Sitting together in the light-filled living room of their family home in Surrey, Caroline and Peter Litman finish one another’s sentences, as can happen after 28 years of marriage.
“We’re not the most well-informed,” says Peter, 57, who wears a small ‘trans ally’ pin on his T-shirt.
“We make mistakes and don’t always use the right words,” adds Caroline, 56.
“But what we hope we can do to help the trans community is humanise the debate. This is just an ordinary family; a coherent, loving family that’s been ripped apart,” Peter continues.
“Not because Alice was transgender,” his wife says, “but because of the reaction to her being trans.”
Their youngest daughter, Alice Litman, was 20 years old and living in Brighton with a close friend when she died on 26 May 2022. Her parents believe firmly that their daughter’s struggles to access timely mental health intervention and gender-affirming care contributed significantly to her death.
Next week a coroner will deliver her written conclusions regarding Alice’s death, and has already stated the evidence before her suggests healthcare provision for transgender people is “underfunded and insufficiently resourced for the level of need that the society we live in now presents”.
Reading Caroline’s witness statement for the inquest, where the family were supported by the Good Law Project, her fury and frustration radiate off the pages as she describes the repeated minimising and dismissal she encountered. “It was an immense battle to get her taken seriously,” she says now.
It was a “complete surprise” to Peter and Caroline when their youngest child – dancer, rugby player, who wanted to be like “that cool science guy [Einstein]” when she grew up – told them she was questioning her gender identity.
The family were aware that something was troubling the 16-year-old: she was increasingly anxious and her school attendance suffered.
Caroline recalls asking her: “Are you in some sort of trouble, has someone asked you to do something illegal, are you being bullied?’ But I didn’t ask her if she was transgender. It’s something I’m a bit ashamed of.”
Caroline herself worked as an NHS psychiatrist for 12 years – quitting the profession over a decade ago partly because, with no small irony now, she acknowledges, she was demoralised by the “sticking plaster” nature of her job.
It was a background, she freely admits, that had presented her with a particular view of gender dysphoria as a psychiatric disorder. “We were taught stories of people who wanted to cut off body parts because they didn’t feel they belonged to them, and that these people were deluded and psychotic.”
Her immediate anxiety was what surgery Alice might seek; Peter worried about her losing her fertility. “But who knows what choices she’d have made if she’d had the right treatment at the right time?” he says. “There is an obsession in our society with what’s between your legs.”
Instead, they found themselves relentlessly advocating for their increasingly depressed and isolated daughter, who was finding her experience of being “in the wrong body” tortuous as puberty advanced, with no immediate prospect of specialist care or the hormone intervention she desperately wanted.
The waiting list for the youth service at the NHS Gender Identity Development Service at the Tavistock was 24 months when Alice joined it in 2019, a year after she first discussed her gender identity with a GP. Although that controversial service has since been shut down, with an independent review recommending the creation of regional hubs, there were still 7,560 under-18s on the waiting list as of May.
After Alice’s referral, she began to socially transition, and the family hosted a tea party to celebrate Alice joining the family: Caroline remembers her beaming and skipping around the kitchen. But soon her hopelessness at the looming wait for treatment returned.
Alice was transferred to the Tavistock’s adult gender identity clinic when she turned 18, but was still waiting for an initial assessment when she died. The adult service has a waiting list of more than 13,000, the inquest heard, with an estimated five-year wait.
In desperation, the family sought private treatment, but Alice was unhappy with the prescription she received.
They say their experience with Child and Adolescent Mental Health Services was just as difficult. Caroline recalls leaving early meetings “with the feeling the diagnosis was bad parenting”.
There was the GP who suggested Alice play more football, and the nurse who blamed her low mood on “lifestyle choices”.
Alice tried to kill herself twice in 2019. Then, three months after the second attempt, she was “suddenly cast out of care”, Caroline says, and discharged from mental health services altogether after she turned 18.
Regardless of the inquest outcome, the family – Alice had two older siblings, Kate, 26, and Harvey, 25 – want to add their voices to calls for systemic change.
“The gender identity clinic needs to be completely overhauled,” says Caroline, “but no amount of money or specialists is going to reduce a waiting list of that length. Without proper planning, they can’t just keep doing more of the same. The only realistic way we see to reduce the waiting list quickly is through primary care.”
GPs need proper guidelines, adds Peter, to assist them in supporting and if necessary prescribing hormone treatment to transgender patients. “That’s what most developed countries do and what most transgender people want.”
Surrounded by framed photos of grinning siblings, the couple are painfully aware of the toxic public discourse that has developed around transgender issues.
“She told us she didn’t deserve to live,” says Caroline. “She didn’t specifically say it’s because people hate me, but that must have preyed on her mind.”
She attended Pride in London in 2019, but had no desire to be an activist, says her father. “She just wanted to be left alone, to be allowed to live the way she wanted to.”
The couple stay clear of social media, but Kate – who posts online about the family’s nascent campaign – has described being “flooded with hateful comments” during the inquest.
“You’re afraid of what people are prepared to say to you about the death of your daughter,” says Caroline. “You don’t have to point out my failings as a mother. I feel guilty every single day that I wasn’t able to save her.”
Despite her struggles, Alice sustained close relationships with her school friends. “They are the loveliest bunch,” says Caroline warmly, “and they’ve helped us know her a bit better.”
Alice loved to play the fantasy role-play game Dungeons and Dragons. “We used to hear her upstairs getting so emotional about it: squealing and roaring and getting cross,” Caroline recalls.
But her laughter cuts off. “I’m sad now, because we weren’t really interested and I wish I’d paid a bit more attention.”
Speaking about their daughter, they are constantly triaging one another’s grief. “You did listen to her,” Peter whispers to his wife, placing a hand on her knee.
“We had a very close relationship,” he adds. “We were very able to articulate how much we loved each other. I have a lot of regrets, but we’re very confident that Alice knew she was loved.”
