The psychiatric assessment can seem like a daunting process but it is vital in terms of providing an assessment of the situation with the individual, looking at the options together and offering support in making the right decisions at the right stage.

The following is a guide to understanding the assessment process itself, why it is important and what sort of questions are asked.

Advice for those who have an assessment

Before going to the appointment it is important to know that you don't have to have made any decisions in advance so don't feel under any pressure. In fact, it is recommended that people seek specialist help as early as possible so that you can access help and support before making any life-changing decisions. There is no expectation for you to have the "right story" or present yourself in any particular (and often stereotypical) way. Although some people like to attend the appointment as their true gender by dressing-up or changing their usual appearance, this is certainly not expected. You should not feel pressurized to turn up in a certain way to make a point - what is more important is for you to feel as relaxed and as comfortable as possible.

Aims of the psychiatric assessment

There are a number of different objectives of the assessment process and the psychiatrist will have the following on his or her mind:-

1. Explore the gender issues in detail and what they mean to the individual.

2. Make a diagnosis of transsexualism, if appropriate.

3. Exclude any important co-existing medical or mental health problems.

4. Assess the readiness of the individual to look at treatment options, including the Real Life Experience, hormonal treatment and/or surgery.

5. Identify barriers or obstacles to achieving goals with treatment and transition.

6. Offer advice regarding ongoing support for the individual, families and friends.

Questions asked at the assessment

There are different areas to cover during the assessment. Emphasis is given on the background history, in terms of family relationships and early experiences, any family history of mental health problems or gender issues and an understanding of how the individual developed emotionally in the context of the family environment.

The gender history is explored in detail. This includes any medical concerns at birth regarding gender and important developmental milestones, such as the first realisation around gender and how that influenced childhood experiences. In particular, the psychiatrist will focus on how the individual developed as male or female, such as what sort of games and activities engaged in as a child, relationships with male and female peers and personal perceptions around gender feelings. For many people, gender dysphoria is present from early memories and this is discussed in detail. Cross-dressing experiences are explored and the associated emotional and sexual feelings related to this. Puberty and sexual development is also examined and understood in the context of intimate relationships, sexual experimentation and views around sexual preference. All these feelings are often difficult to talk about, but it is important to understand how these evolved over time as the indivual matures into an adult, bringing everything into context to current feelings and concerns.

As the assessment is also a medical assessment, questions are asked about physical health problems, previous contact with psychiatric services and any current mental health problems. Tablets and medications are listed and information sought about social and lifestyle choices, such as smoking, street drugs and alcohol consumption.

Although there is no expectation for decisions to have been made, the assessment will involve asking views around the way forward. The goals regarding what treatment is wanted, if any, are discussed and what needs to happen in order for these goals to be reached. Treatment involves some difficult choices around preparing yourself to start the Real Life Experience test, managing the stress and emotional reactions and seeking further advice before startng life-changing treatments. Managing this stress is explored and any obstacles or concerns are addressed as much as possible. Explanations regarding the time-frame involved in realistically accessing the treatment required is considered with steps planned in advance, if necessary.

Finally, there is an opportunity to have a discussion around diagnosis and feelings around the readiness of the individual to seek further advice. This is likely to require a longer period of assessment and perhaps a referral to the specialist gender services, if necessary. There will also be an opportunity to ask any questions, so it is often helpful to have prepared a list in advance!

Following the assessment, the psychiatrist will send a report to your GP and/or the person who referred you for assessment. It is possible to ask for a copy of this report to be sent to you. It is common practice for this letter to also be copied to the individual, so don't be afraid to ask to see it. It is about you, after all!