Lengthy waiting lists and significant barriers that prevent transgender people accessing gender-affirming care in the UK contributed to a decline in the mental health of a young trans woman who killed herself, a coroner has concluded.
Sarah Clarke, the assistant coroner for West Sussex, Brighton and Hove, on Friday delivered a narrative verdict at the end of the inquest into Alice Litman, 20, who had been waiting to receive gender-affirming healthcare for more than three years when she died in Brighton in May 2022.
Clarke raised concerns about delays in accessing gender-affirming healthcare and a lack of clarity for clinicians.
Reading a statement on her family’s behalf, her mother, Dr Caroline Litman, said she was grateful the coroner had given the “full and fierce inquest she promised”, but maintained that healthcare services are “not fit for purpose”.
Her mother said the family, who were supported by the Good Law Project, felt the coroner had listened to the challenges Alice faced. “In her narrative verdict, she really described the problems really beautifully and made us feel validated and heard, where Alice wasn’t,” she said.
“That’s really important for us because, as parents, we really struggle with what we could, should or would have done better to help Alice and it’s really good to have it reflected back from the coroner that, actually, we did do all these things, and we just came up with so many systemic barriers.”
The court heard how Alice had been referred to an NHS gender clinic in August 2019, and had been waiting more than 1,000 days for an initial assessment, which had an effect on her mental health.
Clarke said Alice’s family and friends had described her as “bold and brave, warm and kind” and as “such a well-loved and accepted individual”, but said she fell into a “gap” in the transfer from children’s to adults’ mental health services.
The court heard that Alice was referred to Child and Adolescent Mental Health Services in 2019 after an attempt to kill herself, which was repeated later that year.
Describing the healthcare system as “not fit for purpose” in a statement on behalf of her family outside court, her mother, who was an NHS psychiatrist for 12 years, added: “We’ve heard that if the gender identity clinic continues to see new patients at its current rate, someone referred today would have to wait 20 years before assuming that first appointment.
“We believe that if Alice had been able to access gender-affirming care when she first went to her GP in 2018, she could still be with us today.”
Before the inquest, which took place in Hove between 18 and 20 September, Caroline Litman had described Alice’s death as “preventable with access to the right support”.
The coroner said she would raise a report to prevent future deaths in similar circumstances, which will be sent to NHS England, the Royal College of General Practitioners, the Gender Identity Clinic, and the Surrey and Borders partnership NHS trust.
“We are relieved to hear that the coroner will be sending prevention of future death reports,” Litman said. “It is our hope that these unprecedented reports will help to achieve urgent change.
“We can never bring Alice back, but we will keep campaigning to ensure that all trans people are able to live in dignity and see the healthcare they need and deserve.”
Describing the healthcare system as “not fit for purpose” and referencing the 20-year wait new patients would face before their first appointment, her father, Peter Litman, said: “It’s a good thing, I think, that people realise how big a problem it is. We’re all getting used to waiting lists and having an NHS that is on its knees, but this is different. It is effectively a nonexistent service.”
Alice’s sister, Kate Litman, said the family would continue campaigning for trans people’s rights. “We know that it’s possible for trans people to live happy glorious lives and we want to see those changes so that no trans people are denied that possibility.”
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counsellor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
