CAMH to 'wind down' gender identity clinic after damning review of services

TORONTO -- The Centre for Addiction and Mental Health is "winding down" its gender identity services for children and youth after an external review found its approach was out of step with currently accepted practice.

CAMH made the announcement Tuesday after releasing the report by two independent reviewers, who were tasked early this year with assessing services provided by the Toronto centre's Child Youth and Family Gender Identity Clinic.

The review was sparked by criticisms from the transgender community and others that the CAMH clinic headed by psychologist Dr. Ken Zucker was practising reparative therapy on young people who were questioning their physical gender.

Reparative, or conversion, therapy discourages those who identify as transgender from embracing their non-biological sex. The practice has been deemed unethical by major international medical and human rights organizations.

The reviewers, Dr. Suzanne Zinck of Dalhousie University in Halifax and Dr. Antonio Pignatiello of the Hospital for Sick Children in Toronto, said in their report they were unable to ascertain whether the clinic was in fact practising reparative therapy -- a charge that staff had denied.

But the two psychiatrists said the clinic appeared to operate as a fairly insular entity, with a focus on "intensive assessment and treatment." Current practice in dealing with gender-questioning children and youth favours watchful waiting, while educating and supporting parents to accept a child's gender expression.

Dr. Kwame McKenzie, medical director of CAMH's Child, Youth and Family Program, said services at Canada's largest mental health centre are expected to reflect the latest and best practices in the field.

"We want to apologize for the fact that not all of the practices in our childhood gender identity clinic are in step with the latest thinking," he said.

Zucker, said McKenzie, is "no longer at CAMH," although he would not say when he left his position or whether the psychologist had been fired or resigned.

The director of Rainbow Health Ontario, an organization that works to improve access to services for the LGBTQ community, lauded CAMH for arranging the external review and its response to the findings and recommendations.

"I congratulate CAMH for taking this step, for being public and open about it, for the transparency," said Anna Travers.

Ontario MPP Cheri DiNovo said the CAMH announcement heralds "a new day dawning" for the transgender community.

DiNovo, the NDP's LGBTQ critic, introduced the private member's bill that became the province's Affirming Sexual Orientation and Gender Identity Act in June. The act prohibits doctors from using conversion therapy on LGBTQ kids and teens under 18, while delisting it as a covered service for adults under the province's health insurance plan.

"It's always difficult for an institution, especially one the size of CAMH, to be self-critical, so I would just say kudos for being able to be self-critical and for finally keeping up with the times," she said.

"The fact that they admitted that they made mistakes, that that wasn't the way to go and that they're going to be revamping the policies is a very good thing."

Zinck and Pignatiello's report recommended that CAMH engage with the transgender community and key organizations to determine its future direction.

In releasing the external review, CAMH announced it has created a three-pronged plan to update and improve its services.

Besides winding down the clinic -- it will remain open for the time being to provide services for about 20 to 25 current clients -- CAMH plans to consult with community and academic organizations, clients and families to determine what role it should take in gender identity services and how it can best help clients.

"Early next year, we will start to talk to the community about what we should be doing," said McKenzie.

"What sort of supports do people need? Should that be at CAMH? Should that be in the community?

"We're going to work with the community to build something else. Once we know what that something else looks like ... (we'll know) exactly what CAMH's role should be."

Travers agreed there should be some consultation, "but I don't think we necessarily have to locate these services in a psychiatric hospital."

"I think it's time for a new look at how to help families and children. I think it's time for us to look at what people actually need."