Inadequate mental health services and long NHS waiting times contributed to the death of a 28-year-old trans woman, a coroner has ruled, warning that more trans people could die “unless action is taken”.

At the time of Sophie Williams’ death on 20 May 2021, the Northern Irish artist and activist was under the care of Barnet, Enfield and Haringey Mental Health NHS Trust (BEH) in north London and had been waiting for a first appointment at a UK gender identity clinic for nearly five years.

Inadequate care provided by BEH and distress caused by immense wait times to access trans healthcare were among factors that “exacerbated” Williams’ mental health symptoms and “contributed to her death”, ruled assistant coroner John Taylor in a report handed down on 1 March by the North London Coroner’s Court. “There is a risk that future deaths will occur unless action is taken,” he warned.

Speaking to openDemocracy after the inquest, Sophie Naftalin, a solicitor representing Williams’ loved ones, said the inquest “tells a story of a mental health system in complete crisis” and of a “complete and abject failure in terms of the mental health support provided”.

Naftalin added: “This was exacerbated by Sophie’s additional needs and barriers as a trans woman, and because there was no recognition of these needs within the service.”

In a statement shared on Instagram, We Exist, an organisation that Williams co-founded to support trans communities with grants to access healthcare and cover living costs, said: “Taylor’s conclusions “confirm what we, the trans community, our families and our comrades already know: that structural barriers to care, institutional discrimination and denial of access to life-saving gender-affirming treatment have caused and will continue to cause the deaths of our loved ones far before their time”.

“Sophie’s death was not an isolated incident, but is a recurring tragedy for transgender people throughout the UK. Far too many trans lives have been lost by institutional neglect and denial.”

Institutional neglect

Over three days, between 17-19 January 2023, the coroner heard evidence that BEH had failed to support Williams with appropriate and gender-affirming care.

The court heard of Williams’ “concern” and “anxiety” that the Trust had not provided her with a long-term care plan or a key worker – which left her with “very limited prospects of quickly and easily getting short-term, crisis help”, Taylor explained.

BEH had also failed to carry out its own diagnosis and risk assessments, and did not take reasonable steps to manage risks posed to Williams’ life by dissociative episodes.

Two days before her death, the Tavistock Gender Identity Clinic informed Williams, a Northern Irish artist and activist, that the four years she had spent waiting for a first appointment at Belfast’s equivalent service would not be recognised or count toward her wait-time at the London clinic. Taylor said this news was “devastating” for Williams and left her “raging”.

‘Mental health system in complete crisis’

The inquest into Williams’ death was an ‘Article 2’ inquest, explained Sophie Naftalin, a partner and solicitor at Bhatt Murphy, which represented Williams’ partner Rupi Bond and her friend Toby Attrill throughout the inquest.

“This is invoked where there’s a suggestion that the state knew or ought to have known that someone’s life was at risk, but failed to take reasonable steps to protect that person,” she said.

“It was really important for Rupi and Toby, and Sophie’s wider friendship circle and trans community, that the inquest look at the broader systemic issues and failures that contributed to her death,” Naftalin told openDemocracy.

She explained that local NHS Trusts aren’t required to provide training on delivering gender-affirming care or the needs of trans patients – including how NHS wait times and the “daily stresses” of being a trans person in the UK might impact on patients’ mental health.

Instead, BEH assigned Williams a therapist who misgendered her and asked questions such as ‘when did you decide to be trans’ – remarks that the coroner’s report recognises as being “highly inappropriate”.

“This was really upsetting to Sophie,” Naftalin said. “This was someone who clearly didn’t get it, and that really undermined their therapeutic relationship”.

‘Future deaths will occur’

The assistant coroner also issued a report with recommendations to “prevent further deaths” including better liaison between all services involved in the provision of care for trans people; training for clinicians at local NHS Trusts on the needs of trans patients; and improved mental health support for trans people waiting for a first GIC appointment.

“In my opinion, there is a risk that future deaths will occur, unless action is taken,” Taylor wrote in the report, which was shared with the BEH Trust, NHS England and the Tavistock and Portman NHS Trust, “I believe your organisations have the power to take such action.”

Each of these groups now has a statutory duty to respond to the recommendations by 24 April, providing details and a timetable for action or explaining why no action has been proposed.

‘Apathetic state’

Speaking to Novara Media, trans writer and activist Shon Faye said Williams’ death amounts to “social murder”. Cuts to healthcare by successive right-wing governments, both in the UK and around the world, have created a “scarcity mentality”, she explained, resulting in a fractured left-wing movement comprised of disparate groups who understand their needs to be in conflict with one another.

But failures in mental health services affect both cis and trans people, Faye continued. The UK’s mental health services have been “decimated” by successive right-wing governments. “Where people die because they’re left for years languishing without support, it does amount to a sort of social violence – that is equivalent to murder.”

Faye pointed to the inadequate and overlapping ill-treatment of pregnant people, disabled and chronically ill people, as well as people with underlying health conditions throughout the pandemic. It’s getting harder for women in the UK to access an abortion, she added, writing: “If you have a body that is in any way marginalised by the gender binary”, whether you’re a cis woman or a trans person, “we have a state that is largely apathetic to your pain – both physical and emotional. And I think that should be the start of a broad point of coalition”.

In a press release by solicitors Bhatt Murphy, Williams’ friend Attrill said: “Sophie was an astounding woman… She was dedicated to the liberation of all people, a feminist, a believer in a united Ireland, and the co-founder of We Exist.

“Sophie was failed by the institutions which were meant to provide care for her and which were meant to keep her alive.”

In a statement shared on Instagram, We Exist London wrote: “While we welcome the conclusions, it is not justice. Only with the enactment of systemic change can we get justice. We stand in solidarity with all trans people, their loved ones and their families. Rest in Power Sophie Gwen Williams.”