Talking about conversion therapy

LGBT+ conversion therapy has been the topic of much debate in the Spring of 2022.

Here, we will give an introduction to the current discourse around conversion therapy in the UK, its implications for trans people, and how healthcare professionals can support their patients.

What is conversion therapy?

You may have heard of conversion therapy in the news and media, or about famous victims such as Alan Turing, who was subjected to chemical castration as a form of conversion therapy.

When the first gender identity clinic was created in the NHS, the only treatment option offered to trans patients was aversion therapy; a form of conversion therapy which involved inducing vomiting or administering electric shocks. This will be covered in more detail next week where we talk about the history of trans healthcare in the UK.

Galop, the UK’s LGBT+ anti-abuse charity, describes conversion therapy as any practice which tries to suppress or change someone’s orientation or gender identity. The UK government stipulates that this definition is correct regardless of whether it takes place in a healthcare, religious, or other setting.

Conversion therapy is based on the incorrect belief that LGBT+ identity is a developmental disorder, addiction, or spiritual problem which requires guidance or correction.

Practices can include physical approaches such as “laying of hands”, to psychological and spiritual methods involving prayer, pastoral counselling, fasting, pilgrimages, “covert aversive methods” (e.g. snapping a rubber band on the wrist) and talking therapies. Stonewall’s article on the need to ban conversion therapy outlines some of the harm caused by such practices.

Government analysts have concluded that conversion therapy practices aimed at changing sexual orientation and conversion therapy practices aimed at changing gender identity are similar.

What are the harms of conversion therapy?

There is currently no evidence that conversion therapy is able to successfully change someone’s sexual orientation or gender identity.

The UK government report titled “Conversion therapy: an evidence assessment and qualitative study” found “an increasing amount of quantitative evidence that exposure to conversion therapy is statistically associated with poor mental health outcomes including suicidal thoughts and suicide attempts”.

Those who have undergone conversion therapy report an increase in self-harm, suicidal ideation and attempts, feelings of blame, social isolation, and loss of faith. Negative health outcomes associated with conversion therapy are widely translated through the minority stress model, which you can learn more about in the next step.

The currently legal forms of conversion therapy as well as attitudes towards the acceptability of conversion therapy can spill over into validating illegal methods of attempting to change someone’s orientation or gender, such as physical and sexual assault.

What does banning conversion therapy mean for the community?

The most recent government response has been to introduce a ban on conversion therapy aimed at changing sexual orientation for those under 18 years of age, and those over 18 who do not consent.

There is concern from professional bodies that the exclusion of trans conversion therapy from this ban will negatively affect all LGBT+ people.

Government analysts have concluded that “practitioners of conversion therapy can conflate sexual orientation and gender identity in practice”.

This means that an incomplete ban on all forms of conversion therapy will continue to affect all members of the LGBT+ community by virtue of deviating from the “norm” of being cisgender and heterosexual.

In the 2018 LGBT+ survey conducted by the UK Government, significantly more trans people (13%) reported having undergone or been offered conversion therapy than their cisgender counterparts (7%). This report found that 4% of trans people had actually undergone conversion therapy.

Why do people oppose banning trans conversion therapy?

Groups in opposition to the ban are concerned that due to the broad nature of the term “conversion therapy”, that healthcare professionals will feel unable to have open discussions with their trans patients without potentially breaking this law.

The UK government’s response has also highlighted concerns with “complexities and sensitivities” in this area, a concern primarily drawn from vocal transphobic lobby groups. However, professional bodies and a collaboratively signed Memorandum of Understanding (2022) have collectively recognized the ability for healthcare professionals to continue to support their patients’ discussion and exploration of their gender in the presence of a full conversion therapy ban.

Charities, such as the Evangelical Alliance, believe that a ban on conversion therapy would impose upon religious freedoms and restrict individuals who wish to “transform”. However, this view is not shared by all religious groups, and a declaration calling for a ban on conversion therapy has been signed by over 370 religious leaders from across the world, including Christian, Jewish, Sikh, Muslim, Buddhist and Hindu leaders.

More information about interfaith support of LGBT+ people on the Ozanne Foundation website.

Why is this important to healthcare professionals?

In the UK Government National LGBT Survey, it was reported that 19% of those who had undergone conversion therapy had done so under the direction of healthcare professionals, with further research finding that this includes NHS professionals.

A Memorandum of Understanding outlining the stance that “conversion therapy in relation to gender identity and sexual orientation (including asexuality) is unethical, potentially harmful and is not supported by evidence” has been signed by NHS England, Scotland and Wales, Mind, Royal College of Psychiatrists, the British Psychological Society and GLADD.

Other public bodies such as the General Medical Council, the Health and Care Professions Council, the Nursing and Midwifery Council, the British Medical Association, as well as numerous medical schools, have all publicly stated their support of a full and complete ban on conversion therapy and it’s promotion.

This stance is supported internationally by the Office of the High Commissioner for Human Rights and Amnesty International.

It is important for healthcare professionals involved in providing medical transition services to feel confident in the care they are providing. Those in the wider healthcare community should continue to advocate for safer practices and champion a supportive healthcare service for our patients.

It is vital to know what conversion therapy is and how to talk about it so that we can challenge harmful practices and prevent further harm to those subjected to it.

Patients who disclose being offered, or having undergone, conversion therapy can be directed to the National Conversion Therapy Helpline, supported by Galop. Further information and support for patients can also be found by contacting Stonewall.

Want to know more?

We have added a list of resources and references for this step in the downloads section.