A James Cook University psychiatrist says the practice of assuming people presenting as gender diverse have no underlying mental problems is wrong and potentially dangerous.
JCU’s Dr Andrew Amos is Chair of the Queensland Section of Rural Psychiatry, Royal Australian and New Zealand College of Psychiatrists (RANZCP), and author of a new paper in the journal Australian Psychiatry.
He said the driving principle of gender-affirming care for transgender patients is that the development of gender diversity never involves mental illness, and one of the consequences is that health care professionals cannot assess – but must only affirm – patient reported gender identity.
“Cases where psychosis is the undeniable cause of gender diversity demonstrate this assumption is categorically false. From a psychiatric perspective the proposition that mental illness plays no role in gender diversity is absurd,” said Dr Amos.
He said gender-affirming guidelines forbid the use of core psychiatric skills for the assessment of gender diversity.
“The political goal of expanding personal liberty has been substituted for evidence-based medicine processes of clinical reasoning, rendering the current gender-affirming guidelines incompatible with competent, ethical medical practice,” said Dr Amos.
He said the RANZCP should either point to the evidence that mental illness does not contribute to gender diversity, or acknowledge that it may be involved in some or all cases and help develop the skills and knowledge necessary for safe and ethical treatment.
“At the moment, unquestioning gender-affirming care is unable to exclude the possibility that it’s worsening the mental illness of some, most, or all of its patients.
“This is unethical, and it’s the responsibility of psychiatrists to ensure that no patients are harmed by this dangerous model of care,” said Dr Amos.
