04 February 2022
Here you will find our response to the UK Equality Hub consultation on banning conversion therapy.
We strongly agree that the Government should intervene to end conversion therapy in principle.
There is a growing body of evidence that conversion therapy may be harmful (Jowett and others, 2021). A systematic review undertaken by a task force of the American Psychological Association highlighted serious methodological concerns regarding the designs of Sexual Orientation Change Effort (SOCE) studies, and concluded that enduring change to an individual’s sexual orientation is uncommon, and identified evidence to indicate that individuals experienced harm (Glassgold et al., 2009).
Furthermore, the National LGBT Survey found transgender people were more likely to report having undergone or been offered conversion therapy and that one large study found that transgender people who had undergone conversion therapy were more likely to experience harmful outcomes than transgender people who had seen a professional about their gender identity but had not undergone conversion therapy (Turban, 2020).
The central role of a psychologist, counsellor and therapist is to relieve suffering and to promote wellbeing. Therefore, practising conversion therapy is not in line with the basic tenet of providing care in an ethical manner.
We strongly support this proposal which should further deter acts of violence motivated by efforts to change a person’s sexual orientation or gender identity.
The proposal will allow such motivating factors in a violent crime to be recognised in the sentencing in a similar way to hate crimes.
We welcome the proposal to ban talking conversion therapy for under 18s, people who have not consented or lack the capacity to do so. It is important that talking conversion therapies are included in a ban as this is often the form that conversion therapy takes (Jowett and others, 2021).
We note that the proposal has been drafted to be symmetrical so it would apply to efforts to change someone “from being transgender or to being transgender”. We do not object to the law applying in a universal fashion in principle. However, it should be acknowledged that lesbian, gay, bisexual, trans (LGBT) and other gender and sexual diverse people (e.g. asexual and non-binary people) are usually the targets of conversion practices (irrespective of whether they label themselves as such at the time). As outlined in the Memorandum of Understanding on Conversion Therapy in the UK (Version 2), and the government commissioned research (Jowett and others, 2021), conversion therapies are typically premised on the assumption that being heterosexual and/or cisgender is preferable to being LGBT+ and on the assumption that being LGBT+ is a disorder, defect, deficiency or addiction. It is important to recognise that conversion therapy in the UK takes place within a socio-cultural context in which LGBT+ identities have been historically stigmatised and in some sections of society continue to be so.
We believe it is important for the legislation or accompanying guidance to make clear that the law will not stop ethical, affirmative forms of therapy (which are non-directive and non-judgemental). It is also important that the legislation does not interfere with psychological and medical professionals who are trained and competent in working with trans and gender questioning youth from engaging in identity exploration or performing clinical assessment of suitability for medical intervention. It should not interfere with regulated professionals working in gender identity clinics under NHS specifications (including any changes to practice made in light of the Cass Review).
To assure professionals that providing ethical forms of therapy will not be affected by a ban, we think a clear distinction needs to be made between conversion therapy and normal ethical practice. It may be helpful to highlight key characteristics of conversion therapy such as identified by Jowett and others (2021) and by the American Psychological Association (2009, 2021):
While it is important that the proposed penalties act as a deterrent, we believe criminalisation and imprisonment should be a last resort. We are mindful of the impact that imprisonment can have on the mental health and wellbeing of prisoners.
We would therefore favour a focus on civil penalties, restorative justice and on preventing groups and organisations that specifically provide conversion therapy from operating in the UK. However, we are aware that there are differing views in this area and would like to see further evidence from the Government.
There are a number of areas where we have concerns and believe that further clarification is required:
Jowett and others (2021) found that many of those who undergo conversion therapy do so voluntarily due to internalised stigma, fear of rejection and other social influences. The task force of the American Psychological Association highlighted how ‘Informed consent and self-determination cannot be considered without an understanding of the individual, community, and social contexts that shape the lives of sexual minorities.’(Glassgold et al., 2009). They further go on to state that ‘an understanding of self-determination is context dependant’. Stigma, prejudice and discrimination may be a significant influence on a person’s consent for ‘conversion’ therapy. Other contributing factors, such as coercion, politics, religion and cultural factors may also impact a persons’ self-determination, in addition to psychological factors such as shame, guilt and fear that may be exacerbated by these environmental factors. The task force state that ‘Self-determination and autonomy can vary in degree due to interpersonal and intrapersonal concerns and can be considered in relation to other ethical principles, such as providing services that (a) are likely to provide benefit, (b) are not effective, or (c) have the potential for harm.’ (Glassgold et al., 2009).
Jowett and others (2021) found that there is a growing body of evidence that conversion therapy may be harmful. We are not aware of evidence to suggest such harms are limited to overtly coercive conversion therapy or conversion therapy with people under 18. We believe that young adults who are becoming aware an LGBT identity within cultural or religious social environments which are not accepting of sexual and gender diversity are particularly vulnerable to the harms of conversion therapy.
We also have concerns that the proposed “robust and stringent” consent requirements are realistic or enforceable in practice. The proposals state that consent must be ‘voluntary’, ‘informed’ and the recipient must have ‘capacity’ to give consent.
To be considered ‘voluntary’, the proposals state that the person making the decision “must not be influenced by others”. The American Psychological Association’s (2009) Task Force for Appropriate Responses to Sexual Orientation state that “repressive, coercive, or invalidating cultural, social, political, and religious influences can limit autonomous expression of sexual orientation, including the awareness and exploration of options for expression of sexual orientation”. Jowett and others (2021) similarly reported people being influenced by powerful social pressures and the guidance of people in positions of trust and authority that may limit autonomous consent.
The proposals state that to be ‘informed’ consent, the person must be given all of the relevant information. Further clarity is needed on what this information should include. Given that conversion therapy is typically based on inaccurate, unscientific and misinformation (Jowett and others, 2021), we question the likelihood that those offering conversion therapy would provide full and accurate information and how this would be monitored in unregulated settings.
The proposals also state that the recipient must have capacity to consent. While regulated health professionals are trained to assess a person’s capacity to consent, we know that much conversion therapy takes place in religious and other unregulated settings (Jowett and others, 2021). We are concerned that people in these settings may not be in a position to assess the individual’s capacity to consent to potentially harmful practices.
It is important to note that there are other examples where a ban on conversion therapy has been enacted without the caveat of ‘informed consent’ including in Victoria, Australia.
Overall, the intention of banning conversion therapy must be to protect LGBT+ people from harm. We do not believe that the current proposals go far enough towards a full ban of conversion therapy and we have serious concerns that they would not protect many of those who undergo conversion therapy from its associated harms.
We are concerned that relying on the Ofcom Broadcasting Code rather than specifically banning the promotion of conversion therapy may not be sufficient to prevent its promotion. There is nothing in the Code specifically relating to conversion therapy and the proposals rely on Broadcasters (and Ofcom) interpreting the code in a way that would categorise conversion therapy as “harmful and/or offensive material” or material that “promotes hatred and/or abuse”.
However, we welcome the government expressing its view, that endorsing or promoting any instance of conversion therapy in broadcast media would most likely breach the current Code.
We are not aware of any examples of promotion via broadcast media. We welcome the government’s intention to tackle online promotion of conversion therapy through the Online Safety Bill and believe that it is important to properly consider the impact of social media as well as broadcasting.
We are concerned that relying on the UK Advertising codes rather than specifically banning the promotion of conversion therapy may not be sufficient to prevent its promotion. There is nothing in the codes specifically relating to conversion therapy and the proposals rely on interpreting the codes in a way that would categorise conversion therapy as harmful, offensive or misleading.
We welcome the government expressing its view, that Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) prohibit the advertising of conversion therapy. However, some forms of marketing such as sponsorship are not covered by the CAP Code and ASA won’t pursue complaints about sponsorship.
We are aware that one UK-based conversion therapy organisation has in the past sought to pay for advertising space on public transport in London. We would welcome further measures to prevent online promotion via the Online Safety Bill.
We welcome the proposal for Conversion Therapy Protection orders to protect vulnerable people. However, it is possible that people outside of the UK may offer conversion therapy to people in the UK via online methods. We would welcome further measures to protect people from conversion therapy online.
We welcome, in principle, the idea that those involved in providing conversion therapy be disqualified from serving as a trustee and removing the charitable status of organisations found to be providing conversion therapy. However, we do not feel the proposals currently go far enough.
The proposals state that “a person found guilty” of the new talking conversion therapy offence will be more likely to be disqualified. Under the current proposals an individual could only be found guilty of talking conversion therapy in a very limited set of circumstances (i.e. where it is overtly coercive, delivered to under 18s or to those unable to consent). This means that an individual who provides talking conversion therapy to consenting adults would not be affected by this proposal, nor would a charity that provides conversion therapy to consenting adults have its charitable status removed.
Research by Jowett and others (2021) found people in the UK reported having undergone conversion therapy by registered charities and experienced it as harmful. Given that conversion therapy is unethical and potentially harmful we believe that any charity providing conversion therapy (irrespective of the age of the recipients) should have their charitable status removed. Indeed, we would like to see the Government go further and ban any organisation (charity, registered company etc) that provides conversion therapy.
Police; Crown Prosecution Service; OTHER statutory service
We strongly disagree that statutory services are providing adequate action against people carrying out conversion therapy. We believe this is because it is not illegal to offer or provide conversion therapy in the UK and without a legal ban, statutory services are unlikely to feel empowered to take action. There is also no reporting mechanism for people to report conversion therapy where it is offered or provided by people other than regulated professionals.
Police; Crown Prosecution Service; OTHER statutory service
We strongly disagree that statutory services are providing adequate support for victims of conversion therapy. We believe this is because it is not illegal to offer or provide conversion therapy in the UK and therefore people who undergo conversion therapy are not widely recognised as ‘victims’. We have concerns that under current proposals, those 18 and over who ‘voluntarily’ undergo conversion therapy will continue to not be recognised as victims. Statutory services also often lack LGBT+ awareness training that covers issues such as conversion therapy.
Initially, there needs to be a clear pathway for reporting conversion therapy to the authorities, with reports being treated with appropriate care and expertise. Individuals need to be able to feel safe to report, so clear guidance is extremely import alongside clear feedback about the law regarding conversion therapy and feedback on progression of any criminal cases being investigated.
More LGBT+ awareness training that covers issues such as conversion therapy is essential and would help to better equip those working in statutory services to identify those at risk, to support victims and to signpost victims to relevant sources of support, including dedicated helplines and LGBT+ charities.
Do you have any evidence on the economic or financial costs or benefits of any of the proposals set out in the consultation?
There is a duty on public authorities to consider or think about how their policies or decisions affect people who are protected under the Equality Act 2010. Do you have any evidence of the equalities impacts of any proposals set out in the consultation?