Key findings of the Appleby review of suicides and gender dysphoria at the Tavistock and Portman NHS Trust

Richard Armitage is a GP and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on X: @drricharmitage

The Appleby report is ostensibly a response to claims made on social media¹ that there has been a substantial increase in suicide rates in current and recent patients of the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust. These, it was alleged, followed the restriction of puberty-blocking drugs that followed the Bell v Tavistock High Court judgment² in December 2020. The Appleby report refers to a rise being described by the legal campaign group, The Good Law Project as a “surge” and “an explosion” in suicides, and multiple references made to children dying in the future due to the inaccessibility of puberty-blocking drugs. A specific claim quoted was that there was one suicide by a patient on the GIDS waiting list in the 3 years prior to the High Court judgment, and 16 deaths (rather than suicides) in the subsequent 3 years. These claims have been retweeted many times by other activists and members of the public, and have been repeated by some journalists.*

Professor Louis Appleby – Professor of Psychiatry at the University of Manchester and Chair of the National Suicide Prevention Strategy Advisory Group – was asked by Health Secretary Wes Streeting to review data provided by NHS England on suicides by young patients of the gender services at the Tavistock and Portman between 2018-19 and 2023-24, and to specifically examine evidence for the campaigners’ claims. The data were based on an internal audit by the Trust of deaths among current and former GIDS patients. The independent report was published on 19 July 2024.¹

Appleby begins by recognising the generally poor quality of the existing evidence on suicide risk in children and young people with gender dysphoria, and acknowledges the existence of known risk factors for suicide within this group, including mental health conditions such as depression and anxiety, high rates of autism, isolation, and family conflict. He then notes the unreliable nature of evidence for “gender-affirming care” in the form of puberty-blocking drugs, and cites the recent robust study from Ruuska et al. in Finland,³ which found that suicide risk was reduced after gender reassignment but that this improvement was explained by the treatment of co-existing mental illness.

He then discusses the important role of the media in responsibly reporting suicide as a central feature of the national suicide prevention strategy in England. While originally intended for news media, this guidance is increasingly relevant to users of social media, and requires media to ensure claims about suicide are evidence-based and from a reliable source, to avoid alarming and dramatic language, to avoid implying that suicide is the expected or likely outcome in particular situations, and to avoid oversimplifying suicide by attributing it to a single cause (which others might identify as sharing or being connected with).

Appleby then presents the findings of his analysis. A total of 12 suicides took place during the period of 6 years: 6 in the under 18s, 6 in those 18 and above. 5 took place in the 3 years prior to 2020-21, and 7 in the following 3 years, a difference that would not reach statistical significance. In the under 18s group, there were 3 suicides before 2020-21, and 3 after.

Accordingly, Appleby concludes that the data support neither the claim that suicides rose substantially following the High Court judgement, nor the claim of one waiting list death prior to the judgement and 16 after it. He goes on to say that this issue has been discussed on social media in an “insensitive, distressing and dangerous” way, which “goes against guidance on safe reporting of suicide.” He recognises that the claims fall short of basic standards for statistical evidence despite being inserted into and amplified within the public domain, states that the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of healthcare should be abandoned, and calls for high quality data to be the foundation of improved safety for this at-risk group.

*The facts here are taken from the July 2024 Appleby report for the UK government, which can be accessed below

References

1. L Appleby. Independent report. Review of suicides and gender dysphoria at the Tavistock and Portman NHS Foundation Trust: independent report. Department of Health and Social Care. 19 July 2024. https://www.gov.uk/government/publications/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust-independent-report [accessed 22 July 2024]
2. BBC News. Children not able to give ‘proper’ consent to puberty blockers, court told. BBC News. 07 October 2020. https://www.bbc.co.uk/news/uk-54450273 [accessed 22 July 2024]
3. S Ruuska, K Tuisku, T Holttinen, et al. All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study. BMJ Mental Health 2024; 27: e300940. DOI: 10.1136/bmjment-2023-300940

Featured image by Peter Chiykowski on Unsplash