The EHRC ‘s response to the government consultation on the proposed conversion therapy ban is very welcome in its careful consideration of issues which may result in harmful unintended consequences if not thoroughly scrutinised in advance.
LGBT and transgender organisations should welcome the EHRC’s concern that the consultation does not distinguish between the two very different groups the proposed ban covers:
“Nor does the consultation address the possible need to consider a differentiated approach in relation to sexual orientation and being transgender so as to ensure, in particular, that clinicians and therapists are not prohibited from providing appropriate care and support for individuals with gender dysphoria.”
It is right that the specific needs, rights and experiences of each group are considered separately to ensure the best possible protections for both. This is especially true for children, including adolescents who are exploring their identities and struggling with confusion around their sexual orientation and distress about their developing bodies.
Most people would assume that the term ‘conversion therapy’ applies exclusively to gay people and may support the bill on that basis. Gay conversion therapy is well understood – it is the attempt to change a person’s sexual orientation and it has a shameful history. ‘Transgender’, however, is not so clear. Young people are told that ‘transgender’ can mean anything they want it to mean, it is personal to them and only they know themselves. There is no one way to be ‘trans.’
As the EHRC points out:
“‘transgender’ is a term “which has no clear legal meaning, is potentially wider than the concept of gender reassignment in current UK law, and is understood by different people in different ways.”
There is also little evidence that ‘transgender conversion therapy’ is practised in the UK. On the contrary, the guidance for clinicians, teachers and professionals working with children goes the opposite way. Validation and affirmation of a child’s transgender identity is mandated without consideration of underlying issues which may have led to a child’s feelings of gender dysphoria, and this unquestioning approach has resulted in serious harms done to young people and a resultant NHS review:
“Given the documented lack of evidence about conversion therapy in relation to being transgender, recent attention and litigation on the implications of medical and surgical transition, and the ongoing NHS-commissioned independent review of gender identity services for children and young people led by Dr Hilary Cass OBE, we consider that these matters require further careful and detailed consideration before legislative proposals are finalised and the implications of them can be fully understood.”
The government must consider whether ‘conversion therapy’ is a helpful construct for understanding and treating the clinical condition of gender dysphoria. It is the job of qualified professionals to assess, diagnose and consider the best individualised approach towards troubled young people, which may vary widely depending on a range of factors including autism and mental health co-morbidities. As the EHRC says:
“The Government should make clear that psychological, medical and healthcare staff can continue to provide support to people experiencing gender dysphoria; this should include support to reduce distress and reconcile a person to their biological sex where clinically indicated, including for children and young people aged under 18 if this is in their best interests.”
‘Affirmation’ as a one-size-fits-all approach has caused harms to some young people and we know from recent studies that the number of those who regret medical transition has likely been underestimated. A recent audit of gender transition services in the UK found that a fifth of patients stopped hormones, of whom more than half cited regret or detransition experiences, and concluded:
“Research is needed into the current “affirmative” approach that is supported globally and by NHS England, in order to minimize potential harm to patients from complications of treatments, or their cessation.”
Keira Bell, who was ‘affirmed’ as a boy at the Tavistock GIDS, when asked what she would have liked to see done differently that would have helped her, said in an interview:
“Definitely some intensive mental health care…that’s the fundamental issue here is we’re not receiving proper mental health support”.
Her words reflect the testimonies of the increasing number of young people who regret their medical transition but have to live with the consequences for life. The most recent study of detransitioners found that 55% “felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition”.
The medical harms done to young people through unquestioning gender affirmation is reason enough to pause and think through the impact of adding ‘transgender’ to a conversion therapy bill, all the more so because such a large percentage of these young people are gay. The same study of detransitioners found:
“Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition.”
The demographic where we are most likely to find testimony of the harms of conversion therapy in clinical settings in the UK today is detransitioners, who feel that the ‘gender affirmative care’ they received was a form of conversion therapy in itself. A conversion therapy bill without proper research into this group will inevitably lead to further harms.
We have recently seen conversion therapy bans hastily implemented around the world, all of which have tacked on ‘transgender’ without proper scrutiny. This threatens to undermine the whole purpose of the proposed ban and risks causing harm to the very people it is intended to protect.
The Memorandum of Understanding on Conversion Therapy (MOU), the professional practice guide for counselling and therapy bodies, provides insight into the impact of adding ‘gender identity’ to a conversion therapy ban without thorough consideration. The ‘gender affirmative’ model of care has become entrenched in mental health services (CAMHS) and clinical settings; the ‘affirmation’ approach has been mandated for teachers, social workers and professionals working with children and young people; parents have been reported to social services for failing to ‘affirm’ their child as transgender; and the number of detransitioners speaking out on social media has increased exponentially.
The chilling effect of the MOU on therapists and counsellors has already resulted in fewer counsellors willing to work with children who self-identify as ‘transgender’ out of fear they will be accused of ‘conversion therapy’ if a child’s gender dysphoria is resolved through explorative therapy. The added threat of criminalisation will inevitably make this situation worse.
The UK has led the way globally in reviewing gender transition services to ensure the best standard of care for children with gender dysphoria: other countries such as Sweden and Australia have followed suit. We hope the UK will also lead the way in being the first country to properly scrutinise the evidence and think through the risk of unintended consequences of adding ‘transgender’ to a conversion therapy ban.
Given the complexity of introducing government legislation into the clinical care of children and young people in an area of controversy that is undergoing review, it makes sense to take the time required to fully investigate the issues. We agree with the conclusion of the EHRC:
“we recommend that legislation should initially focus on banning conversion therapy attempting to change a person’s sexual orientation, where the evidence and impacts are clearer.”
We commend the EHRC for their considered, impartial response to the government consultation in an area that has become highly politicised. We urge the government to show equal care and caution in properly scrutinising the issues to reduce the risk of unintended consequences. Given that the stakes are so high for children and young people it is imperative that the government gets this right. Delaying the bill is better than getting it wrong.