**8. Perth experience**

The Gender Diversity Service (GDS) located at Perth Children's Hospital (PCH) in Western Australia, has been specifically designed as a dedicated tertiary specialist service for children and adolescents who present with clinically significant forms of GD. The author's first-hand experience of working in GDS gives her additional insight into the benefits and challenges of operating of such Tier-4 clinical service. GDS is a state-wide service that that has been set up in 2015 as part of local child and adolescent mental health services to provide assessment, consultation and gender-affirming treatment for young people under 18. From the outset, this recently established public service has been committed to embedding research in everyday care by developing a longitudinal cohort database "The GENder identiTy Longitudinal Experience" (GENTLE) and attracting research staff to their multidisciplinary team [13]. GDS has been conceptually developed with so-called Dutch model of care in mind after the process of comprehensive national and international consultation and developing adequate skill base.

For the purpose of this publication, the author wanted to use Western Australian example in order to illustrate how does influential Bell v Tavistock ruling affect other jurisdictions. The Australian legal system historically takes a very respectful view of advances in English law, and it is assumed that an Australian judge would be expected to give significant weight to the Bell v Tavistock ruling. Australian services, such as PCH GDS, are following the recommendations from Bell v Tavistock ruling and there is a sense that Australian health practitioners would be viewed in a negative light if they were aware of the Bell v Tavistock ruling but continued to practice in a way that is not consistent with court's recommendations. The Court authorisation is intended to take into consideration the young person's best interests as well as the court's view of their capacity and will provide some validation to the consent gathering process and lend some additional support and security for treatment to be considered medico-legally sound.

From now on, all young people under 18 who wish to start new puberty suppression treatment or cross sex hormone treatment will need to go through the Family Court via Legal Aid and gender service providing necessary mental health and endocrinology reports to the court. Regardless, if both parents consent, or/ and if the gender clinician determines that the young person does have capacity to consent, the decision to treat is to be taken to the Family Court to provide a further level of authorisation. On a positive note, it could be opportunistic that a new body of case law, arising from young people's cases, may establish Australian precedents which could support young people in accessing gender affirming health care in Australia and internationally.
