Blog

Yet another draft conversion therapy bill has been published after several failed attempts to get a ban into law. This time it’s the Labour government’s version, now called a Conversion Practices bill and with a carve-out for healthcare providers, but not for parents, teachers or child protection professionals. It is the worst proposed bill we have seen yet in terms of child safeguarding and in its inherent conflict with the Cass Review.

The carve-out for healthcare professionals makes little difference because they are governed by professional associations that already have their own trans-inclusive ban on conversion therapy, the Memorandum of Understanding on Conversion Therapy (MOU). Therapists already dare not say anything that might result in a child changing their mind about being trans which may lead to a charge of conversion therapy.

The MOU shows us how a ‘trans conversion therapy’ ban is so effective in distorting the practice of counselling and therapy from a genuinely open-ended exploration as Cass recommended to a guarded and careful tip-toeing around the child who says they are trans. That’s if a therapist dares to venture outside the model of unquestioning affirmation at all.

So the drafters of the new Conversion Practices bill know they are already  on safe ground there. It is parents who will feel the full force of this bill’s authoritarian dictates on language and behaviour. As family lawyer Sarah Phillimore says

The ‘chilling effect’ of a criminal prosecution on responsible and protective parents is obvious.

The bill criminalises any conduct carried out by a person towards an individual with the intention of causing the individual

• (i) to have or not to have,
• (ii) to believe that they have or do not have,

a transgender identity or a particular transgender identity.

The bill presents these things as symmetric, a dishonest wording of a bill specifically designed to protect gay and trans people from conversion practices, not the other way round.

Gay conversion therapy itself is vanishingly rare and already legislated for, it is not a problem that needs urgent legislation. But this is certainly not a bill for heterosexual people with a long history of awful experiences of being forced to be gay. The government knows the issue of gay conversion therapy is not symmetric.

For ‘transgender identity’ the imbalance is the other way round. The problem is the opposite. Everywhere we look children are being encouraged to understand themselves as ‘trans’ and to believe they have a ‘gender identity.’

Online, across media, in children’s books and entertainment, in schools, universities and health services, and even in High St shops, ‘transgender identity’ is celebrated and elevated to special status. There is no equivalent encouragement of children to feel proud of their ‘cisgender identity.’ In fact ‘smashing cisheteronormativity’ is the specific aim of some classroom resources.

There is no pressure on children not to be trans, all the cultural messaging to children and young people is the opposite. The government knows the issue of ‘trans conversion therapy’ is not symmetric either.

But this is not a bill that has been fought for by parents worried sick that their child’s school is presenting concepts of ‘gender identity’ to their child that they are too young to understand but are in one of the vulnerable groups highly susceptible to believing it.

This is a bill fought for by transgender activists. Why? The sheer number of children on the waiting list for the new gender hubs and the number of young people in line for the adult services shows that there is not a problem to be solved here, there are plenty of children and young people who are adopting a ‘transgender identity’ all the way to the clinic. They are not being dissuaded, but the opposite. They are being ‘affirmed’ as trans every step of the way.

But the safety of the ‘gender affirmative’ approach is now in question. From Keira Bell’s case against the Tavistock to the Cass Review, the closing of the GIDS, and the setting up of the new gender hubs under a new holistic model focused on psychological and therapeutic exploration and support, the unquestioning gender affirmative approach is in trouble. It needs shoring up, legislatively. This is what the draft bill will do. It’s a last-ditch attempt to get gender self-id onto the statute and to stop people’s right to question it.

It’s difficult to claim that affirmation of a child’s transgender identity is conversion therapy. Conversely, it’s very easy to claim that a parent exercising caution in order to protect their child from the potential medical consequences, and keep their child’s options open, is conversion therapy. We know this because cautious parents who want to slow things down are already accused of conversion therapy.

The bill loads the dice between two approaches towards children who say they are trans. The bill’s overreach is not just into family life and parental authority, but into clinical models of care.

The gender-affirming care (GAC) treatment model, involving gender affirmation and social transition, puberty blockers, cross-sex hormones and surgeries, replaced the developmentally-informed watchful waiting approach through no clinical reasoning (children were not being harmed) but through political advocacy.

The gender affirmative approach was found to be unsafe at the Tavistock GIDS and the clinic was closed down. One of the problems identified in the Cass Review was ‘diagnostic overshadowing.’

‘Another significant issue raised with us is one of diagnostic overshadowing – many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be subsumed by the label of gender dysphoria.’

Children being unquestioningly affirmed in their ‘transgender identities’ has led to the unprecedented rise in the numbers of children seeking puberty blockers and hormones. For the Cass Review, the University of York carried out a systematic review of social transition which found

‘those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway’

This bill effectively prevents parental opposition to a child who wants to socially transition as it could be construed as ‘controlling or coercive words or behaviour’ or ‘use of psychological or emotional pressure’ which causes ‘serious alarm or distress to the individual.’

Yet Cass describes social transition as 

‘an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning.’

And that

‘it is possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence.’

The Conversion Practices draft bill interferes with the evidential basis of clinical decision making by weighting support for a gender affirmative approach over recent findings and emerging concerns about that very approach, as set out comprehensively in the Cass Review. It is beyond the government’s remit to become involved with a live and contested clinical issue with profound impacts on children’s health and wellbeing.

The draft bill supports an unevidenced, one-size-fits-all approach to children who are experiencing gender-related distress which may place parents in opposition to the clinical advice they are receiving. Parents may have informed themselves by reading the Cass Review but they will be prevented from following it.

The bill would significantly reduce patient options by discouraging exploration and reframing a cautious exploratory approach as harm. The bill proposes an unquestioning acceptance and agreement with a child’s self-diagnosis which has profound implications for the child’s ability to give informed consent to medical treatments.

It is not the government’s job to advocate an active intervention and effectively prevent a cautious, developmentally appropriate approach through the threat of criminal prosecution. The draft bill attempts to do this by targeting the most important adults in a child’s life whose job it is to safeguard children from harm and whose authority should not be undermined by state intervention.

The Conversion Practices bill is dangerous for children because it does not distinguish children from adults and it ignores childhood developmental stages. The term ‘transgender identity’ hides the reality that it mandates adult agreement with a boy that he is a girl, or with a girl who says she is a boy. It mandates agreement with a transgender identity declared by a child who has no understanding of what that means.

The evidence of the danger for children was revealed by Hilary Cass in the House of Lords last week. A two and a half year old boy was told by his parents that he was a girl and brought up as a girl for all his early childhood, with no interference from teachers, doctors or social services.  

The bill should enable professionals to report such cases of child abuse as ‘causing the individual to have a transgender identity’, but it won’t. People are justifiably terrified of losing their jobs and livelihoods if they question anyone’s transgender identity. Societal pressure and bullying goes only one way; the professional risk too is not symmetrical.

The bill will increase the fear already felt by professionals of daring to challenge a ‘transgender identity’ even in a child who is many years away yet from understanding what that could possibly mean.

It is entirely inconsistent for a government that has claimed at every opportunity to be ‘following Cass’ when it comes to the puberty blockers trial, to undermine its own stated commitment to be guided by the evidence through a draft bill that is actively in opposition to the Cass Review’s findings.