The really frightening thing about today's cuts is that no one knows their combined impact

The sums just don't add up.

"How will I cope with the bedroom tax? I already have more outgoings than ingoings. I don't have my heating on, I don't have my fridge on. I buy reduced food, 10p loaves of bread. I go to the swimming pool to shower so I save gas. I can't make any more savings."

This is Debbie, 45, from Newcastle.

Until a few months ago, she claimed no benefits and was paying her own rent. Then she suffered a serious illness and lost her job as a support worker. She is thankful her £71 rent is currently being covered by housing benefit, but is struggling to survive on just £71 a week Employment Support Allowance. As of this month, she will be hit not only by the bedroom tax, but will also face a £64 council tax bill as Council Tax Benefit is withdrawn.

Crisis is working with Debbie to help her rebuild her life, but our fear is that these measures could leave her, and thousands of others like her, in serious trouble.

Debbie faces losing her home, and with a severe lack of one-bedroom properties in the area, she is justifiably scared about the future. She is one of millions struggling with a bewildering array of cuts that come in April 2013. The one thing they have in common is that they all hit those with least to lose - those already closest to homelessness.

The really frightening thing about today's cuts is that no one knows their combined impact. Indeed, the influential Public Accounts Committee has expressed concern that:

"The Department is introducing these significant changes without comprehensive modelling of the likely outcome on individuals"

The scale is enormous: 660,000 households will be hit by the bedroom tax; 2.4 million households by the Council Tax Benefit cut; 56,000 households by the overall benefit cap; 9.6 million households by 2015/16 by benefits uprating; 1.36 million households by Local Housing Allowance cuts; 500,000 disabled people will lose out when DLA becomes PIP. Last year 1.7 million grants and crisis loans were made to people on the brink of destitution or rebuilding their lives following homelessness - these are to be abolished, cut and localised. Even Legal Aid for housing and benefit disputes is to be stopped, so people who believe they have been treated unfairly will have no power to challenge.

The result for households budgeting for these multiple cuts will be a cold, bleak April of misery, debt, food banks, unheated rooms, unpaid rent and homelessness. Leaving aside the moral repugnance of forcing the poorest in our society to bear such a burden, this is going to cost us all dearly.

The price to the public purse of keeping someone in their home pales into insignificance next to the cost once they lose it. The price of B&Bs, hostel rooms, A&E departments, mental ill-health and rough sleeping services is enormous. These cuts are not only cruel - they are counter-productive for us all.

And they come at the worst possible time. Homelessness is already rising as the economic downturn and previous cuts take their toll. Over the past two years rough sleeping has risen by 31 per cent, and the number of households accepted as homeless by local authorities has gone up by 26 per cent. Unemployment and underemployment remain stubbornly high.

In the words of Debbie: "It will be impossible to cope - the sums just don't add up." I couldn't put it better myself. The sums don't add up for Debbie, and they don't add up for society either.

Photograph: Getty Images

Leslie Morphy is the outgoing Chief Executive of Crisis, the national charity for single homelessness people.

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How society is failing transgender children

In the wake of the cancellation of a public debate on this subject, one of the speakers shares her view on where society's approach to gender nonconformity is going wrong.

In August this year, several UK councils issued guidance to schools on accommodating female pupils who wear binders. A binder is a constricting undergarment for the upper body: what it binds are the breasts, pressing them down to a flatness that the wearer feels is appropriate to their self-perception as masculine or gender-neutral. According to Cornwall Council, the binder is “very important to [the wearer’s] psychological wellbeing.” But binders have unwelcome physical side-effects too, including “breathing difficulties, skeletal problems and fainting.” Lancashire Council’s advice urges teachers to “monitor [wearers] carefully during physical activities and in hot weather. It may be necessary to subtly offer more breaks.”

When the NSPCC invited me to participate in a discussion on the subject “is society letting down transgender children?” (part of its Dare to Debate series), those guidelines were one of the first things I thought of. They’re written in accordance with the overriding principle of gender identity politics, which is that affirmation is all. Any bodily harms incurred count for little compared to the trauma believed to be inflicted by a “mismatch” between appearance and identity. It’s a doctrine that insists we’ve moved beyond the tyranny of physical sex and social pressure, and into a realm of pure selfhood where all must be able to live in accordance with their own inherent being.

And yet, look again at that list of side effects: breathing difficulties, skeletal problems, fainting, inability to participate fully in exercise. The female adolescents wearing binders have reproduced all the problems of tight-lacing corsets, this time in the service of restrictive anti-femininity rather than restrictive femininity. So is issuing guidance to reduce the harms of binder-wearing in schools an act of care for transgender children, or an abdication of it? Is the role of adults in authority – whether parental, educational or medical – to validate everything that comes under the rubric of transition, regardless of long-term consequences, or could another approach be better?

The number of children who identify as trans is small, but rapidly increasing: referrals to the Tavistock and Portman NHS Trust’s gender identity development service have doubled year-on-year. Putting gender-nonconforming youths on a medical track opens the possibility that they will be prescribed puberty blockers, delaying the physical changes of adolescence that individuals may find distressing. Later, treatment can include cross-sex hormones and surgery to create the desired sexual characteristics.

For many, this can alleviate profound anguish about the self, but not without costs. The long-term effects of hormone therapies aren’t known, and won’t be until the current generation of trans children have lived well into adulthood. There’s a risk that increased medicalisation could be imposing permanent physical changes on children who, left to their own devices, would discover they are quite happy living with their natal sex – about 80 per cent of children diagnosed with gender dysphoria desist before adulthood, but the normalisation of medical transition could commit many to irrevocable treatments they would otherwise avoid.

Remarkably, as I found out when I worked on a long feature on the subject, there isn’t any agreement on what gender identity is or how it relates to the physical body. Which means that transitioning children are receiving an untested treatment for an undefined condition. Medicine often involves a surprising degree of idiosyncrasy and guesswork, but this uncertainty both about what is being treated and the effects of the treatment should be a cause for caution. While many who transition find it wholly positive, not everyone does: doubt and detransition happen, and these stories tell us that the quickest path to reassignment is not always the best treatment for someone presenting with dysphoria.

Sometimes, a diagnosis of gender dysphoria might mask a different underlying cause to a child’s distress. Psychiatrist Susan Bradley reports that children with cross-sex identification are often (not always) either responding defensively to a violent background or engaging in the obsessive behaviours associated with autistic spectrum disorders. A policy of “watchful waiting” – listening to the child, supporting them and giving them freedom to experiment and develop – is vital if we are to give children the kind of help they really need. But in an environment where anything short of total and immediate reinforcement is deemed abusive, “watchful waiting” is not an option.

One more problem: if gender dysphoria is conceived as the problem, and gender reassignment as the solution, then transition represents the summation of a process which should in theory resolve everything. In practice, newly-transitioned young people (especially those crossing the threshold from child and adolescent mental health services to adult provision) can find themselves stranded, no longer in receipt of the support they had during transition. We simply aren’t getting the treatment of transgender children right if we’re only treating their gender.

The consequences extend well beyond children who identify as trans, of course. Schools are suffused with sexual harassment and sexual violence, yet girls are expected to accept a child they previously knew as a boy as female like them, or be called bigots. The naturalisation of sex-stereotypes in parental narratives of transition surely has a limiting influence on other children’s conception of sex-appropriate behaviour. For some gender-nonconforming children, the cultural celebration of transition leads to anxiety about whether they themselves should be trans, even if they’re happy in their bodies. Certainly, many gay and lesbian adults have looked back on their own childhoods and remarked nervously that their behaviour then would qualify them as trans now.

If we’re not able to address these issues, then we’re manifestly failing children. But addressing them is incredibly difficult: practitioners who privately mention their doubts about current approaches to gender noncomformity are afraid to ask questions publicly, anticipating personal attacks and the loss of their jobs.

They’re not wrong to do so. After announcing the Dare to Debate event, the NSPCC was put under sustained pressure, I was persistently abused, and following the withdrawal of the other panelist, the charity cancelled the event. Previous installments in the series have looked at child sexualisation, foetal alcohol syndrome, and asked whether the investigation of child sexual abuse has tipped into “hysteria”, but apparently it would be just too daring to talk about gender. Doctrine so bitterly defended that it must even be protected from good-faith debate is a kind of restrictive garment for the intellect. Wearing it can ease our mental pangs. But the damage it does besides is very real.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.