NHS doctors take part in the Pride in London parade. (Photo by Wiktor Szymanowicz)
Artillery Row

Trans activism before medical standards

Professional counselling bodies have sided with Stonewall against standard paediatric practice

The first few months of 2022 have been eventful and revealing in terms of how we treat children and young people experiencing gender-related distress. To anyone paying attention, two very significant things happened: there was an ongoing government consultation on a conversion therapy ban which closed on 4 February, and the Cass Review published its Interim Report on 10 March. Both of these events should have engaged the professional interest of anyone involved in the treatment and care of gender dysphoric children, as well as any lobby groups advocating for them.

On 1 April all hell broke loose when the government performed two swift U-turns on the conversion therapy bill, ending up with a bill that left out transgender people. This was met with an immediate and furious response from LGBTQ+ and trans lobby groups. Over 100 LGBT organisations boycotted the government’s flagship Safe to be Me conference in protest, leading to its cancellation. After Stonewall withdrew, the government really had no choice.

So far, so predictable. We are used to seeing the trans lobby throwing their toys out of the pram; nobody who has been following the issue could have been at all surprised by their reaction. Then something else happened. On 7 April the BBC reported that various professional counselling bodies had joined Stonewall et al in issuing their own protests against the government decision. The Coalition Against Conversion Therapy (CACT) — the loose association of queer theorists now in charge of the UK professional practice guide the Memorandum of Understanding on Conversion Therapy (MOU2) — published a list.

Why are professional health bodies supporting the political activism of lobby groups on this issue?

The Cass report exposes a service that has failed in its duty to children

Going back to the government consultation itself, two professional bodies published their responses: the British Psychological Association (BPS) and the British Association of Counselling and Psychotherapy (BACP), along with CACT. Their responses are revealing. Given that “gender identity” was added to the original MOU back in 2017, you might have expected the management group and main signatories to have significant insights to share regarding the impact of their own professional ban on “conversion therapy” for transgender people. Some research perhaps, or at least collation of feedback responses from members. But no, they had nothing to add that was any different to the arguments of Stonewall. The promise to review the MOU2 after a year has still not even materialised.

In their responses, CACT, BPS and BACP all recommend that the government adopt the MoU2 definition of conversion therapy, without having done the most basic research into whether the effects on therapists and their clients have been positive or negative. The wording of their responses is indistinguishable from the activist groups, in their calls to protect “everyone from the LGBTQIA community”, “other gender and sexual [sic] diverse people” including “bisexual, asexual, intersex and non-binary people” and a full ban on conversion therapy for all adults as well as under-18s.

The flawed government research these groups draw on to support their position was referenced by the Equality and Human Rights Commission (EHRC) in their much more considered response to the consultation. The EHRC highlighted the “significant challenges in drawing conclusions from the survey” and concluded “We are therefore cautious about interpreting this data”.

It was left to the EHRC to point to “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”. The professional bodies themselves did not think to consider the potential impact on their members’ ability to do their jobs properly.

The EHRC also highlights the need for a clear definition of “being transgender” — which is not a clinical diagnosis — and clarity on which forms of communication would be caught by a ban on “talking conversion therapy”. Professionals must be able to offer legitimate professional services which “should include support to reduce distress and reconcile a person to their biological sex where clinically indicated” without being afraid of being caught by a ban.

In between the consultation closing and the government’s U-turn, the NHS-commissioned Cass Review of the Tavistock Gender Identity Development Service (GIDS) published its interim report.

If the signatories to the MOU2 had not previously considered the impact of a “transgender conversion therapy” ban on their members, there was no excuse not to do so now. The Cass report was unequivocal about the significant impact the MOU2 has had, referencing several times the concerns of therapists who “feel under pressure to adopt an unquestioning affirmative approach”. This is at odds with normal standards of paediatric practice.

This passage from the report is worth quoting in full:

“Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach. Some clinicians feel that they are not supported by their professional body on this matter.”

The Cass report is a stark exposure of a service that has utterly failed in its duty of care to children. What has led to these failings? The report states:

“From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach.”

And the conclusion:

“A fundamentally different service model is needed which is more in line with other paediatric provision.”

Pause for thought for the professional health bodies? Time for a reassessment of the MOU2? No. The professional bodies have doubled down.

In an act of solidarity with the lobby groups, the BACP, the BPS, the UK Council for Psychotherapy (UKCP), the Royal College of Psychiatrists (RCPSYCH) and the British Medical Association (BMA) all issued statements expressing their shock and disappointment in response to the government U-turn.

In line with Stonewall — who on 10 March promised an “in depth analysis” they have still not delivered — not one of these bodies has issued a response to the Cass interim report.

It gets worse. The disgraced service at the centre of the Cass Review itself, the Tavistock GIDS, added its own voice to the activist outrage in a statement that clearly revealed the ideological underpinnings of the service. Language such as “vulnerable marginalised people” and rallying calls like “It is time to stand with trans and gender diverse people” are more the language of a political treatise than the impartial considerations of health professionals.

Using politically-loaded language like “being trans or cis, or any other gender identity” to characterise children would earn top marks from Stonewall as the correct view of children seen through an adult political lens. Perhaps the Tavistock would like to provide us with definitions of what a “trans child” or a “cis child” is.

Neither has the GIDS published a response to the Cass interim report. The only reference to Cass on their website is a letter from Chief Executive Paul Jenkins and Director Polly Carmichael in a defensive response to an Observer editorial that begins, “Ideology has no place in medicine.”

In their letter Jenkins and Carmichael make the same claim as their defence at the Bell v Tavistock judicial review, that “only a minority access puberty blockers”. Their own paper from 2018 states on average 38–40 per cent of all clients attend the joint endocrine clinics — technically a minority, yes, but hardly an insignificant one. It is in any case a callous justification of a service that is failing to provide proper care: one child who is put on blockers without thorough investigation or proper diagnosis is too many.

How would the blunt tool of a conversion therapy ban help teachers?

On 14 April the National Education Union (NEU) joined the activist protest, calling for a ban on conversion therapy for “trans and non-binary people” and urging the government to work with “all the major psychological bodies in the UK”. The Cass report states that the final Review will cover the important role of schools; we will have to wait and see what the final recommendations will be. But there is enough in the interim report to make educators sit up and seriously think about policies currently taking off in schools. Social transition, for example, is described in Cass as an “active intervention because it may have significant effects on the child or young person in terms of their psychological functioning”, adding “better information is needed about outcomes”.

How would the blunt tool of a conversion therapy ban help teachers to sensitively navigate situations with a distressed child, with the threat of criminalisation hanging over them if they are accused of getting it wrong?

The only relevant voice in this discussion is that of Dr Hilary Cass. This is the voice that health bodies and the largest teaching union have chosen to ignore, in favour of the ideological proselytising of Stonewall and other activist groups.

It seems that in this case it is only the government itself who has done the necessary reading and acknowledges the central recommendation of the report:

“Children & young people with gender distress must receive the same standards of clinical care, assessment and treatment as every other child or young person accessing health services.”

It is naïve in the extreme to think that a conversion therapy ban would do anything other than exacerbate the problems outlined in Cass’s sobering report, a report that should be read as a wake-up call to all professionals that the current politicised and ideologically-based system is fundamentally failing and harming vulnerable children.

We only have to take a look at other jurisdictions that have rushed through “transgender conversion therapy” bans to know what the consequences will be for the UK. Victoria, for example, passed a bill after only a 12-hour debate. How is that going? The Australian Spectator reports:

“Any pushback or exploration of a child’s gender distress is considered ‘gender identity conversion therapy’ akin to the barbaric practices inflicted on gays and lesbians in the past. Victoria has effectively criminalised any treatment other than ‘affirmation’.”

Criminalising “conversion therapy” for the nebulous concept of “gender identity” or “being transgender” would be legislation in opposition to the findings of the Cass report. Why are professional bodies lobbying for it?

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