A mental health trust has come under fire for training materials instructing employees to avoid using traditional terms of address when speaking to unfamiliar patients.
Fiona McAnena, director of campaigns at Sex Matters, a charity promoting clarity about sex in law and policy, condemned the guidance issued by Birmingham and Solihull Mental Health NHS Trust. She described the directive as “dehumanising and uncaring to everyone” despite being presented as inclusive for transgender individuals.
Ms McAnena argued that patients deserve “the warmth and respect of normal human speech when attending medical appointments” rather than what she characterised as robotic, impersonal language. She criticised the trust for expecting staff to perform “mental gymnastics” to avoid conventional terms.
The training programme, delivered by Birmingham LGBT charity, is offered to all 5,300 employees across the trust’s 40 sites. The charity confirmed it had previously provided training at the trust but not since November 2024, according to reports. However, the trust stated Birmingham LGBT delivers the training three times annually on a voluntary basis.
Internal training documents advise staff uncertain about a patient’s pronouns to use they/them as an appropriate approach. The materials recommend replacing words like “lady” with “person” when referring to service users not known to staff members.
Telephone interactions receive particular attention in the guidance, with materials cautioning against making assumptions about callers’ gender based on voice characteristics. The documents note transgender individuals may have voices at different pitches than expected, either deeper or higher.
Staff are instructed it would be inappropriate to address someone as “sir” due to having a deep voice if their records indicate their name is Ms Katherine Sullivan, for example. When gender remains unclear, using the patient’s name is recommended as an alternative to gendered terms.
Birmingham and Solihull Mental Health NHS Trust defended its approach, describing itself as “a values-based, inclusive organisation” that takes “a person-centred approach in everything we do.” The trust stated that getting pronouns right represents “a simple but powerful way to affirm identity, build trust and create environments where transgender staff, patients and service users feel safe, respected and seen.”
Ms McAnena raised concerns that unclear and vague terminology could discriminate against those with English as a second language. She called for the trust to abandon the policy and return to ordinary, well-understood terms for men and women when addressing patients.
The British Medical Association recommends discreetly asking about pronouns when uncertain. Current NHS England guidance for treating transgender patients suggests accommodating them according to their chosen gender, though this policy is under review.
The trust has not indicated whether it will revise its training materials in response to the criticism. The outcome of NHS England’s review of transgender patient treatment guidance may influence future approaches to patient address protocols across the health service.
