L \l l 'Jl\11\\lll r;) HEALTH

133 Molesworth St POBox5013 Wellington 6145 New Zealand T+64 4 496 2000

Response to your request for official information

I refer to your request of 19 November 2018 under the Official Information Act 1982 (the Act) for:

"I would like to ask for these statistics under the Official Information Act. I previously asked about anorexia nervosa diagnoses however I think there may have been a typo in the information given to me so I am asking that question again to double check. Nationwide, how many females under 18 with a diagnosis of gender dysphoria and/or gender identity disorder were prescribed puberty blockers (usually Leuprorelin or goserelin) each year of 2008, 2009, 2010, 2011, 2012?

How many males under 18 with a diagnosis of gender dysphoria and/or gender identity disorder were prescribed puberty blockers (usually Leuprorelin or goserelin) each year of 2008, 2009, 2010, 2011, 2012? (If separating by sex is difficult feel free to simply state the number of children per year as you have done previously)

How many females of all ages were diagnosed/in secondary health services with a primary diagnosis of gender dysphoria and/or gender identity disorder in each year of 2006, 200~ 2008, 2009, 2010, 2011, 2012, 2013,2014, 2015, 2016, 2017?

How many males of all ages were diagnosed with gender dysphoria and/or gender identity disorder in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many females were diagnosed with anorexia nervosa in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were diagnosed with anorexia nervosa in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many females were under 18 were put under the mental health act for any periodoftimeeachyearfor2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were under 18 were put under the mental health act for any period of time each year for 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many females were diagnosed with precocious puberty in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? How many males were diagnosed with precocious puberty in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014,2015, 2016, 2017?

How many females were diagnosed with precocious puberty and prescribed a puberty blocker such as Leuprorelin or goserelin in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were diagnosed with precocious puberty and prescribed a puberty blocker such as Leuprorelin or goserelin in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 201~ 2017?

How many females were diagnosed with bulimia nervosa in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were diagnosed with bulimia nervosa in each year of 2008, 2009, 2010, 2011, 2012,2013, 2014, 2015,201~ 2017?

How many females were diagnosed with eating disorders not otherwise specified in eachyearof2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were diagnosed with eating disorders not otherwise specified in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many females were diagnosed with gender dysphoria or gender identity disorder in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

How many males were diagnosed with gender dysphoria or gender identity disorder in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

Nationwide, what percentage of under 18 years old referrals to secondary services are for females? And what percentage of 18 year old and over referrals to secondary services are for females?

How much funding does the Ministry of Health set aside for eating disorder specialist services?

How much funding does the Ministry of Health set aside for gender identity specialist services?"

Please note that you were advised via email on 4 December 2018 that the Ministry of Health (the Ministry) would be extending the timeframe for responding to your request under section 1SA of the Act as further collation and research was required.

The information relating to this request is itemised in Appendix One, with copies of documents attached.

Certain questions have been refused under section 18(f) of the Act, as the information requested cannot be made available without substantial collation or research. These grounds are noted next to the corresponding questions in Appendix One.

I trust this information fulfils your request. You have the right, under section 28 of the Act, to ask the Ombudsman to review any decisions made under this request. Please note this response (with your personal details removed) may be published on the Ministry of Health website.

Yours sincerely

Ann-Marie Cavanagh Acting Deputy Director-General Data and Digital Appendix One

Request ; Response

1. Nationwide, how many females under 18 with a diagnosis of gender dysphoria and/or gender identity disorder were prescribed puberty blockers (usually Leuprorelin or goserelin) each year of 2008, 2009, 2010, 2011, 2012? These parts of your request are refused under section 18{f) of the Act, 2. How many males under 18 with a diagnosis of as the information requested cannot gender dysphoria and/or gender identity disorder be made available without substantial were prescribed puberty blockers (usually 1 collation or research. Leuprorelin or goserelin) each year of 2008, 2009, 2010, 2011, 2012? (If separating by sex is difficult I feel free to simply state the number of children per year as you have done previously) I

3. How many females of all ages were diagnosed/in secondary health services with a primary diagnosis Information is provided from 2009 of gender dysphoria and/or gender identity disorder onwards, as the implementation of in each year of 2006, 2007, 2008, 2009, 2010, 2011, PRIMHD in mid-2008 means that the 2012, 2013, 2014, 2015, 2016, 2017? numbers pre-2008 are not comparable. 4. How many males of afl ages were diagnosed with gender dysphoria and/or gender identity disorder in Please see Attachment 1. each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014,2015, 201~ 2017? . Information is provided from 2009 onwards. The implementation of PRIMHD in mid-2008 means that the 5. How many females were diagnosed with anorexia numbers pre-2008 are not nervosa in each year of 2008, 2009, 2010, 2011, comparable. The National Minimum 2012,2013, 2014, 2015,2016,2017? Dataset (NMDS) and Programme for the Integration of Mental Health Data 6. How many males were diagnosed with anorexia (PRIMHD) have been used to answer nervosa in each year of 2008, 2009, 2010, 2011, these questions, as both collections 2012, 2013, 2014, 2015, 2016, 2017? capture people with this condition.

I Please see Attachment 2.

7. How many females were under 18 were put under I the mental health act for any period of time each year for 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? Please see Attachment 3. 8. How many males were under 18 were put under the mental health act for any period of time each year for 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? I 9. How many females were diagnosed with precocious puberty in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? Please see Attachment 4. 10. How many males were diagnosed with precocious puberty in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

11. How many females were diagnosed with precocious puberty and prescribed a puberty blocker such as Leuprorelin or goserelin in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, These parts of your request are 2016, 2017? refused under section 18(f) of the Act, as the information requested cannot 12. How many males were diagnosed with be made available without substantial precocious puberty and prescribed a puberty blocker collation or research. such as Leuprorelin or goserelin in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017?

Information is provided from 2009 onwards. The implementation of 13. How many females were diagnosed with bulimia PRIMHD in mid-2008 means that the nervosa in each year of 2008, 2009, 2010, 2011, numbers pre-2008 are not 2012, 2013, 2014, 2015, 2016, 2017? comparable. NMDS and PRIMHD have been used to answer these 14. How many males were diagnosed with bulimia questions, as both collections capture nervosa in each year of 2008, 2009, 2010, 2011, people with this condition. 2012, 2013,2014, 2015, 2016, 2017? Please see Attachment 5.

Information is provided from 2009 15. How many females were diagnosed with eating onwards. The implementation of disorders not otherwise specified in each year of PRIMHD in mid-2008 means that the 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, numbers pre-2008 are not 2016, 2017? comparable NMDS and PRIMHD have been used to answer these 16. How many males were diagnosed with eating questions, as both collections capture disorders not otherwise specified in each year of people with this condition. 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? Please see Attachment 6.

17. How many females were diagnosed with gender dysphoria or gender identity disorder in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017? These questions are interpreted as repetitions of questions 3 and 4, 18. How many males were diagnosed with gender answered above. dysphoria or gender identity disorder in each year of 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 12016, 2017? We have interpreted this question as a request for the information by year, 19. Nationwide, what percentage of under 18 years like for the previous questions. The old referrals to secondary services are for females? years chosen were 2009 through 2017, in order to be consistent with 20. And what percentage of 18 year old and over previous questions. referrals to secondary services are for females? Please see Attachment 7.

The Ministry allocated $14.87 million 21. How much funding does the Ministry of Health to these services during the 2017/18 set aside for eating disorder specialist services? financial year.

1 The Ministry does not set aside any money for gender identity specialist services.

I

I With regard to genital reconstruction surgery, a rate of surgery was set for three feminising and one masculinising surgeries every two 22. Ho_w much funding does the Ministry of Health years. Funding for this was drawn set aside for gender identity specialist services? from the larger ($2.5 million per annum) High Cost Treatment Pool. Over the nine financial years from 2008/09 to 2016/17, the Ministry 1 spent an average of $185,670.91 per year on genital reconstruction surgery, but the actual expenditure \ fluctuated from year to year. Number of People Diagnosed in Hospitalisation or Specialist Mental Health Services with Gender Dysphoria by Calendar Year and Gender Sources: MoH NMDS and PR:vsata co ll e c t ~tracted December 2018

Gender Dysphor;a was defined i>{~ code o~285 or ICD-10-6 code of F642, F648 or F649 on any fagnos;s ;n NMDS or PRIM HD

~((~1 Age~~rt of Yea r 18 and over Under 18 ( J ~ ' M nderon ~ I Calenda r Year I Male Fema le U n know~/ / I Male Female Unknown 2009 2 3 13 2010 s 6 11 2011 3 6 12 2012 4 5 18 2013 5 5 / ~ '-"' L; ~ 13 1 2014 13 5 (/'0~ 1_1' / 17 1 2015 18 8 ~ ~3 .;:;_, 22 2 2016 21 20 1 2 2017 29 25 1 \S/<®;: v~ 2

Notes ~,,-:0 ~A Th;s data only includes d;agnoses recorded ;n publicly funded hospital;sations or second~~tefh~ ~h and ~n serv;ces. PRIMHD diagnosis data has increased in completeness over time, so any increase may reflect thitj~rfa in rep6rtin~ t~~n increase in the disorder. These numbers may differ slightly to other dat a extracted at different times - PRIM HD is a dynamic W~ and sub~ct0oj:h}ng e. {Q)4)/v~ "):,,

~..... ~ ~© ~ ---i ~ -...... Number of People Diagnosed in Hospital or Specialist Mental Health Services with Anorexia by Calendar Year and Gender Sources: MoH NMDS and PRl ~J"'qata collectio~s~tracted December 2018

Anorexia was defined by DSM-I V ~ or ~de of FSOO on any diagnosis in NMDS or PRIM HD

Gender on NHI ~1)) 2011 39 718 ~ v~

~~:e~~ta only includes diagnoses recorded in publicly funded hospitalisations or s~~· I he~~ i):t ion services. PRIM HD diagnosis data has increased in completeness over time, so any increase may ren :tt(is 1 oc reasi-~epo~i~ than an increase in the disorder. These numbers may differ slightly to other data extracted at different times - PRI MHD is a ' (!3 (l~,c' c:oJl ~t i on and)Object to change. In addition, when these numbers were previously provided to you under the OIA, the gender hea.ding~ r.e applied t~ t ife~ong columns (as you mentioned in your email). / ~@i~~

~ ...... ~ ,_,~ ~q., ~ ©~ ~

("--' Number of people with a legal status starting in the year· by year Source: MoH PRIM HD Ref: MHP1641, extracted 22 June 2018

Calendar Year People 2017 7389 2016 7375 2015 6980 2014 6875 2013 6632 2012 6159 2011 6116 2010 6175 2009 5785

The Legal status standing order methodology has been applied to this;.-tn@ J. :>- ~~ corrects for some duplicate records. ('{/). D ~ 1 Other Ministry of Health legal status reporting includes manual dat(~ijli tted o~t_zia;~ PRIMHD system by DHBs, may not have applied the corrections descri~~;;'°or m9Y'. av)een extracted at a different date, so any comparisons should be made wit ~~ ~ This includes people with any of the below legals~ ~ SM: S.11 Entering 5 day assessment ~ \v( SN: S.13 - Entering 14 day assessment ST: S.14 (4) - Application to court for mak~~ co P6fsory t-<~o of the Act \_<::_) '1 () SS: S.15(1) - waiting to see Judge. Co~pu1$o~atme~t {§TO) applied for MH: S.15.2 - Judge extends time ~ore decfsion ~· s ~~ CK: s.29 - Community CTO "" Cl: S.29 with Section 34(2)~e ~ ten~s·o G · onths after initial CTO under Section 29 \> (2, S. 29 with Sectloi::_ ~ ~ e g.anting<;J.~ efin;te Order one yea rafter the ;n ;tia I CTO under Section 29 . ~ ' ~"'0 TY: S.29(3)(a},(l~a~ytreatmen~~fA) Tangata whaiora/consumer under community order havl~~t Pf episod ~E~~~~ s . CL: s.39-)f . CTO or(e\. ~~' s3~ ~ ct;on \~~ · rst extens;on forsix months after Initial CTO under Sect;on l2: S.30 with SeeYb~4. ) - The granting of an Indefinite Order one year after the initial CTO underSect~

Precocious Puberty was defined ~~ c~ on any diagnosis in NMDS

GenderCodeonNHlo ?~ ~A CalendarYear Male Female ~'/? ~a 2008 2 11 %! ~(/~A. 2009 2 15 ~ur 2010 1 6 // / 2011 3 11 2012 5 7 2013 3 13 2014 2 15 w~-/~ 2015 3 10 2016 3 9 2017 4 19

This question usesthe ICD-10-3 as opposed to ICD-10-6, asthere wasa coding change mid -2 ~~ - if~

~ ~1}? %~ -.\ -4 ,..,:::z.. ::t: ~ ~ ~© <:. -\ ~ -t' Number of People Diagnosed in Hospital or Specialist Mental Health Services with Bulimia by Calendar Year and Gender Sources: MoH NMDS and PR~ata co llect i~~r;: December 2018

Bulimia was defined by DSM-IV c~~ an~Cfl~code of FS02 on any diagnosis in NMDS or PRIM HD

Gender on NHI: © ~ >~~ <:::'

F¥' ~ ealth atj$ add~ ~ PRIMHD diagnosis data has increased in completeness over time, so any increase may refle~~tjlll r ,ase in rapo;jJJ than an increase in the disorder. These numbers may differ slightly to other data extracted at different times · PRIMHD is a dyna .;&1co lle ~ io n an cl~ub~hange. ~©4}%~ ::i:. ....,--l ~,...... ::?:: ~ ~ ©~ "'~ ~ c.., Number of People Diagnosed in Hospital or Specialist Mental Health Services with an Eating Disorder NOS by Calendar Year and Gender Sources: MoH NMDS and PR~ata co lle ction s('.\~ ract ed December 2018

~-' . v · ~ Eating Disorders NOS was defineh~ ~ ode · ~003~~ !CD-10-6 code of FS09 on any diagnosis In NMOS or PRIM HO

Gender on NH!: ~© '->~ Calendar Year I Male Unknown~ 2009 14 25 2010 20 2011 31 44536S -- ~ ~@ 2012 50 551 2013 51 595 1 2014 46 642 2015 65 666 W~ ~ 2016 78 663 2017 78 678 )~ ~ .. ..~ • - '· · PRIM HO diagnosis data has increased in completeness over time, so any increase may refleC~tj1j{r~e in rl!poyt J n~ than an increase in the diSO

Age Group: / ~ ""> ~~ Calenda r Year Under 18 18 and over b '/? ~4) 2009 41.88 47 ~ -v~A 2010 42.52 46.89 ~

Data from 2012 is considered complete enough for NGOs to compare onwards. This count includes people with no activity status. The Gender code used came from NH I.

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