A transgender woman who exhibited erratic behaviour before her death was taking unprescribed hormones as she sat on a years-long gender clinic waiting list, a court has heard.

Amarnih Lewis-Daniel was referred to the Tavistock Clinic in August 2018 and was still on the waiting list by the time of her death in March 2021, her inquest was told.

Amarnih’s probation service officer had told jurors last week that she complained constantly of the lengthy waiting list.

In the meantime, Amarnih was receiving no treatment from her local mental health trust North East London NHS Foundation Trust (NELFT) for her gender dysphoria.

According to the NHS website, gender dysphoria "describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity".

Yet in police body cam footage shot weeks before her death, she was captured asking officers to retrieve her hormones from her flat before they took her into custody.

Jurors heard there was no evidence in her medical records of any doctor prescribing Amarnih hormones.

The police video was captured on January 29, 2021, as Amarnih was arrested for barricading herself inside her flat, smashing the windows and throwing furniture onto parked cars below.

An expert mental health doctor told jurors he could not say what impact the hormones might have had on her behaviour in the weeks leading up to her death.

Amarnih was found dead at the foot of Highview House, the Chadwell Heath tower block where she lived, on March 17, 2021.

Barking and Dagenham Post: Amarnih lived and died at Highview House, off of Whalebone Lane in Chadwell Heath. Her body was found in the car park on March 17, 2021Amarnih lived and died at Highview House, off of Whalebone Lane in Chadwell Heath. Her body was found in the car park on March 17, 2021 (Image: Google Streetview)

A jury at East London Coroner's Court, Walthamstow, has heard that she repeatedly came to the attention of the authorities between January and March 2021 due to her erratic behaviour.

They have been tasked with determining whether Amarnih deliberately brought about her own death and whether the actions or inactions of any agencies contributed.

Expert witness Dr Duncan Harding, a forensic psychiatrist, described Amarnih as an “incredibly complicated” and “very complex” person.

In addition to her gender dysphoria, she was diagnosed with anxiety, depression and traits of emotionally unstable personality disorder. She was also awaiting an autism assessment.

With all of these conditions, said Dr Harding yesterday (November 27), Amarnih’s chosen gender was perhaps “the one thing in her life that made sense”.

But evidence from NHS England, read into the record by coroner Nadia Persaud, said: “Unfortunately, waiting times for a first appointment at a gender dysphoria clinic remain very high.”

As of September 2023, NHS England wrote, a patient attending their first appointment has waited an average of seven years.

The problem is due in part to a national shortage of gender specialists, the body explained.

Barking and Dagenham Post: A jury was sworn in for Amarnih's inquest, at East London Coroners' Court in Walthamstow, last Monday, November 20A jury was sworn in for Amarnih's inquest, at East London Coroners' Court in Walthamstow, last Monday, November 20 (Image: Google Streetview)

“The services are massively stretched and struggling,” said Dr Harding, who does not specialise in gender services.

“Who knows what the effects of being on the waiting list for the gender dysphoria were,” he said.

“And… she was taking hormones. Who knows what effect they could have?”

He told barrister Sophie Walker, representing Amarnih’s family: “We are in completely unknown territory here. The fact that she’s taking medication which hadn’t been prescribed makes the situation that much more complicated – but I don’t know how it impacted on risk.

“The gender issue is obviously relevant to this case, but in a way that we don’t understand,” he said. “What would be good is to learn from this as best we can.”

Mrs Persaud asked Dr Harding if he felt there was anything local services could do to better support trans patients while they are stuck on waiting lists.

“It’s very, very, very difficult because it’s such a specialised area,” he said.

“If you’ve got specialised commissioning, do you really want to try and do a lesser version of it when you haven’t even got the diagnosis yet? It’s very complicated.”

He added: “Where we are at the moment is that there’s a massive waiting list.

“It’s a new field. It’s an expanding field. We’ve got a whole raft of young people coming up into adulthood with this issue and it’s really going to cripple services.”

The inquest continues.