REPATH LAUNCH
15 September 2026
Global
Genspect's REPATH campaign — calling for a return to proper psychiatric assessment and differential diagnosis in place of automatic affirmation — launches at a moment when Britain is still working out what should replace the model the Cass Review condemned. Stella O'Malley and Mia Hughes explain what re-psychopathologisation actually means, why it is not what its critics claim, and why it matters for NHS clinicians, therapists and policymakers trying to rebuild gender services on firmer ground.
The launch of REPATH marks a significant moment in the international debate about how medicine should respond to people who experience transgender ideation. Genspect's Re-psychopathologisation Campaign argues that clinical practice has drifted away from its foundations — that what should be a careful, individualised diagnostic process has been replaced, in too many settings, by a policy of automatic affirmation. REPATH calls for that course to be corrected, not by pathologising gender non-conformity or same-sex attraction, but by restoring the kind of thorough psychiatric and psychological assessment that any presentation of this complexity deserves. In this launch episode, Stella O'Malley and Mia Hughes unpack what the campaign is actually asking for — and what it is not. The distinction matters. Critics of re-psychopathologisation often frame it as a desire to return to a world in which being transgender was treated as an illness to be cured. That is precisely what REPATH rejects. The campaign's target is the ideological framework that removes differential diagnosis from the picture entirely, leaving clinicians unable to explore underlying mental health conditions, trauma, autism, or sexual orientation without being accused of practising conversion therapy. For British listeners, the timing is striking. The Cass Review — the most comprehensive independent assessment of NHS gender services for children ever undertaken in this country — reached many of the same conclusions. It found that young people were not receiving adequate psychological exploration before being placed on medical pathways, that the evidence base for puberty blockers and cross-sex hormones in minors was alarmingly thin, and that clinicians felt unable to raise concerns without professional risk. The closure of the Tavistock's Gender Identity Development Service and the creation of new NHS regional hubs are a direct consequence of those findings. What REPATH adds to the British picture is a principled, international framework for what the alternative should look like. The NHS is currently attempting to build new gender services from the ground up, and the question of how much weight to give psychological exploration versus medical intervention remains deeply contested. REPATH's insistence on differential diagnosis — on understanding why a particular person is experiencing gender dysphoria before deciding how to treat it — maps closely onto what the Cass Review recommended, and gives clinicians, commissioners and policymakers the language to defend that approach. The campaign also carries weight in a specifically British legal and professional context. Proposed conversion therapy legislation has raised genuine fears among psychotherapists that ordinary, exploratory clinical work could be criminalised if a client later identifies as transgender. REPATH pushes back against that framing by articulating a clear distinction between coercive practices and open psychological inquiry. For therapists working in schools, in the NHS, and in private practice, that distinction is not abstract — it shapes what they feel professionally permitted to say in a session. Stella O'Malley brings the perspective of a practising psychotherapist who has worked directly with gender-questioning young people, and Mia Hughes as a researcher who has scrutinised the evidence base closely. Together they make the case that restoring psychiatric rigour to this field is not a step backwards — it is, for the young people caught in the middle of an unresolved ideological argument, the most genuinely compassionate option available.
