English transgender woman (died 2022)
Alice Litman was a transgender woman from Brighton, England, who took her own life in May 2022, aged 20, after spending 1,023 days waiting for her first appointment with the Gender Identity Development Service (GIDS). Her case received criticism due to the duration of her wait to receive gender-affirming care and insufficient mental healthcare. Litman's death led to an inquest and a prevention of future deaths report.
Background.
Litman came out as transgender and first sought medical support with her gender transition from her General Practitioner (GP) in September 2018, when she was 16. Litman's GP vastly overestimated the proportion of people who regret gender transitions, told her the extended delay before receiving gender-affirming care was a good thing, and suggested a "watch and wait" approach. Litman was not referred to GIDS, which works with transgender patients under 18, until nearly a year later in August 2019. This referral came after her first suicide attempt in June 2019, the first of two that year. In March 2020, after turning 18, Litman was discharged from mental health services because she did not meet the threshold for adult intervention, despite having previously attempted to end her life on two occasions at that time. As a result of the GIDS waiting list being too long, Litman's parents contacted Michael Webberley, a co-founder of GenderGP, who then met Litman in September 2019. GenderGP later prescribed cross-sex hormones to Litman in April 2020.
Litman was never prescribed testosterone blockers and became increasingly distressed by this fact over time. Her sister, Kate Litman, said receiving them from the age of 16 when she first went to her GP to ask for trans healthcare "would have stopped transformations in her body which she did not want." On 26 April 2022, before she died, Litman contacted her GP in Brighton via an online form. In her message, she said she had been on the GIDS waiting list for too long, that she needed an appointment, and that she felt hopeless and that her life was not worth living. On 26 May 2022, Litman's body was found on the Undercliff Walk in Roedean, Brighton, after she took her own life. She was 20 years old, had been on the waiting list for GIDS for 1,023 days, and had not had her first appointment at GIDS at the time of her death.
Inquest.
A pre-inquest review was held at Woodvale Coroner's Court in Brighton on 27 January 2023. The court heard Litman was on the waiting list to be seen at GIDS and had received support from the CAMHS (Child and Adolescent Mental Health Services) at the Surrey and Borders Partnership NHS Foundation Trust before being transferred to adult services when she turned 18. Assistant coroner Sarah Clarke said she would examine the availability of trans health and mental health services and the transition to adult mental health services, and recognised that long waiting lists for such services were a national problem. A three-day inquest was scheduled for 18 September 2023.
The inquest was heard over three days from 18 September 2023 by Brighton and Hove Coroner's Court at County Cricket Ground, Hove and was led by the coroner, Sarah Clarke. The inquest was adjourned for two weeks while Mrs Clarke formed her conclusion and the prevention of future deaths report. When it reconvened, Clarke released her conclusions, including that transgender healthcare services have insufficient funding and resources, that Litman's transfer from mental health services for children to those for adults was "non-existent", and that the support she received generally was "half-hearted". The prevention of future deaths report found several matters of concern, including delays to accessing trans healthcare, insufficient mental healthcare for those waiting for trans healthcare, and insufficient training and procedural clarity for those supporting young transgender people.
Impact.
On 13 July 2022, Kate Litman, Alice Litman's sister, wrote an article in PinkNews in which she criticised the absence of gender-affirming healthcare her sister had received and the lack of knowledge in those caring for her. She also gave a speech at the Transgender Day of Remembrance vigil in Soho, London on 14 November 2022. The Litman family ran fundraisers for the charities Allsorts Youth Project and Gendered Intelligence. Litman has been mourned in numerous vigils on Transgender Day of Remembrance.
The long waiting times for gender-affirming healthcare experienced by children and young people, highlighted in part by Litman's case, were one of the failures identified in the Cass Review. Litman's family criticised the review, saying it recommends "gatekeeping" care. As of 30 August 2024[ [update]], Dr Caroline Litman, Litman's mother and a former psychiatrist, is writing a memoir book discussing her daughter's life and death. The book, titled "Her Name is Alice", is due to be published by HarperCollins on 13 March 2025.
References.
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