In November 2021, the NHS Confederation’s Health and Care LGBTQ+ Leaders Network and Mental Health Network conducted a short survey to help determine member views on a government consultation on banning conversion therapy.
Asking our members about their views on conversion therapy elicited more responses than we have ever received, demonstrating the strength of feeling on this topic. Our respondents expressed that they consider conversion therapy to be “grossly offensive”, “immoral”, “inhumane”, “barbaric”, “inherently wrong” and “despicable” and that:
“there is nothing right or okay about it.”
They told us that any endorsement of conversion therapy endorses a harmful message that it is morally wrong to be LGBTQ+ and endorses the delivery of physical and psychological trauma.
Given these views, it may surprise some people that conversion therapy still happens in the UK today. Conversion therapy covers a wide range of practices based on a discriminatory belief that a person's sexual orientation or gender identity can and should be changed. One respondent reflected: “it is disgusting frankly, to hear that such conversion therapies exist and that they are labelled as therapies”, because the set of practices involved are ineffective at their goals, as well as being psychologically and sometimes physically harmful. Yet conversion therapy continues to be offered and carried out by a minority of health professionals, as well as by faith organisations, family and community members all over the world. According to the National LGBT survey in 2017, five per cent of LGBT people in the UK have been offered conversion therapy, and two per cent of LGBT people have been subjected to it.
That conversion therapy is wrong is not in dispute. The government has already committed to banning it. The consultation asks how they should impose that ban. The LGBTQ+ health and care leaders who responded to our survey said that:
“the LGBTQ+ community deserves better than a partial ban with copious loopholes and very little action against those who practise/promote it” and that “if conversion therapy is to be made illegal, it should be made illegal full stop.”
Loopholes in the proposed conversion therapy ban
One loophole is a proposal that conversion therapy could legitimately occur if the person receiving it gives consent. The NHS states that for consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
While a minority of respondents wondered if consenting adults should be able to explore conversion therapy options, most strongly rejected this proposal on the basis that the concept of informed consent is invalid for conversion therapy, and would create wriggle room that would leave vulnerable people subject to coercion and abuse, for four key reasons:
1. No-one consents to abuse
Conversion therapy constitutes inhuman or degrading treatment under Article 3 of the Human Rights Act and on that basis, capacity is not relevant and informed consent cannot be provided. Further, “This ban puts the onus on the recipient who is vulnerable and feeling under pressure. Surely the onus should fall onto the therapist. If someone gives consent it does not make this acceptable.”
2. Consent may not be voluntary
Respondents reflected that: “if family members make someone 18+ feel mentally unwell enough to believe the lies that identifying as LGBTQIA+ is unhealthy or a sin, they will likely be coerced into consenting” and speculate that: “because of the amount of power that religious organisations hold over individuals and groups, consent can be easily manipulated and hard to document.” Several respondents assessed that: “people from certain religious or ethnic backgrounds may face more acute pressure from families/friends to seek out conversion therapy and take this action based on this pressure. They may be assessed as providing informed consent but really they have done this due to excessive pressure from their communities.”
3. Consent cannot be informed
Providing informed consent for a potentially harmful treatment “implies an expected benefit from treatment”. Given that “there is no evidence that any form of conversion therapy is effective”, people are likely to provide their consent based on “false and wrong information that conversion therapy is appropriate”, misleading them to believe that it may benefit them. It would therefore be very difficult to achieve genuine informed consent for conversion therapy.
4. The person may not have capacity to consent
Our respondents wonder: “who is assessing capacity? Is it the person employed into the conversion therapy clinic, as this will already create an inherent bias to say the person has capacity?” Others reflected that: “even where people appear to have capacity to make the choice there are often strong environmental and societal influences and this should be considered when deciding the boundaries of this law around capacity or coercion.”
Another proposed loophole is potentially imposing different rules for talking therapies and physical therapies. Respondents called for physical acts of conversion therapy to be treated on a par with other types of assault or physical abuse. However, respondents were concerned about inadequate protections proposed against the damage caused by talking therapies. One member reflected the general view with the comment: “All forms of conversion therapy should be banned, including talking therapies even when consent is given” and another concurred: “I think it should be a full ban. Not sure the government are doing this though, which is awful.”
Partly from personal experience, respondents expressed particular concerns about religious coercion that may come under the category of ‘talking therapies’, informally referred to by LGBTQ+ communities as “pray away the gay”. Respondents felt there is a need for an end to all “religious exemptions” to protect LGBTQ+ members of religious communities from these harmful practices.
Our members expressed strong feelings that currently “these crimes are not taken seriously” and that they “would like to see strong protection for the victims and strong prosecution for the perpetrators”. Reflecting on the proposals in the consultation, one respondent said: “it appears to be a ‘slap on the wrist’ approach that is being proposed, which, given the horrific outcomes of conversion therapy, does not add up.”
Several respondents felt concerned that proposed measures, like: “removing the passports of potential victims at risk of being taken overseas for conversion therapy, feels like a penalty to the victim rather than perpetrator. We need to focus on penalties for those committing violent acts and protection, safety and support for victims”. Views on how perpetrators should be treated included prison sentences, rescinded accreditation by professional bodies, prohibition from future work with vulnerable people and compulsory education around gender and sexuality to raise awareness. It was proposed that: “charities or CICs found to be practicing conversion therapy should be fined and stripped of their charity status” and that "if someone is guilty of conversion therapy or promoting it, they should be removed from their position and prevented having another that allows them to work with a vulnerable population.” Respondents also felt that: “the same premise for legislation for under 18s should also apply to adults” and that there should be consequences for facilitating conversion therapy, as well as delivering it.
Protecting vulnerable people
Several respondents reflected that: “those at risk of coercive and abusive practices, should be subject to the same protections as others within society we would deem to be vulnerable and require safeguarding protection” and “we could do more to support people who are vulnerable to this as a form of abuse. Does this need to be part of everyone's safeguarding training, similar to other radicalisation training?” There were concerns about a lack of understanding of conversion therapy and its intersection with homophobia, biphobia and transphobia. “All bodies involved in protection should have to attend specific training, to help them to fully empathise with victims, and to challenge their own prejudices.”
In terms of protecting and supporting people at risk, respondents considered that we need “more public education on what conversion therapy is”. “Perhaps also, children in schools should be made aware that this is abuse, and they should be provided with some safe space for reporting/discussing this abuse” and there should be “adequate helplines/support organisations”. Respondents reflected that:
“it is important to recognise that due to prevalent homophobic and transphobic attitudes in society, such beliefs may become internalised and people affected may not always recognise what is happening to them as abuse.”
Another concern expressed by respondents is that this legislation might drive the practice of conversion therapy deeper “underground” where even fewer protections might be available. As one member reflected: “not sure that these (proposals) would be effective given the coercive and secretive context in which pressure to undertake conversion therapy often occurs”. Respondents pointed to particular concerns about the power dynamics in some religious organisations, with respondents suggesting that: “LGBT+ people in religious organisations need much stronger protections than those proposed by this increasingly narrowing piece of legislation.” And “I would like to see a much broader duty of care placed on religious groups than simply seeking to ban the worst extremes of their practice.”
Supporting victims of conversion therapy
For those people who have been subjected to conversion therapy, respondents called for funded specialist psychological and social support to reduce the risk of “long-lasting trauma” and help these people feel comfortable with who they are; this may include mental health services and support groups. In particular, “a stronger support network, more help offered from the police especially, to keep checking in with these people and offer them long periods of counselling to help with trauma - not a limited number of sessions.” And “victim support would be useful but longer-term support would be necessary, especially for people leaving close knit religious groups who would be extremely vulnerable outside of them”. As well as counselling, practical interventions like safe housing were also identified.
Making sure LGBTQ+ people get appropriate support
Respondents were also keen to ensure that any new legislation does not create barriers for people who are exploring their LGBTQ+ identity to access the appropriate support they need. Many respondents expressed significant concerns that the proposed ban “will stifle genuine therapy” where “the aim of the therapy is not focused on changing a person's sexuality or sense of gender identity but helping the person to gain a better understanding of themselves in the context of their lives”. Many wondered: “is there a risk of criminalising therapy that offers a non-judgemental space to explore gender identity? How can the legislation make sure that it is not abused to scare clinicians to offer any therapeutic non-judgemental conversation about gender identity/sexuality, or helping clients with the wish to explore their gender and sexual identity in therapy?” There was a clear concern that as a result of poorly worded legislation, “professionals may feel scared to support people” and “it could make clinicians avoid the topic altogether for fear of putting themselves at risk.” Respondents expressed particular concerns that the government or activists might “use the legislation to ban therapy that helps people who might identify as transgender under false fears that young people are being ‘converted’ to being transgender.”
Tackling the root causes
A very strong message from respondents was that while this legislation will be very important, so is tackling root causes. As one respondent said: “more could be done to tackle the cultural and societal issues that are the root problem that leads to such awful behaviours here” as well as “internalised shame”. Our members explain that:
“if people are struggling with their sexuality, it isn't due to an inherent condition. It is driven by societal views on being LGBT and the attached stigma. Therefore the ‘treatment’ shouldn't be to supress the feelings within individuals, it should be to address the stigma and inherent discrimination within society against the LGBT community.”
Another respondent proposed that: “this legislation must be developed alongside meaningful action on how we as a country perceive and support LGBTQ+ people.” Members reflected that even those who had fairly recently left school had rarely experienced accurate, positive education about LGBTQ+ matters; “if it was ever mentioned, it was brief and inaccurate.”
The clearest message from LGBTQ+ health and care leaders is that alongside the need for a ban on harmful practices based on the premise that LGBTQ+ people need to change to be accepted, societal education is needed to shift this harmful and pervasive belief that is the root cause of the persistence of conversion therapy in the UK.
The NHS Confederation’s LGBTQ+ Health and Care Leaders Network and Mental Health Network will respond to the government’s consultation on banning conversion therapy reflecting the views of our members.
The government’s consultation closes Friday 10 December. Individuals as well as organisations can submit their own response, help ensure a total ban by submitting yours on the GOV.UK website.