Trans people are at risk of death due to lengthy delays in accessing NHS gender identity treatment, a coroner has ruled, after a trans woman died in a fall from a tower block window.
Armanih Lewis-Daniel, 24, was found dead in a car park below her seventh floor flat in Highview House, Chadwell Heath, on March 17, 2021.
An inquest heard she had suffered a mental health spiral after waiting more than two and a half years for an appointment at the Gender Identity Clinic, and had also faced a two-year wait for an autism assessment.
Coroner Nadia Persaud was told the average wait time for gender identity treatment is seven years, and has now issued a report to the NHS warning of further deaths if action is not taken.
She said an expert told the inquest "long waiting lists could intensify distress arising from gender dysphoria", while "there is little local support available to patients who are waiting for assessment and treatment by Gender Identity Clinics".
"There was a lack of clarity as to who is responsible for the wellbeing of the patient during the waiting period, for any distress caused by the gender dysphoria," said Ms Persaud.
"Local mental health services have very little specialist knowledge as to how best to support a person suffering from Gender Identity Dysphoria."
She said inquest witnesses were "unclear" about guidance in this area to GPs, including on the prescription of bridging hormones while the patient is waiting for a clinic appointment.
"There is a concern that primary and secondary/tertiary services are not working optimally, to support those during the lengthy waiting periods," her report concluded.
The report was published on the same day as the Government's long-awaited new guidance on transgender in schools, which said teachers do not have to use pupils' preferred pronouns or accept a child’s request to socially transition.
Amarnih’s inquest heard she suffered from emotionally unstable personality disorder, anxiety and depression, anger management difficulties, and gender dysphoria.
She had suffered bullying and abuse and had been taking unprescribed hormones, the hearing was told.
"The hormone medication was not supervised by any healthcare professional," the coroner said.
"In the months leading up to her death, Amarnih’s mental state declined, and she came into contact with the police, criminal justice system and mental health professionals.
"On the 17 March 2021 she jumped…and sustained fatal injuries in the fall. Amarnih was still awaiting care from the Gender Identity Clinic when she passed away."
Amarnih’s mother, Angela Lewis-Campbell, described her daughter as "kind-hearted, protective and fiercely loving".
She added: "She knew what it was like to be bullied, and, because of this, she did everything within her power to ensure that others did not have to feel the way she did."
Lawyers for the family, from Imran Khan and Partners, INQUEST, and One Pump Court Chambers, said the NHS "had sufficient contact with Armanih or her close family members to enable them to reasonably know about the risk to Armanih’s life".
They also said there were "red flags" following a "tumultuous" court appearance nine days before she died. Referring to her daughter’s mental health and gender dysphoria struggles, Mrs Lewis-Campbell said she was "like walking along the branch of a tree".
"She felt strong and stable until at some point she simply could not take it anymore and she snapped," she said.
The coroner’s report has been issued to NHS England, with the warning: "Action should be taken to prevent future deaths."
