Trans and non-binary assessment of forensic patients

Increasing numbers of people within forensic histories, including those in the community and those in prisons and secure hospitals, are requesting assistance for trans (in the widest sense) related matters. As trans becomes... [ view full abstract ]

Increasing numbers of people within forensic histories, including those in the community and those in prisons and secure hospitals, are requesting assistance for trans (in the widest sense) related matters. As trans becomes more known and accepted socially, staff who work with these groups who previously may have dismissed such requests are now seeking assistance for them.

Consequently clinicians in specialist gender services are increasingly receiving enquiries and referrals from the forensic sector concerning physical treatments; differentiating mental health issues from trans issues; and differentiating offending issues from trans issues - as well as requests for basic advice on accommodation, name changes, and other trans-related education.

In order to deal with such matters, and to develop appropriate protocols, since 2013 The Nottingham Center for Gender Dysphoria has run a specialist clinic for people with forensic histories. This is a collaboration between a Gender specialist psychologist and psychiatrist and a forensic psychiatrist. This practice-based presentation will outline our work in this area to date.

To review the source of referral, type of offences, and treatment types of 22 people (21 natal male, 1 natal female) with offending histories referred to the Nottingham Center for Gender Dysphoria. To consider the... [ view full abstract ]

To review the source of referral, type of offences, and treatment types of 22 people (21 natal male, 1 natal female) with offending histories referred to the Nottingham Center for Gender Dysphoria.

To consider the implications for treatment of offending for this population.

To consider the implications for assistance with gender for this population.

A clinical notes review was undertaken in August 2016 as a form of audit to give descriptive statistics of the people with forensic histories who were referred to the Nottingham Center for Gender Dysphoria since 2013. ... [ view full abstract ]

A clinical notes review was undertaken in August 2016 as a form of audit to give descriptive statistics of the people with forensic histories who were referred to the Nottingham Center for Gender Dysphoria since 2013.

Clinical review discussions between the clinicians involved in the service derived a series of considerations and recommendations for working with this group.

Descriptive statistics of the offender demographics. Clinical implications drawn from the work. [ view full abstract ]

Descriptive statistics of the offender demographics.

Clinical implications drawn from the work.

Of the 22 people seen in the forensic clinic referrals came from: Prison (n=11); Hospital/low secure (n=6); Internal (n=4); Other Gender Clinic (n=1). Offending consisted of: Sexual offences (n=13) violence (n=7)... [ view full abstract ]

Of the 22 people seen in the forensic clinic referrals came from: Prison (n=11); Hospital/low secure (n=6); Internal (n=4); Other Gender Clinic (n=1). Offending consisted of: Sexual offences (n=13) violence (n=7) (ABH/GBH/attempted murder/wounding); murder (n=1); arson (n=2); robbery (n=2); burglary (n=2); possession of explosive substances (n=1); none – violence/aggression and self-harm in hospital – never been to court (n=1). Outcomes were as follows: Discharge with no treatment (n=7); Ongoing assessment (n=6); Hormones recommended (N=3 [2 community, 1 low secure]); Surgery recommended (n=2 [1 orchiectomy hospital, 1 breast augmentation prison]); Hormones in process (n=2 [1 community and 1 low secure]); Opinion given to another clinic (n=1).

Clinical considerations consist of determining whether gender dysphoria has led to offending behavior (ie shoplifting female clothing due to embarrassment) or vice versa (ie. escape from recognising oneself as a sex offender because 'women don't do that'). In addition, matters such as secondary gain in the prison estate; the violation of trans prisoners rights (and need for professional advocacy); integration of trans elements into the Sex Offenders Treatment Programme; and non-binary/genderqueer people in the binary prison and secure hospital estate must be managed. A full list of assessment considerations is outlined.

Trans people should have timely assistance whether they have forensic histories or not; however the assessment process for those with forensic histories can have significant added complexity due to the possible interplay... [ view full abstract ]

Trans people should have timely assistance whether they have forensic histories or not; however the assessment process for those with forensic histories can have significant added complexity due to the possible interplay between the offence and the gender dysphoria.

In addition, some people with significant sexual offending histories have complex reasons for being troubled about their gender which may not be the same as those people who do not have such histories. These reasons include, but are not limited to, seeking secondary gain from presenting as trans while serving very long sentences.

The Nottingham Center for Gender Dysphoria forensic service are developing theory and protocol from clinical experience in order to aid these various groups to live the best lives their circumstances allow.