender diverse children and adolescents. Clients should be provided with timely triage, assessment and treatment pathways. A comprehensive, multidisciplinary patient and family-centred approach which collaborates with community-based health and support services will maximise mental health outcomes (quality of life, reduced suicide risk).
A conservative approach, with ongoing psychological care, is appropriate for younger children. Older children who successfully demonstrate stable gender identity may proceed to medical interventions. These include puberty suppression, gender-affirming hormones and clinical education of patients and their families. After an appropriate period of acclimatisation, the definitive medical and surgical interventions may be undertaken. Long-term follow up is arranged.
All specialist programs will include a research component that includes clinical evaluation and analyses outcomes.
Services should comply with “Australian Standards of Care and Treatment Guidelines”.
Last updated 12 February 2021
POLICIES for Prevention of Mental Disorders
[3] Indicated Programs
a) Biological factors
i Brain injury
ii Chronic illness
iii Drug and alcohol abuse
iv Psychosexual and gender dysphoria
b) Psychological factors
c) Social factors
[3 a iv ] Psychosexual and gender dysphoria
MHYFVic advocates that gender dysphoria assessment and transitioning programs be undertaken only at multidisciplinary specialist settings with established expertise in this area.
MHYFVic advocates that the primary goal of gender programs should be to improve the physical and mental health and wellbeing outcomes of the clients.
Last updated 12 February 2021
BEST PRACTICE MODELS for Prevention of Mental Disorders
[3] Indicated Programs
a) Biological factors
i Brain injury
ii Chronic illness
iii Drug and alcohol abuse
iv Psychosexual and gender dysphoria
b) Psychological factors
c) Social factors
[3 a iv ] Psychosexual and gender dysphoria
The Royal Children’s Hospital (RCH) Gender Service aims to improve the physical and mental health outcomes of children and adolescents who are trans or gender diverse. Being trans or gender diverse is seen as part of the natural spectrum of human diversity.
Some trans or gender diverse children and adolescents experience gender dysphoria. Gender dysphoria is a medical term that refers to the distress that a person may experience when there is an incongruence between their gender identity and their gender assigned at birth. Trans and gender diverse children and adolescents have considerably higher rates of depression, anxiety, self-harm and attempted suicide compared to their cis-gender peers.
This is due to their experiences of stigma, discrimination, social exclusion, bullying and harassment. Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.
The mental health service State Government website provides contact details for Victoria’s regionalised mental health services and the suburbs and regions they cover http://www.health.vic.gov.au/mentalhealthservices/.
If you or someone you know needs someone to talk to urgently:
Referrals
Children and adolescents up to 17 years
We accept new referrals from across Victoria for any child or adolescent up to the age of 17 years with concerns regarding their gender identity. A referral from a General Practitioner (GP) to the Gender Service is required.
To facilitate the processing of new referrals we request referring General Practitioner’s please ensure that referrals to the Gender Service:
Once a referral has been received by the hospital a phone SMS from the hospital is sent to confirm the referral has been accepted. All new referrals will receive an appointment in the mail outlining the details of the first appointment. There is a wait time for this.
Referrals can be made to the Gender Service using the interactive Referral form which should then be faxed to (03) 9345 5034.
Adolescents 17 years and over
The RCH Gender Service see children and adolescents for a new assessment up to their 17thbirthday. Adolescents who are 17 years or over may be eligible to access adult services:
Monash Medical Centre Gender Clinic
Referrals accepted from age 17 years
Phone: 03 9556 5216
Fax: 03 9556 5256
There are also a number of community adult services including Northside Clinic, Equinox Gender Diverse Health Centre, Prahran Market Clinic and Trans and Gender Diverse Community Health Services in Preston (PANCH) and Ballarat.
Contact information
Pre-referral
The Gender Service Clinical Nurse Consultant can be contacted on (03) 9345 4719.
Changing new appointments
The Gender Service administration coordinator can be contacted on (03) 9345 5890.
Changing review or follow up appointments
Specialist clinics can be contacted via switchboard on (03) 9345 6180 – specifically ask for Desk D.
The Service
Once a referral has been received by the Gender Service you will be sent an appointment in the mail.
Families who access the Royal Children’s Hospital Gender Service with their child or adolescent will be provided with a family centred approach to care. This will entail a multidisciplinary assessment of their child or adolescent regarding gender diversity or gender dysphoria. As an outcome of the assessment, support and treatment pathways will be offered.
Assessment
When an appointment for your assessment becomes available you will be contacted by our Administration Coordinator to confirm details.
Children under 8 years
The initial consultation for children 8 years and under will entail a review by a psychologist or child psychiatrist. They may be referred later to a paediatrician who specialises in adolescent medicine and gender diversity if required.
Children and Adolescents 8-16 years
Assessment and Support
The initial consultation is the entry point into service for children 8 years and adolescents up to their 17th birthday. This is a one off consultation with the Gender Service clinical nurse consultant or one of our adolescent medicine doctors.
This initial consultation will involve an assessment that will allow the Gender Service team to provide you and your child or adolescent with information regarding the service. As an outcome of this assessment you will be provided recommendations to the relevant supports that are available within the Royal Children’s Hospital and external community organisations.
Treatment
Treatment provided by the Gender Service involves development of a comprehensive management plan made in collaboration with the child or adolescent and their family.
Following your initial assessment you will be offered four appointments with a child and adolescent clinical psychologist or psychiatrist and then a paediatrician both of whom specialise in gender identity.
For pre-pubertal gender diverse children, assistance is provided to develop gender affirming environments both at home and at school. Once puberty starts, options for medical treatment include:
Gender affirming hormone treatment initiates pubertal changes consistent with the young person’s affirmed gender. The timing of hormone treatment is individualised based on the young person’s circumstances. Trans feminine young people can be offered oestrogen treatment and trans masculine young people can be offered testosterone. These hormones are only partially reversible in their effects.
Guidelines
The RCH Gender Service provides care that is consistent with the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (Version 1.3, 2020).
Resources
Australian Standards of Care and Treatment Guidelines
Parent support groups
Support groups for young people
Community information and support services
Education, sport and other information links
Research and evaluation
Research into trans and gender diverse children and young people has been increasing over the past 10 years however, further evaluation and research is required to maximise treatment outcomes. To provide great care to children and adolescents with gender diverse or experience gender dysphoria, the RCH Gender Service is undertaking research and evaluation to better understand gender concerns in children and adolescents. For more information, please see visit Gender Research
Professional affiliations
More about the RCH Gender Service
Last updated 12 February 2021.
We welcome discussion about any of the topics in our Roadmap epecially any wish to develop the information or policies.
Please send your comments by email to admin@mhyfvic.org
Speak about issues that concern you such as gaps in services, things that shouldn’t have happened, or things that ought to happen but haven’t; to make a better quality of service…….
Help achieve better access to services & better co-ordination between services together we can…….
Mental Health for the Young & their Families in Victoria is a collaborative partnership between mental health & other health professionals, service users & the general public.
MHYFVic
PO Box 206,
Parkville, Vic 3052
