Comment: Why are we allowing gay conversion therapy on the NHS?
By Tom Stephens
Why has the government indicated its willingness to support moves to posthumously pardon Alan Turing, when not-so-famous figures in gay history will still have their criminal records tarnished
Among the many reasons, one sticks out for me: more than many others, Turing was killed by government policy. The law, predicated on the belief that homosexuality was an illness, prescribed him drugs to neutralise his same-sex attraction. The resulting sense of dejection he felt, most accounts suggest, led to his suicide. He was the victim of a system which made him feel ashamed of his own sexuality. Its cruelty is reflected in the single word he was persuaded to say at the beginning of the trial in 1952, in an effort to reduce his sentence: "Guilty."
Yet even today, it's no exaggeration to say that many LGBT people in Britain are being told by their parents and peers that their sexuality is something to be ashamed of. Some are then driven to try to alter it through a form of gay-to-straight conversion therapy which, although quite different from the treatment Turing underwent, has the same effect of making them feel dejected, isolated and even suicidal. But there's a yet more chilling comparison with Turing: the government is being complicit in the practice by doing nothing to solve the problem. Indeed, if they go ahead with their scrapping of the public sector equality duty – which mandates the public sector to proactively address issues of inequality in their services – they may even make things worse.
Gay-to-straight conversion therapy isn't just the resort of a few quack Christian evangelicals operating in esoteric gay conversion camps. Far more than this, it's actually an issue in the clinics of accredited counsellors and psychotherapists and even the surgeries of NHS general practitioners. It reflects a much wider issue of poor LGBT-oriented provision in the public sector. To deal with it government doesn't just need to make moves to ban the practice. They also need to improve LGBT-friendly services, particularly in the health sector – something only possible if the public sector equality duty is kept in place.
A 2009 survey of 1,328 accredited mental health professionals, published in the BMC Psychiatry Journal, proves precisely this point. It's been reasonably well-reported that a shocking 222 (17%) of those surveyed admitted to having assisted at least one client to reduce their same-sex attraction (55 admitted to still offering conversion therapy), but the wider findings are more shocking.
Those therapists who had practiced conversion therapy were then asked to give details of some patients they had offered treatment to. Some 138 (35%) of patients described were, by the therapists' own admission, referred to them for treatment by general practitioners and 88 (22%) by other professionals. Moreover, although the majority were reported as having been seen in private practice, 40% were reported as being treated inside an NHS practice. Lesley Pilkington, one conversion therapist discovered in an undercover investigation by Patrick Strudwick, vindicated this study: she readily admitted to having most of her clients forwarded to her from her local GP's surgery.
These revelations prompted welcome moves from the main professional organisations to steer their members away from practicing conversion therapy, with Pilkington herself struck off from the body she was accredited to, the BACP. But there are limits to what they can do. For one, anyone can practice in the psychotherapy sector without being a member of such a professional organisation – a legal loophole which leads to the abuse of non-LGBT people too. Also, as Strudwick has himself pointed out, it's rather difficult to press a case against an accredited therapist who has practiced conversion therapy. Finally, we already have evidence which suggests that one group of people subject to strict regulations on professional probity – GPs – are sometimes being complicit in the problem.
Therefore, although a simple, overall ban on conversion therapy, or at the very least effective regulation of the psychotherapy sector, would help tackle these injustices, we also clearly need to think in terms of a more long-term means of delivering effective public services to meet the needs of LGBT people. The crucial question is this: if you're a gay person and you approach a professional in the medical or therapy sectors expressing uneasiness about your sexuality, what should they say to you? All the evidence suggests that the best response is to work to reassure you and encourage you to feel happy being who you are. Doing otherwise, and offering harmful conversion therapy, doesn't just hurt the patient themselves but also the non-LGBT taxpaying majority: public money thrown into a treatment that palpably makes the patient worse is not public money well-spent.
Yet I'm not convinced that all therapists would say this: some clearly are treating patients' uneasiness as a sign that their sexuality could be changed and forwarding them on to conversion therapists. Moreover, plenty of evidence exists to show they're not alone in giving LGBT people – who, be it noted, pay taxes just like everybody else – a raw deal in public services. Consider, for instance, Stonewall's 2011 survey of 6,861 gay and bisexual men– the largest of its kind in the world. Of those gay and bisexual men who had accessed healthcare services in the past year, one third reported having had a negative experience related to their sexuality. This at least partially explains the higher incidence of drug and alcohol abuse reported by the respondents compared to the general population.
Likewise, the disproportionate suicide rates in the gay community –three per cent of gay men and five per cent of bisexual men having attempted to kill themselves in 2010-2011, as compared to 0.4% of men in general – can be explained by many things. But in 2010, PACE, in an excellent survey of LGBT mental health provision in Britain, noted one surprising contributory factor: no national, LGBT-oriented website currently exists which offers suicidal users direct on-site counselling services to reduce suicide. Instead, the LGBT community, and especially young people, are forced to rely on a patchwork of mainstream or LGBT-oriented services, with 23% of respondents to PACE's online survey reporting a negative experience relating directly to being LGBT when accessing such services.
Similarly, gay and bisexual men, Stonewall's survey showed, are not just three times more likely to have suffered from domestic abuse than the average man, but are actually almost twice as likely to have been abused at home than women. Yet despite this, of those who reported their experiences to the police (and three quarters weren't confident enough to do even this), more than half were unhappy with the police's response. Many told Stonewall of police officers finding it inconceivable that domestic violence between two gay men could possibly take place.
Many of the solutions to these problems are extremely simple – measures like putting up LGBT-friendly posters in clinics to properly-training staff, developing LGBT-specific services where appropriate and advertising job vacancies in the LGBT press – and some are more long-term. But in driving forward exactly these reforms, the public sector equality duty – enshrined in law in the 2010 Equalities Act – is absolutely vital. Under it, public services are required to proactively drive forward improvements in their services to achieve equal treatment for all groups, and publish year-on-year assessments of their progress in achieving these goals.
The government's current review of the duty is under the impression it is 'red tape'. This is disturbing. If they do indeed, as reports suggest, work to repeal this core tenet of the Equalities Act, they risk stopping the clock on a promising future of development of public services fit for the needs of women, the disabled, the LGBT community and minorities. This would be an absolute disgrace. It would stain their commendable record on gay marriage and completely undermine any legal moves they did make against conversion therapy. This duty is not an unnecessary burden on the public sector but a driver of parity: ensuring that everyone gets the services they deserve for the money they pay in.
This past year, our group's been fortunate to have attracted support from a broad cross-section of society: partisan and non-partisan. Both our paper petition against the practice, submitted to the House of Commons on Monday 15th July, and our early day motion on the issue have both attracted support from all political persuasions. In future, we hope for a backbench business debate and, ultimately, legislation to outlaw conversion therapy, possibly in the form of a private members' bill. We've welcomed these links because we don't believe that conversion therapy is an issue which requires party political point scoring. But to Tories and Lib Dems reading this, I have to say: the public sector equality duty is a vital means of achieving parity in public service delivery and dealing with the closely-connected problem of conversion therapy. Coalition ministers cannot be allowed to get rid of it.
Tom Stephens is on the steering committee of the Hull and East Riding Labour LGBT+ Network, which has spent the past year campaigning against gay-to-straight conversion therapy in Britain.
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