Woman's Hour - Weekend Woman's Hour: Emma Webber & Sinead O'Malley Kumar, Gender Dysphoria research, Daisy May Cooper

Episode Date: February 8, 2025

Anita Rani speaks to Emma Webber and Sinead O’Malley Kumar, mothers of Barnaby and Grace, both 19, who were killed in Nottingham in June 2023. They’ll be responding to the findings of a major review of the NHS care of Valdo Calocane, the man who attacked their children. The Oscar-nominated actress Mikey Madison tells Clare McDonnell about playing the title role in Anora, a film about a sex worker in New York. Mikey spent months embedded in a strip club to fully immerse herself in the world. The film is nominated for six Academy Awards as well as BAFTAs and Golden Globes.New research has quantified for the first time how many young people have been diagnosed with gender dysphoria by GPs in England. Anita hears from Professor of Health Policy, Tim Doran, about the work academics at the University of York are doing. They studied a decade’s worth of NHS records and discovered a 50-fold increase in this particular diagnosis between 2011 and 2021. However each general practice will only see one or two such patients each year. The West End star Marisha Wallace, the latest actor to play Sally Bowles in Cabaret at The Kit Kat Club in London, performs a song from the show.The actor and writer Daisy May Cooper talks to Clare McDonnell about the second series of the BBC female-friendship thriller, Am I Being Unreasonable, which she both co-wrote and stars in. Presenter: Anita Rani Producer: Rabeka Nurmahomed Editor: Rebecca Myatt

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petruzzella, and from the BBC, this is Extreme. Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks it will take to feel truly alive.

If I tell all the details, you won't believe it anymore. Extreme peak danger. Listen wherever you get your podcasts. BBC Sounds, music radio podcasts. Hello, I'm Anita Rani and welcome to Woman's Hour from BBC Radio 4. Just to say that for rights reasons, the music in the original radio broadcast has been removed for this podcast. Hello and welcome to another packed programme where we've collated a selection of the standout moments from the week just gone. So, coming up. Emma Webber and Sinead Omali Kumar, the mothers of Barnaby Webber and Grace Omali Kumar, who

were killed in Nottingham in June 2023 by Valdo Calacane. They gave their reaction to the 300 page report made public this week admitting how the system got it wrong with his care and treatment. We have the young actor enjoying a huge Oscar buzz right now, Mikey Madison, as she's nominated for Best Actress for her lead role in the film, Anora. There's been a 50-fold increase in the number of young people who are diagnosed with gender dysphoria since 2011. We'll hear about a new report that has for the first time quantified the actual figures. A performance from the West End star Marisha Wallace,

the latest actor to play Sally Bowles in the musical Cabaret, and the actor and writer Daisy May Cooper on the second series of her BBC comedy thriller, Am I Being Unreasonable?, and the online forum that inspired it. These incredible women who I will never meet and they will never know that it was me, sort of gave me the best advice and support. And I just thought, God, I have to use that in some way. This is my tribute to those women.

All of that is coming up. But first, a major NHS review was published on Wednesday which investigated the care and treatment of Valdó Calacan, a paranoid schizophrenic who killed Barnaby Webber, Grace O'Malley-Cummar and Ian Coates in Nottingham in June 2023. Since that time, their families have fought tirelessly for answers to understand what led to these terrible events. And now this independent mental health homicide report has thoroughly reviewed the NHS care and treatment provided to Calicane by Nottinghamshire Healthcare NHS Foundation Trust and the interactions the NHS had with other agencies involved in his care. It identified numerous failings that show, and I quote, the system got it wrong. Overall, his risk was not fully understood, managed, documented or communicated. Emma Webber and Sinead Omali-Khamar are the mothers of Barnaby and Grace,

both 19 when they died. They both joined me in the studio on Thursday and I asked Sinead how she felt now the report had been finally published. It's such a relief that finally all of the details about the treatment that that father Calicane received are actually out in the open that we can speak about it openly because it's something we've known about for a few weeks. We've been kind of gagged, well we were gagged, we had signed an NDA. So we're really relieved to be able to talk about the failings and try and use this now as Sandra said yesterday, a turning point, you know, a line in the sand for moving things forward.

You were given the report a couple of weeks ago. About three weeks. Three weeks ago. All 300 pages of it. It was commissioned by NHS England and the Themos Consulting who carried out the investigation. Looking at a three-year period from Calicane's first contact with mental health services in May 2020 to June 13th 2023 when he carried out the attacks. It must have been unimaginably difficult to read. What

do you make of the information that's come out of it Emma? Yeah, it's an appalling horror show. It's as bad as you could imagine it might be to hear it and to read it. It was presented to us and at the time, as we've alluded to, we had to sign an NDA and feeling gagged to talk about it was very difficult. But it's really important that this extensive review identifying failings is one of 600 over the last 30 years that are on the 100 Families charity website of NHS investigations into deaths, murders through mental health illness. And I think that's the stark reality that we're facing here because this is six hundred and something in a report. It's not a one-off.

It has happened since, as is evident by the heinous atrocity in Southport, just to name one. And what we're trying to illustrate and did, I hope well yesterday, is that this report is one of nine that we've had to suffer the torture of being involved in and we've had to fight at pretty much every corner. All of those reports across the police forces, across the NHS, they are not in their entirety adequate, they do not address the real situation and the failures and so therefore the call really is yes that happened that's yesterday that's this big awful fat report with catastrophic

findings but we must have the statutory public inquiry because it all has to come out the truth has to be outed and in it still isn't. You described it, I was picking up on you describing it as a horror show what was the most difficult part of it for you to read? When the report was being presented to us, we didn't actually have the opportunity to flick through the actual details of it. But when you look into the minutiae of how some of his care coordinators wanted him or suggested he might have depot or long acting intramuscular medication and he did not have that. He was deemed to have capacity to actually choose not to have that. That was horrific. The fact that the

the risk he posed to healthcare professionals was documented and there was no loan working allowed and it was changed that only two nurses could see him at a time. That was horrific. It's horrific because they knew the risk he posed, they knew how violent he was and the mental health trust just did not treat him. They could have changed the course of his direction. They could have moved him a few degrees away from the 13th of June. Our children could still be alive if he'd have been adequately medicated. He just simply wasn't. And that's very hard to bear. That's so hard because we're just heartbroken, aren't we Emma? We're just heartbroken. And when you hear that simple medical management wasn't followed, it's

changed the course of our lives. It's resulted in our beautiful children being killed, and Ian, and the three others that were injured. It's had such a far-reaching effect and it's heartbreaking. What stood out for you? The detail, having it in front of you, seeing it is, I expected it to be bad. It clearly, there were terrible failures and very poor decision making leadership. But seeing the stark facts of forced sectionings, for violent, escalating violent offenses, the fact that the people on the ground were too afraid to visit him on occasions, they had to plan their exit routes to make sure they knew how to get out.

And the fact that there are numerous instances these these care workers in the community escalating their concerns voicing their concerns about how dangerous to the public he was not just to himself and that didn't go is as the NHS use the term vertically yeah this leadership didn't do anything the the the note-taking is appalling, there's hardly any. We could pick this report apart, but what purpose would that serve? Because it's one of hundreds and hundreds of reports. So now is the time for it to be addressed fully and the point that we've both tried to make very clearly this morning is that we are not witch hunting, we are not here with pitchforks asking for public naming

and shaming but what we are insisting upon and we will make sure we get is individual accountability through the professional means for those people who didn't do their jobs properly. I'm just going to pick another piece that came out of the report that's in September the 22nd, he was discharged from early intervention in psychosis service to his GP and there was no contact between Calicane and mental health services or his GP for roughly nine months from this time until the case. Look, Anita, my husband's a GP, okay?

GPs have thousands and thousands of patients. They get discharge letters from Hospital and various services all the time saying hundreds a week. Yeah, absolutely hundreds a week if not sometimes a day on a Monday, you know, yeah, but Saying oh patient discharged due to lack of engagement What is it? What is a GP supposed to do with a complex patient like valdo calicane? But he didn't know he she that yeah He didn't know I mean, what are they supposed to to do with a complex patient like valdo calicane? But he didn't know. He, she, the GP didn't know. I mean, what are they supposed to actually do with that information? Are they supposed to try and chase them up?

Are they supposed to call them in for an appointment when the specialists can't engage? It's complete. And so I don't blame a GP for not following up on that. The point is, is that the consultant who helped bring this report together, her name was Jane Ubank, Dr Jane Ubank, she said herself, discharging a patient because of non-engagement is very poor practice. Another thing that was highlighted in the report was that the family, Calicane's family said that they weren't listened to.

How does that make you feel? Well, I think we're not here to comment on what the family have or haven't said. You know, they've had their panorama documentary. There's clear attempts that they did and we're not here to read and analyze that. What's painful is to, when you talked about retrial, this report does evidence that what was put forward in the hearing, it wasn't a trial, what was put forward in the hearing to the court by the expert doctors appears to be wrong because he was sentenced based on his treatment resistance, which means that the treatment didn't work. Actually what's evident is that when he did take his medication, it did work.

He did get better every single time. And as his brothers alluded to himself, he's now responded to treatment and they've got him back. They said that a year ago nearly in their Panorama documentary. So how can it be fair? How can that be right that that was allowed to be presented at court? That this individual that was presented at Court was a very very different individual that

Is evident in this report in great detail, so he did respond to medication every single time He didn't want to take it. He chose not to take it. He didn't like needles It's not for us to analyze in great detail what the family did or didn't do, what the healthcare professionals did or didn't do. It's shameful that we're even here. It's lovely as it is to meet you. It's absolutely shameful we've had to do this. And the fact that two police forces had countless missed opportunities to stop him, to change that degree, that course. And I maintain that had all of those individuals across all of those agencies done their jobs properly, Barney would be alive, Grace would be alive

and Ian would be alive. Marjorie Wallace, who's the chief executive of the mental health charity SANE, said the publication of the review should act as a watershed moment. Watershed, that's the word. The NHS has been given six months to consider Themis's recommendations. You say there's nothing to compel the NHS to implement them or any mechanism to hold the NHS to account if they fail. What would you like to see happen? Can I just make a point about this themis report? There's no point going into the great

detail of the great battle we have had to have with NHSE with regards to how they've handled all of this and us and the publication. But what's relevant is that two days before this report was published in full because of the enormous fight and pressure that was very public with the U-turn that 11th hour, two days before that, the decision had been made and an email was received where I was told, Emma, you asked to be kept up to date with what happens for the cost of publication. This report will be sent to all with what happens for the cost of publication. This report will be sent to all mental health trusts across the country.

They will be compelled to read and to implement recommendations. To which I went back and said, that's fine. So can you please confirm what reports who are receiving, what are the media receiving and what are the trusts receiving? What do you mean regarding trust? The email came back and said, I need to know what the trust is getting. Are they getting the executive summary, which is 30 pages, or are they getting the 300 page full detailed? Oh no, no, they'll just be given the executive summary. And I think I just leave it

there. So that's how we improve in this country. That's how those lessons that are learned after all the unreserved apologies, which is a copy and paste in my opinion. That is, how can that be adequate? NHS England, how can that be adequate? You send an executive summary and that's almost like a revelation. Yeah, this is why, you know, a statutory inquiry like the Mids-Daffricher Hospital Inquiry and the Francis Report, that will lead to changes in legislation, changes in code of practice, changes in the way expectations and standards are. We need legislation change. How likely is that to happen?

I don't know, but I tell you what, the Royal College of Psychiatrists need to take a good hard look at this, need to see where their members are falling short. You know, the consultant I spoke about who was part of this report said that this kind of behaviour is widespread. We were horrified by that. She said this is quite common that you just discharge a patient. I mean, I know in the meantime, West Eating has said no patients are to be discharged due to lack of engagement, but this was common practice. Now that's just not good enough. What other common practice falls short of what's good practice? I'd like to ask you both about your driving force through all of this and

is it anger that's pushing you on? I think, I often say, people always say, and I know they say the same to Sinead, I didn't know how you have the strength to do it they say the same to Sinead, I don't know how you have the strength to do it, where do you get it from? And I don't have an answer to that. But I do have a clarity of mind that I don't know where that comes from. I suspect it's Barney. He is, you know, a mum.

It's that invisible umbilical cord. And it's the same with the dads and the brothers. You know, we have to do this for him. He didn't lose his life on the 13th of June. He didn't lose anything. What he had was taken, stolen. His future was taken and we've got this individual that now resides as a patient in a hospital in receipt of income from the state and there's every chance he'll be out within 10 to 20 years. So yeah, I want to be positive, I want to change the language, use it. It will change. We will meet with the Prime Minister and the team. And what's about you, Sinead? Well, you know, just from the

point of view as a doctor, and I know I've labored this perhaps, but you know, every health care professional has to deliver the best care that they can. I don't want to hear about resources. You just do the best you can. I don't blame an operating department. I get on and I do the job. I do it the best I can. And I'm afraid that from my point of view, I just want accountability.

And like I said, it's not about naming publicly. It's about accountability. Who did what, who did what was done wrong because we've been told you know repeatedly by the CQC, by a homicide report that things have been done badly and I want to know what was done badly and what can be improved because I tell you what the next time a kid goes off to university I don't want the parents worrying about them coming home and being safe, you know. I've been thinking about you a lot in the last 24 hours, both of you, and thinking about you coming in to talk to me and how this report has come out and you're in all the newspapers this morning. You've been doing other interviews this morning. Does the campaigning help with your grief or can

it be re-traumatizing? It's constantly re-traumatizing. It's trauma upon trauma upon trauma. It's unimaginable. It's hard to describe it but I think it's making it count. We and I foolishly put my trust in the criminal justice system after June the 13th when the Chief Constable at times said don't worry Emma we've got him he's going down you think okay so now I have to try and think how do I even survive how do I get through each day and as all of these epic levels and unfathomable level of failures have come out. It's not waging a war, I don't want to become a campaigner, but we have to do the right thing. We have

to just get the answers and the truth. It's that simple. And how do you get through a bad day, Sinead? Well, because I'm doing it for grace. Can't do anything else. I've read criticism in the papers about these campaigning parents who do nothing but go on breakfast TV, bang their drum, and it's so insulting. Because all we're doing is, it's for Barney and Grace. What else? We've got nothing else left. There's nothing more we can do but try and make, and I know it may sound, you know, trite and it may be a cliché, but we should try and improve the system because that's all we can do.

No, I think we will improve the system. We have to make this that watershed moment, Sinead, because how many parents say to you, I'm so worried about my son and my daughter at university, but also you can't send your children to a holiday club. How important is the support that you give each other? It's vital, I think. Don't cry. Why do you cry? We cry every day, don't we?

You're the only one that knows, Emma, you know. So it's horrible. I wish there wasn't an Emma. But at least we know how each other feels. Our families, our sons, our husbands, we're in the same boat. We do take strength from each other. Barney and Grace were friends and now we know the Coates family as well. And we're part of this... It's a crazy new family that we've got but I live with guilt I wasn't there for Barney. I know it's irrational I said that last night but also I live with that knowledge that that beautiful girl tried to stop this monster from hurting my son. And she could have run and she didn't. And I think that Barney chose well when he chose her as a friend.

And that's why I hope, well, we're friends, but it's more than that. We're family. And I always think we'd have met each other anyway somehow one day. Maybe not the coats, but you know, those boys, that family, they're amazing. The people of Nottingham are amazing. but we just have to get this done Anita. And the two of you are quite remarkable the strength that you have found within this unthinkable tragedy and the family of one of the three young girls murdered in Southport made contact with you Emma. Yeah amongst lots of people that reach out. And how have you been able to support them? I think as Sinead has just said

it's, we can't make it better for anybody, we can't change what happened but what we have is this awful solidarity and understanding where you don't have to mask, you don't have to put that that front on because even with your own friends and family on occasion it's hard because you almost want to look after them and protect them whereas all of that stripped away when you're talking. Sometimes people just don't get it. No and you know, friendships suffer, all sorts of things suffer because of this because I mean this whole whole, I often say I'm in a whole new world, but when that type of, when they reach out, I know how important it was to me when Sinead got my number that godawful day that it happened and she sent a message to me and it was, I think it was the first

time I'd, in that awful, bleak new world, I thought, okay, there's someone else. What did you say, Sinead? Oh my goodness. I think you said something, I don't know, God, no, I think you said something like, Emma, it's Grace's mum. Yeah. Sinead. And it was something like, how do we do this? I don't know.

And then we met, do you know, the first time the families met was in Nottingham at the University at that vigil. That's right. When I thought there might be 50 people there and there were thousands and thousands that day. And what was that like to experience that and to meet Sinead for the first time? It's one of those visceral moments, it's one of those you cannot, it's hard to put into words the power, the emotion and the feeling from those amazing people that turned up at that vigil at the university, but also the next day in the city. Yeah, market square.

Oh, God. Yeah. So there's more good than bad out there. And we have to believe in that as well. Emma Webber and Sinead O'Malley-Kumar, and we had a huge response to this interview with an anonymous listener sending us this on WhatsApp. I'm a social worker on my way to see someone I support. I had to pull over as I was weeping listening to these two mothers talking with such heartbreaking dignity about the failure in our systems which led to the deaths of their children. Many of us inside the system are also fighting for change and for better and ongoing

provision for people who are too ill to engage. Thank you for finding a way through your grief and to carry on speaking out however uncomfortable the truth is. And if you'd like to get in touch with the program about anything you'd like us to talk about, then feel free to email us via our website. On Monday, Oscar nominated Mikey Madsen, who you may know for appearing in Quentin Tarantino's Once Upon a Time in Hollywood, joined Claire O'Donnell in the studio to discuss playing the title role in the film, Anora. The film follows Anora, or Annie, a sex worker in New

York, as she meets and marries the son of a Russian oligarch and what follows is a chaotic and often comedic portrayal of a world not many of us see. Anora has been nominated for six Academy Awards including Best Film, Best Director and Best Actress for Mikey's Performance, as well as BAFTA's and Golden Globe's The Lot. She started by telling Claire where she was when she heard about her Oscar nomination. I was in a hotel in New York, but I was FaceTiming with my mom and my dad and my brother and my dog.

And yes, it was very, very surreal, but it was nice to be on FaceTime with my family. I think it felt a little bit more real to experience it with them. You are only 25. What a trajectory. Does this feel real? No. No, it doesn't. It's very surreal.

I feel like I often have to sort of be mentally pinching myself and trying to hold certain memories in my head and really think of things or write certain things down just because I want to remember certain periods of time. I think the last year or since last March has been such a whirlwind and it feels like it's simultaneously gone super super fast and also slow and so yeah it's been a very interesting experience. Let's take our listeners then into Annie's world, into the world of Anora. Tell us about her, tell us about who she is, what

she does, where she lives, the choices that she's made in her life thus far. She's a young woman who lives in Brighton Beach in Brooklyn. She works in the city at a club called Headquarters. She's a dancer and a sex worker and she ends up And she ends up meeting the son of a Russian oligarch at work. And it's not a spoiler, but she ends up marrying him. They have a shotgun wedding and sort of things happen where his family is sort of trying to tear them apart. And she's kind of working to fight to save her marriage and preserve some of her dignity I think throughout the film.

And she does fight doesn't she? In so many ways. Oh yeah she's a true fighter. That's one of the things I recognized from the beginning is her amazing fighting spirit. She's scrappy. But she's a fighter not just physically, but emotionally as well. She is really willing to put herself out there to fight for what she believes is rightfully hers. So you, to do your research, I mean you went full-in, didn't you? And on the

research you did on those kind of clubs and the women that work in those kind of clubs, tell us what you did, who you spoke to. Oh yeah, I went to clubs and I shadowed women which was such an interesting experience. Shadowed women at some clubs in New York and specifically at Headquarters or Rosewood, the club in New York that my character works at. And that was really interesting to kind of just be a fly on the wall in a way and just try to observe and soak in the environment as much as possible, understand what that's like, what the conversations are like. There's a great camaraderie amongst the women. There's competition as well though, isn't there?

Because you're earning a living and you only earn as much as you dance for people. I think there's certainly camaraderie and I think it differs person to person, but also like you, you really have to hustle doing that kind of work, especially working as a dancer at clubs in the US. You know, you most of the time have to pay a fee, like a fee to work there. So I think a lot of women pay like maybe $200 to just enter the club. And then you have to work to make up that amount. And then you're also tipping the DJ, the bouncers, the security guards. It's hard, you know, and so to even just break even you really have to kind of

work your butt off. You have to charm everybody because everybody in the chain helps you earn your living. Well, I mean, you know, it's a psychological job as well. You have to be quite intuitive, I think, to do that kind of work. And it's physically demanding and emotionally demanding as well, because you're walking up to someone, trying to connect with them, trying to read them and see, oh, what can I offer them? What can they offer me? Like, how can we have a connection and both enjoy each other's company as much as possible? Did you have any hesitations about portraying a sex worker?

Because it's a controversial choice, shall we say, for some people. No, I didn't. I mean, I've seen I'd seen Sean's films and he's dedicated most of his career to telling these stories and trying to de-stigmatize sex work as much as possible. And he's not interested in sensationalizing the work or dramatizing it in any negative way. He really just wants to tell the stories of what these people are like and what they do. And so I was also interested in that.

You know, Annie is a sex worker but that's just what she does for a living. You know, she's just Annie. Yeah, I mean it's very transactional isn't it? There's a lot of sex in the film as people might expect. How comfortable were you with all of that? I was very comfortable. I think because I had done so much, I mean, first of all, I had never done anything like that before, but I had done so much research and had talked to so many consultants and

had been training for so long to be a dancer. I felt like I was in tune with my sexuality in a way that I hadn't been before. I just, I know that it was kind of a performance for the character too. You know, she's putting on a specific version of herself and as an actress I think I was as well. And so, the scenes were fun to shoot. And I also think that the way that Sean Baker, our director, was portraying a lot of those scenes, it was quite light-hearted and funny and yeah, so it was a really positive experience but I think also it's important for you to see my character at work because

she's good at what she does. It's a comedy in parts where this unlikely band of you and these henchmen that have been sent by the Russian oligarch's father to find him. You kind of go on this road trip through this part of New York that has a very big Russian community. And that was something you also did. You learned Russian. Yes, I did.

How hard was that? Oh man, Russian is such a complicated language. There are so many sounds that native Russian speakers make that Americans do not. I don't even think British people do either. It was really difficult and I dedicated two months to really trying to cultivate my Russian language skills as much as possible. And so I would fall asleep listening to ten hours of Russian speaking and wake up and do my Duolingo and, you know, have my two-hour Russian sessions. But it was really important because it's, I think, immediately when Annie starts speaking Russian, she speaks it in a very specific way.

That's very, um, it really tells you a lot about the character, I think. She speaks it kind of like an American does. And so she's, you know, trying to connect with her new husband by speaking Russian, and, uh, you know, she's always an outsider in lots of ways and I think that that's echoed even with her Russian dialect. Well it's an incredible piece of work and just finally what do you hope the people who see this film take away from it? What were you hoping to achieve? I think that we were just interested in telling a human story about unlikely connection.

I mean, I hope that people laugh watching it. I hope that it makes them feel something. I don't know. I mean, I think that for me, I'm really interested in making films that garner conversation. And I think that our film has done done that so I don't know I I think it's really up to an audience to decide what what they feel watching the movie but the film has always been very special to me and I think it's special to other people now too.

Mikey Maddison talking to Claire. Still to come on the program we have a performance from the West End star Marisha Wallace who's starring as Sally Bowles in the musical Cabaret at London's Kit Kat Club and the actor and writer Daisy May Cooper talks about the second series of her BBC comedy Am I Being Unreasonable. Now new research has quantified for the first time how many children and young people have been diagnosed with gender dysphoria by GPs in England. Academics at the University of York studied a decade's worth of NHS records and discovered a 50-fold increase in this particular diagnosis between 2011 and 2021.

However, each general practice will only see one or two such patients each year. Well on Wednesday I was joined by Professor of Health Policy Tim Doran from the University of York. He told me how he defined gender dysphoria for this research. What we're looking at is anyone who has a record of gender dysphoria or gender incongruence or related diagnosis on their primary care records. So there's actually something like 20-25 diagnoses which sort of fall under that umbrella and I think one of the difficulties of doing research in this area is gender dysphoria has evolved as a diagnosis over the period that we were doing the work. It used to be known as something called gender identity disorder, was considered a mental health

condition 10 or 15 years ago. It's now been changed to either gender dysphoria or gender incongruence depending on which classification system you're using. But really what it's referring to is a persistent and intense distress arising from a perceived mismatch between biological sex and experienced gender. And why did you want to carry out this research and how did you go about it? Well it was part of a program of work that the University of York undertook to support the CAS review, which published last year. So Hilary CAS, when she started out on that review, was struck by a lack of

robust evidence in the area. So she asked NHS England to commission independent research into gender dysphoria in this age group and the University of York undertook that research. So there were three main components to that. One was a series of systematic reviews on the existing evidence around diagnosis treatment and that was published at the same time as the CAS review last year. There was then a series of interviews with children with gender dysphoria and their families and then there were data linkage studies. So one using primary care data or general practice data which is what we're discussing today.

And then there was going to be another data linkage study using hospital data. That second study didn't go ahead. So then how many children and young people were you able to calculate have this diagnosis from their GP in England? Well, we were looking at a sample of about 20% of practices in England. So we were looking at records for about three and a half thousand children who had had a diagnosis of gender dysphoria at some point. So what you're looking at is an increase in prevalence of gender dysphoria in everybody

under the age of 19 from about one in 60,000 to one in 1,200. So if nationally that's equivalent to an increase from fewer than 200 cases in 2011 to over 10,000 cases in 2021. But I should say it remains very rare in children under 10. So if you focus on 17, 18 year olds who are most likely to be affected, prevalence has increased from less than one in 10,000 to just under one in 250 or about 0.4% of 17, 18 year olds. And what proportion of the children are being prescribed puberty blockers via their GP? Well on the records that they have within primary care there were fewer than 5% had a record of puberty suppression and around 8% had a record of taking a cross-sex hormone. But those figures are lower than we see in the

specialist centre, the gender identity development service based at the Tavistock. Rates there were closer to 20% and there's reasons for why we might see that discrepancy. So one reason is that GPs are often reluctant to prescribe off-label, which is essentially what they would be doing with puberty suppression. It may be that these hormones are being prescribed elsewhere and they're not being recorded on the clinical computing systems within primary care but also we know that after about 2016-2017 the waiting lists were getting very long for attending the identity service at the Tavistock and so there will have been waits for them to get in to get assessed and then to then be referred on to the endocrinologist and to start on these treatments.

What were the biggest surprises for you Tim? Again, the studies that have been done previously have all been based within the specialist centres. So this was the first study that really looked out at primary care, what was happening in general practice, which is where most patients first present. And so the increase, this sort of 50-fold increase, I think was very striking.

But again, I should emphasise it's gone from being an extremely rare condition to being just an uncommon condition. It's still not seen very frequently within primary care within this age group. So as you said before, the average general practice is only going to have one or two patients with this condition. So that was striking. I think the rates of anxiety and depression, we suspected they might be high and we did compare the rates within children with gender

dysphoria to the rates in children with autism spectrum condition or eating disorders. Those are groups that we know have very high rates of anxiety and depression. And the rates of anxiety we were seeing in children with gender dysphoria were of a similar level but the rates of self-harm were even higher. So just over 50% of these children had a record of anxiety, depression and or self-harm but children with multiple conditions were at particular risk. So around 73% of 17, 18 year olds who had both gender dysphoria and an autism spectrum condition had a history of anxiety, depression or self harm. What do you want policy makers to take from this research?

Well I think that there's clearly an urgent need to tackle vulnerability to mental health difficulties and to improve mental health support for children and young people experiencing gender dysphoria. We're going to need robust networks to provide guidance and support for primary care services who have the responsibility of coordinating care for children with these complex needs and say, despite this rapid rise, the average practice isn't going to see more than a couple of patients within this age group. And I think also any future research needs to address the causes, pathways to diagnosis

and the interactions of gender dysphoria with mental health conditions supported by improved data recording, which includes having greater clarity around sex and gender. There's still a degree of confusion, even within general practices, about what they're recording when they record sex and gender. And what about the general public? What do you want them to hear from what you're telling me? Well, I think, you know, again, it's important to say that this is still quite uncommon for children within this age group to get to the point where they receive a diagnosis of gender dysphoria, but it's likely to be the tip of an iceberg.

So there are going to be other children who are questioning their gender, who won't actually reach that threshold or won't actually present to primary care. Because again, if you imagine a 14-, 15-, 16, 16 year old, it's quite a thing for them to sort of go into a general practice either with or without their parents to discuss this. So I think some sort of awareness around that. But again, I think as you'll be aware, this is a very sort of charged area. There's a lot of noise, ideological noise, political noise around this issue and I think I'd want people to look at this and sort

of try and keep it in proportion. Yes it's something that seems to be increasing quite quickly and we want to know what the reasons for that are and you know we can, I can discuss those but also just to be, you know to keep it in proportion it is still quite an uncommon condition. Well what's it like being an academic in this area? It can be challenging. I think a lot of researchers and institutions still won't go near this topic because the debate around it has become so toxic. You're really walking into the middle of an ideological mud wrestle. I think people often assume that you're on one side of the debate or the other which means

they'll either be inclined to accept your results uncritically or reject them out of hand depending on whether they agree with the position that they imagine you have. Neither situation is good. I think the research really needs to stand a fall and so merits not the real or imagined beliefs of the authors. But obviously if you sit on the fence you risk drawing fire from from both sides. But I think it's important to emphasise as researchers we don't face the kind of challenges that patients or their families do. We can always walk away and do something else.

That's not a luxury they have. I was speaking to Professor Tim Doran. Now the actor and writer Daisy May Cooper shot to fame with this country. The mockumentary about the other side of life in the Cotswolds, the story of life on the council estates on the edge of the villages with the gastropubs and the Hunter Wellie Brigade. She wrote This Country and starred in it alongside her brother Charlie. It went on to win multiple BAFTAs.

She was the lead in the BBC HBO show Raindogs and then in 2022 she co-wrote and starred in the twisting female friendship comedy thriller Am I Being Unreasonable. It was first broadcast in September 2022 and also won the Royal Television Society and BAFTA Awards. Fans will be pleased including me to know that the first episode of a second series was broadcast this week. Daisy May Cooper came into the Woman's Hour studio and spoke to Claire, starting with a brief synopsis of Am I Being Unreasonable?

So Nick is somebody who is, on paper everything should be fine, she's got the house, she's got the husband, she's got a son that she has a great relationship with. On paper everything should be brilliant, but actually there's something missing and lacking in her life. And she is sort of holding on to a big sort of family secret that she can't tell anybody. And then she ends up meeting fellow mum Jen, who's played by my best mate, Celine Hissley, who ends up becoming this kind of confidant and becomes sort of Nick's soulmate. And from then on, it just starts kind of spiralling into chaos. Yeah, and it's dark. And where we start in series two, the question is, has Nick got

away with murder? Yes, that is the question. And I mean, I wish I could tell you, I can't. It sort of comes in right in the middle of the action and you're thrown straight back into it. And you play alongside the wonderful Lenny Rush who plays your son, Ollie, and he won a BAFTA, the best male comedy performance for his role, as well as two Royal TV Society Awards and he is back and even quoted as saying there's no point you showing up to work because he's such a scene stealer. Oh my god I mean I've never met anybody so talented and he's

only 15 years old. Yeah. Like I just it's so annoying I mean I think of what I was doing when I was 15 I think I was just sort of prank calling ex-boyfriends or guys that I had a crush on at school on the landline. I think that's all I did when I was 15. And he's won BAFTAs. Yeah. And also there's a real depth to his performance and your relationship with him. You play mother and son, but there's some truly moving moments. Oh, that's so lovely. Yeah. I suppose. A lot of it is sort of based on my relationship that I have with my seven-year-old daughter, who she's more like the parent and I'm like

the child and she sort of likes to parent me. She does bully me sometimes, but it's a very close relationship that they have and I think the character of Ollie is a lot older than he years. Yeah, I mean, I just want to talk about you creating, you mentioned Celine earlier and you co-created Am I Being Unreasonable with Celine Hissley and you're very old friends, aren't you? And this is essentially a story of women who feel like they don't quite fit. Is that the story of you and Celine? Is that how you kind of got together? Because I know you met at RADA, didn't you?

Yes, we did. We met at RADA and weirdly, we were both so traumatized by RADA. We kind of isolated ourselves. So we didn't really hang out. We used to have a laugh by drawing silly cartoons of teachers and stuff in lessons. But apart from that, we didn't really reconnect

until lockdown. And I was just having the worst time. My marriage was breaking down. I just had a baby. I felt so lost. And she came into my life and just kind of rescued me in a way. And we were both on the same level and both really needed each other at that point. And from then on, we've just been inseparable really. She's my savior. Yeah. And you've written some incredible comedy together. Where did that come from? I mean, I guess you always made each other laugh back in the day. Oh, absolutely.

You've rediscovered it. Oh, yeah. I mean, we love making each other laugh. There's nobody funnier on this planet than her. It was sort of like therapy in a way. It was having to put all those awful things that had happened to us and all our deepest insecurities and trying to make something positive out of it, trying to laugh at it, I suppose. Yeah. And is that the whole kind of female experience or the mother experience? What was the kind of starting point for all of that? Oh I think definitely the mother experience. I mean I felt like everybody knew what they were doing when it came to parenting and I just had no idea. It was like everybody gets this and I don't.

Why am I not getting it and why do people do it so effortlessly? And I really struggle having to, you know, play Sylvania and Families with my kids. I find it really boring. Why do people bake cakes and pack their kids lunch boxes so perfectly? And the more women that I talk to, they say, look, we don't get it either, which is lovely. Well, this is the point, isn't it? And kind of Motherland started that conversation in a brilliant and comedic way. But even the people who project that perfection are slowly dying on the inside. Yes, absolutely. And it's the sort of thing.

It's like, I suppose what really bonded me and Celine was we showed each other our cracks and then it was like, oh God, I get you so much. I'm feeling the same thing. At least let's just go through this together. And my being unreasonable is a strand from a forum on Mumsnet. It is. So explain that one. What would you get when you went there? Oh, Mumsnet is amazing. It's absolutely any problem that you have, you can just go on Mumsnet. And do you know what's so funny is actually during Covid and lockdown and my

marriage was breaking down and I didn't and I felt so lost and I didn't feel like I could talk to anybody about it. So I kind of did a post anonymously on Am I Being Unreasonable Forum and these incredible women who I will never meet and they will never know that it was me, sort of gave me the best advice and support and I just thought, God, I have to use that in some way. This is my tribute to those women. They'll never know how much they helped me at that time. And how has it changed your attitude to motherhood and your relationship with that role now then, having touched the bottom, reached out and found other women are saying,

you know, that's my life you're talking about. How do you go forward now? Are you less hard on yourself? I think I am. I used to have so much, I mean self-loathing and I don't have that now. I'm forgiving myself a lot and I know that because I'm doing everything that I do is from a place of love and I might get it wrong but I'm trying and I'm trying to give my best because my kids need that from me. Yeah, I mean during this series, the filming of the second series, you were pregnant and your son arrived seven weeks early.

Seven weeks in the middle of filming. Can you imagine that? I mean I started having on set, I was having these contraction pains and I thought this can't be right. I thought I was just imagining it and I was having to lie down on the bed, Nick's bed on set and I thought this can't be right. I thought I was just imagining it and I was having to lie down on the bed, Nick's bed on set and I said to my partner I think I'm gonna have to go to hospital and then my waters broke and he he came seven weeks early and it was really frightening but I think after going through that and then having to then kind of come out and rewrite some of the second series, because we lost a lot of the cast availability, because they'd gone on to other jobs. So I mean, episode

one is kind of a complete rewrite from... Yeah, that's incredible. So you've had a premature baby and all the time you're lying there, you're obviously worried about you, your child, but also thinking this huge responsibility to keep this series on the road. It was really hard. But now I've been through that, I could get through it. I think I could do anything now. I think you could.

I could do anything apart from going on gladiators. I don't think I'd do very well on that. Leave that one off the list. I saw you recently, you were talking about rewatching the first series and noticing the sort of dramatic difference in your look because that was two years ago. Oh, it's so funny. Okay, so tell everybody who won't know how you looked and how you look now, what was the difference?

What did you do? Well, I've lost about, the funny thing is, season two is meant to literally happen about half an hour after season one finished. And yet I've lost about ten stone. I've had my lips done. In some scenes I'm pregnant and some I'm not. People are going to be thinking, what on earth is going on? But please just bear with me. Just go with it. I did say to the BBC, do you think we should just put a disclaimer, like a black card saying, she's had her lips done, just go with it. And they said, no, just don't draw any attention to it.

Don't blame continuity. It's not continuity's fault. There's a really funny scene, I think it's in episode two, where there's a flashback to season one, where it's really obvious, obvious because in season one I have no lips. I have none. In the second I'm like Donald Duck. But it's so refreshing that you talk about it like this because so many women in the public eye and no judgment get work done and then pretend they haven't. So why have you gone on the sort of front foot? There's no shame but you have taken that kind of unashamed approach to this, haven't you? Oh, I think, but it's like the Eminem rap battle in Eight Mile. You know, if I take

the mickey out of myself, it's sort of like a defense mechanism in a weird way. But yeah, I've had all the stuff done. I've never had plastic surgery, but I've had all Botox and stuff, but I couldn't move my face, which isn't great as an actress. My agent said yeah. My eyebrows were so stiff I looked like that cartoon Count Duckula. Oh yeah. I do remember Count Duckula yeah. Triangles. No I wouldn't do that again. Yeah but it's moving now.

Oh yeah. All the old lines are back. Great. The brilliant Daisy Mae Cooper talking to Claire and the second series of Am I Being Unreasonable is available now on iPlayer, which I will be binge watching this weekend. That's it from me, but as New York Fashion Week begins, join Nuala on Monday when she'll be looking at the trend moving away from body diversity on the catwalk and asking if the body positivity movement has come to an end. That's with Nula just after 10 on Monday. That's all from me. Have a lovely rest of your weekend.

I'm Sarah Trelevin and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started like warning everybody. Every doula that I know. It was somebody out there who was faking pregnancies. I started like warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth.

How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's baby. It's a long story. Settle in. Available now.