Summary
We are concerned that an upcoming conference organised by The Royal Australian and New Zealand College of Psychiatrists (RANZCP) may promote conversion practices against transgender people, and that attendees may then carry out illegal conversion practices in Aotearoa.
This is the open letter we sent to the NZ National Office of the RANZCP, and the RANZCP New Zealand National Committee, also copied to Te Kāhui Tika Tangata Human Rights Commission, Conversion Practices Services.
An open letter to:
The Royal Australian and New Zealand College of Psychiatrists (RANZCP)
NZ National Office Tu Te Akaaka Roa,
And the RANZCP New Zealand National Committee Tu Te Akaaka Roa,
nzoffice@ranzcp.org
ranzcp@ranzcp.org
With notice to Te Kāhui Tika Tangata Human Rights Commission, Conversion Practices Services
infoline@hrc.co.nz
Concerns about Canberra conference: conversion practices
We are concerned about a session nominatively about “Transgender Mental Health,” and that it may encourage actions that contravene human rights legislation in Aotearoa, specifically in relation to conversion practices.
We refer to Session 2D, Monday, by Alison Clayton, Roberto D’Angelo, and Patrick Clarke, as listed on your programme: https://congress.ranzcp.org/program
Te Kāhui Tika Tangata Human Rights Commission says:
“Conversion practices in healthcare settings are typically non-affirming practices directed towards an individual because of their sexual orientation, gender identity or gender expression.”
Te Kāhui Tika Tangata Human Rights Commission – Conversion Practices guidance for medical healthcare professionals
We are aware that two presenters on this session have publicly argued for “non-affirming” approaches to be directed at transgender patients on the basis of their gender identity (and not toward other patients). They have also argued for the disestablishment of affirming approaches toward transgender people’s gender identities. We consider that it is extremely likely that any presentation by these presenters will advocate for “non-affirming” approaches to transgender people’s genders, and against affirming approaches. The entirety of their writing on transgender mental health appears to be about rejecting transgender people’s identities within therapeutic and psychiatric settings.
Given this, alongside the membership of the presenters in pro-conversion practices organisations, and previous activism they have engaged in in favour of conversion practices, we consider it very likely that they will argue for conversion practices in their presentation. Their work does not seem to allow for any non-conversion approach, as they comprehensively reject the idea that transgender people should be accepted as the gender that they say they are (i.e. affirmation.)
Promoting “therapeutic” practices of denial of transgender people’s genders is equivalent to promoting conversion practice. We are concerned that RANZCP members may attend this conference and session, without prior warning that they are likely to hear the speakers promote activities which are illegal in Aotearoa.
While the presenters in this session have published papers denying the evidence that conversion practices targeting gender identity can cause harm, NZ law recognises that conversion practices targeting gender identity are harmful, and outlaws these practices. The Human Rights Commission has done a great job of collating evidence of the harm of conversion practices, including studies from within Aotearoa.
The presenters
Alison Clayton:
Alison has previously presented at a conversion therapist conference run by pro-conversion organisation SEGM.
SEGM argues that the definition of “conversion practices” cannot include conversion targeting gender identity, only sexuality. This is not in line with Aotearoa law on the subject, which is clear that conversion practices targeting gender identity are conversion practices.
Alison’s professional position is that she is “skeptical” of affirming transgender youth – she believes that professionally, transgender young people’s genders should be met with skepticism. She has never on record argued for this kind of skepticism targeting cisgender people’s genders. A practice of a healthcare professional denying a transgender person’s gender identity would almost certainly constitute a conversion practice under NZ Law.
https://link.springer.com/article/10.1007/s10508-021-02232-0
In the following linked paper, she has argued that gender affirmation (which includes respecting a transgender person’s name, addressing them as the desire to be addressed, etc) for transgender people is possibly a “placebo.” Respect for patients is not a placebo, and is in fact a cornerstone of medical rights in Aotearoa.
The paper also conflates any affirmation of gender with hormones and surgery for children, to argue against affirmation of transgender patients broadly, using the existence of risks around other parts of medical care. She argues that social transition may be harmful to transgender children (social transition is where children are allowed to wear clothes they prefer, use a name they prefer, and are referred to with terms that they consent to.) There are no known risks to allowing transgender children freedom of gender expression. Denying a transgender child’s freedom of gender expression in a therapeutic or clinical setting is extremely likely to fall afoul of the NZ law on conversion practices.
She describes this as “non-promotion of social transition” e.g. an unquestioning approach to binary and assigned sex/gender.
This is an approach that would prevent positive attitudes and affirming attitudes toward transgender youth. The Human Rights Commission is clear about the fact that transgender people’s genders should be affirmed, the same as the genders of people who are not transgender.
Roberto D’Angelo:
Roberto is a member of three anti-transgender pro-conversion organisations: SEGM, Genspect, and one organisation explicitly dedicated to conversion practices, the “Gender Exploratory Therapy Association (GETA).” [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018052/]
He is vocally critical of the practice of affirming transgender people (e.g. respecting their gender identity, or providing any healthcare that respects their gender identity) generally.
Patrick Clarke + Roberto D’Angelo:
These two presenters are co-authors on a paper that does the following:
Argues against the idea that conversion practices intended to change gender identity are harmful, because the transgender people who experienced conversion practices were probably less mentally well to begin with. Aotearoa law recognises that all conversion practices targetting gender identity are harmful.
Argues that psychotherapy that does not respect transgender people’s gender is not conversion, and that the conversion approach described by “Gender Exploratory Therapy” should completely replace respectful approaches that affirm/accept transgender patients’ transgender identities.
Argues that anti-transgender conversion practices within diagnostic contexts, contexts that do not primarily focus on gender identity, and contexts that do not include explicit “shaming” and “threats” shouldn’t count as conversion practices. This is not in line with the conversion practices law in Aotearoa, which do not require “shaming” and “threats” to occur for a practice to constitute a conversion practice. NZ law also does not legalise conversion practices in diagnostic contexts, and does not legalise conversion practices in contexts that do not primarily focus on gender identity. In NZ law, conversion practices are conversion practices. The presenter’s open disagreement with this idea is likely to lead to him promoting practices that are against the law in Aotearoa, by insisting that they do not count as being against the law.
Argues that it is “emotionally charged” to describe attempts within healthcare to “stop [people] being trans” as conversion practices, and believes a better term for these attempts is “non-affirmative.” This contextualises his promotion of (in his words,) “non-affirmation” as a concept that certainly encompasses attempts to stop people from being transgender, which are explicitly conversion practices. “Non-affirmation” itself is explicitly named in Te Kāhui Tika Tangata Human Rights Commission’s Guidance on conversion practices in healthcare settings, and the Guidance for mental health professionals. The fact that this presenter argues that it is “emotionally charged” to classify “stopping people from being trans” as conversion practice is further evidence that the practice he promotes is not in line with NZ law, and he will be unlikely to present in a manner that is fully aware of, or respectful of, the conversion practices legislation in Aotearoa.
Argues that attempts to “stop [people] being trans” may in fact be “agenda-free ethical psychotherapy.” His apologia for conversion practices (when they target gender identity) and his argument that they are ethical demonstrates further that he is likely to argue in favour of illegal practices while painting them as “ethical” and “therapeutic.”
For context around this paper’s argument that “It is also likely that the clinician might focus on treating the comorbid condition(s) first, before pursuing “gender-affirming” interventions,” note that gender-affirming interventions include respecting a transgender person’s gender, using their name, and not misgendering them. The paper argues that this lack of respect is directly caused by a patient’s poor mental health, shifting blame for clinicians’ disrespect toward transgender people and identities.
The paper promotes the idea that there should be debate around whether conversion efforts should be banned. This debate already occurred in Aotearoa, and these practices are banned. The legal environment is extremely important context for clinicians to understand when information is presented that may promote illegal practices.
This paper argues that there is no clear link between conversion practices targeting transgender people and poor outcomes. However, the Guidance says:
“Research published in Aotearoa in 2023 found young people experiencing conversion practices:
- had increased frequency of non-suicidal injury
- had double the chance of planning suicide
- had triple the chance of attempting suicide.”
https://link.springer.com/article/10.1007/s10508-020-01844-2
Patrick Clarke:
Patrick Clarke publically argued against a ban on conversion therapy in Iceland, due his support of conversion practices that target transgender people. https://www.althingi.is/pdf/erindi_mals/?lthing=153&malnr=45
Patrick Clarke also wrote in support of a non-affirming “Psychotherapy for Gender Dysphoria.”
Generally:
A non-affirming approach to gender identity is not in line with equal rights law in Aotearoa, as well as possibly encouraging breaches of conversion practices law.
These presenters argue that even social affirmation should be avoided – in practice, this means not respecting transgender patients’ gender. A non-affirmative approach to a patient’s gender is not advocated for in the case of cisgender patients by any of these presenters. This discriminatory approach treats only transgender people’s genders as pathological.
We note that a pathologising approach may itself fall under Aotearoa’s conversion practices legislation. The Guidance on Conversion Practices in Healthcare Settings gives one example of conversion practices as: “expressing the belief that being transgender is an illness and suggesting counselling to ‘fix it.’”
The approach of non-affirming psychotherapy targeting transgender people’s gender is unquestionably an approach that sees transgender people’s genders as something that can possibly be “fixed.” The promotion of the idea that transgender people can be “fixed” in ways that prevent them from being transgender will likely lead to an increase in attempts to ‘fix’ transgender people rather than simply affirm that transgender people exist.
It is widely recognised that if a clinician refused to address a psychotherapy patient who is a cisgender woman as a woman, that this would be a confusing and disorienting practice, and not in line with basic standards.
While the presenters in this session may define “gender-affirming healthcare” differently, the Te Kāhui Tika Tangata Human Rights Commission makes reference to The Transgender Health Research Lab at the University of Waikato, who define gender-affirming healthcare as “Healthcare that is respectful and affirming of a person’s unique sense of gender and provides support to identify and facilitate gender healthcare goals.” This level of respect for people’s genders is necessary whether a person is transgender or cisgender.
We note that treatment that does not align with this respectful and affirming approach may also be in breach of other legislation that Te Kāhui Tika Tangata Human Rights Commission names as relevant in their guidance:
“The Human Rights Act 1993 (the right not to be discriminated against based on sex)
- The Bill of Rights Act 1990 (section 14, freedom of expression; section 19, freedom from discrimination)
- The United Nations Declaration on the Rights of Indigenous People (the right to identity, the right to protection against destruction of culture, and the right to future manifestations of culture)
- The Code of Health & Disability Services Consumers’ Rights (Right 2, services free from coercion; Right 4, services of an appropriate standard; Right 6, to be fully informed; Right 7, to give informed consent),” as well as Te Tiriti o Waitangi, Articles 2, 3 and 4.
Healthcare must be “respectful and affirming of a person’s unique sense of gender” no matter who is receiving that healthcare. If an approach of non-affirmation targets only transgender people, it is almost certainly discriminatory.
We also note that Aotearoa law on conversion practices does not only address attempts to change gender, but those to “suppress” it.
Te Kāhui Tika Tangata Human Rights Commission’s guidance on Conversion Practices in Healthcare Settings names “encouraging someone to believe their sexuality or gender is defective or disordered” explicitly as a form of conversion practice.
Presenters in this session, in our cited papers of theirs, promote the “watchful waiting” approach, which is explicitly named by Te Kāhui Tika Tangata Human Rights Commission in their guidance on conversion practices, saying “deliberate delays such as the ‘watchful waiting’ approach exacerbate gender dysphoria, mental health problems and other negative and avoidable outcomes.”
One example of possible conversion practices given in the Te Kāhui Tika Tangata Human Rights Commission Guidance is “creating delays to obstruct access to gender-affirming healthcare,” if this is non-affirming and “directed towards an individual because of their […] gender identity.” The presenters’ previous advocacy for non-affirming and delaying care is of concern.
The Guidance also notes that “all people seeking gender affirming healthcare should be able to access it.”
Te Kāhui Tika Tangata Human Rights Commission’s Guidance for mental health professionals explicitly names “deliberate referral to non-affirming healthcare providers” as an example of a conversion practice on page 5.
We note that the Guidance for mental health professionals quotes the RANZCP, saying “People distressed by their sexual orientation should be assisted with treatment approaches that involve
acceptance, support, and identity exploration, and aim to reduce the stigma associated with alternative sexual identities, and demonstrate respect for the person’s religious, spiritual and/or cultural beliefs.” This quote describes an affirming approach to sexual orientation. The conversion practices legislation, and the guidance on the legislation from the Human Rights Commission, is clear that gender identity should be treated with the same respect as sexual orientation.
We suggest that allowing a presentation by people who advocate for conversion practices towards transgender people may cause confusion, and mislead attendees of your conference, possibly resulting in breaches of The Conversion Practices Prohibition Legislation Act 2022, and beyond.
We would very strongly recommend that any RANZCP members should be warned that the presenters in this session may promote illegal practices such as “psychotherapy” to “stop people being trans” that cannot be legally carried out in Aotearoa.
We would very strongly recommend that RANZCP members should be updated with the HRC guidance on conversion practices (linked below) to ensure that they understand the basic level of respect that is legally required toward transgender people’s gender identities in healthcare contexts, and so that they understand how to avoid illegal practice.
Links:
The Conversion Practices Prohibition Legislation Act 2022.
https://www.legislation.govt.nz/act/public/2022/0001/latest/whole.html
Conversion Practices Guidance for mental health professionals
Conversion Practices Guidance for medical healthcare professionals
