Dr Cass warns conversion therapy ban risks “frightening” clinicians

Dr Hilary Cass, the author of the recent Cass Review, examining services for children and young people questioning their gender identity, has warned that Scotland’s proposed conversion therapy ban risks “frightening” clinicians from working with young people who identify as trans.

The Scottish government, led by the SNP, has previously investigated banning ‘conversion therapy’, which is defined as any attempt to change or suppress a recipient’s sexuality or gender identity.

Giving evidence to the health committee of the Scottish Parliament, Dr Cass said, ““This one is a big challenge, and all I can say is I’m glad I’m a doctor and not a litigator, because it is a really difficult problem. Everyone should be protected from conversion therapy – it’s a completely unacceptable practice.

"But because, thinking about the legislation, the issue has been about intent – and if a therapist engages with a young person and they change their views about their gender identity during the course of that therapeutic relationship, and then they subsequently say it was because the therapist had an intent to change their gender identity, that puts the therapist in a difficult position, because how can you legally determine intent?

"The anxiety that you may be the test case is making clinicians even more anxious, potentially, about working in this area, and we don’t want to do anything to frighten professionals off from working in this…

“I don’t know how we get that balance right of protecting people from conversion therapy and not frightening therapists who are just doing their job, and having an appropriate exploratory conversion with a young person.”

The Cass Review was published in April and was the largest examination of gender services for young people published to date worldwide. Its findings and recommendations were groundbreaking, including

• A recommendation to stop the use of cross-sex hormone treatment for under 18s, as ““No changes in gender dysphoria or body satisfaction were demonstrated by them”

• Warnings that the practice of social transition was dangerous and could to young people being channeled into a particular pathway: “Social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence”

• A recommendation that primary school children should be given opportunity to see paediatrician or child psychologist

• Analysis which showed that over 60% of children referred to gender services have previously suffered neglect or abuse, and that there were also links with high levels of parental mental illness, substance abuse and exposure to domestic violence.

In response, two Scottish health boards (including the one responsible for Scotland’s only gender clinic for young people) have paused new prescriptions of puberty blockers, and the Scottish Government have said they are “considering all of the recommendations.”