The National Association of Practising Psychiatrists (NAPP)
Submission to the NSW Department of Communities and Justice and the NSW Ministry of Health regarding Banning LGBTQ+ Conversion Practices: Consultation Paper dated 31st July 2023
Understanding Conversion Practices Legislation: Navigating the Distinctions
Conversion practices legislation has become a critical point of discussion in recent years, with governments seeking to protect individuals from harmful attempts to change or suppress their sexual orientation or gender identity. While the Government is understandably committed to safeguarding vulnerable communities, it is essential to recognize and address the distinctions between same-sex attraction and gender identity concerns when formulating these laws in order to prevent harms by limiting access to appropriate treatment for individuals experiencing gender dysphoria or incongruence.
To ensure the effectiveness and fairness of such legislation, it is imperative to avoid conflating conversion practices with appropriate and ethical psychological interventions for gender dysphoria.
This submission explores these issues and recommends a balanced approach to conversion practices legislation.
Differentiating Sexual Orientation and Gender Identity
The first step in drafting any comprehensive conversion practices legislation is to distinguish clearly between sexual orientation and gender identity concerns. Sexual orientation relates to an individual’s emotional, romantic, or sexual attraction to others, regardless of their gender identity.
Gender identity pertains to an individual’s internal sense of their own gender, whether it aligns with their biological sex or not. Unlike sexual orientation, medical interventions, such as hormonal treatments, and sex reassignment surgery, may be required to assist individuals in achieving a gender identity that is congruent with their internal sense of self.
Supporting Gender Dysphoric Young Persons
Conversion practices legislation must also consider the evolving international standards of care for gender questioning or gender dysphoric young persons, including the important role of parents in supporting their child in the decision-making process (Vrouenraets et al 2022).
Psychological interventions that promote exploration of gender identity, while identifying and addressing any underlying conditions or family circumstances, have become the standard for first-line treatment internationally (see references 10, 29, 30, 31, 32, and 33 in the NAPP Guide to the Management of Gender Dysphoria in Young People on the NAPP website – napp.org.au). These non-directive interventions prioritize the well-being and self-discovery of young individuals, ensuring that they receive appropriate care and support during their gender identity journey (see reference 10 in the NAPP Guide) and include sharing of knowledge between the young person, their parents and clinicians.
Health Practitioners and Regulation
The regulation of health practitioners is another vital aspect of conversion practices legislation. Health practitioners registered with the Australian Health Practitioners Regulation Authority (AHPRA) already undergo strict oversight and disciplinary actions under AHPRA’s various health boards. Therefore, subjecting them to additional conversion practices legislation should not be necessary, as they are already held accountable to stringent professional standards.
The Western Australian Government has taken this approach. Accredited health professionals who provide lawful and ethical care will not be included in the conversion practices ban and are properly regulated through their professional bodies. This will enable health professionals to provide suitable care for people, particularly young people, without the fear of being prosecuted (WA Government statement 1 December 2022).
Non-Directive Psychotherapy and Clinical Interventions
It is crucial for any legislation to include a specific exclusion for non-directive psychotherapy practices or other clinical interventions that do not proactively affirm or support a person’s gender identity and expression. For example, the Queensland Government’s conversion practices legislation provides some level of protection for health practitioners in that it allows for evidence-based and reasonable clinical practices even if they do not actively affirm or support a person’s sexual orientation or gender identity (see legislation exemption and Queensland Health’s explanation below). This exemption recognizes the importance of individualized treatment plans that prioritize a person’s well-being and overall care.
To create effective and balanced legislation and to prevent harmful unintended consequences, it is essential to differentiate between sexual orientation and gender identity concerns, to support young persons experiencing gender dysphoria with appropriate clinical interventions, and acknowledge the existing oversight of health practitioners under AHPRA.
Moreover, a clear exemption provision for non-directive psychotherapy and clinical interventions will ensure that the legislation promotes safe and respectful practices appreciating the rights and needs of individuals exploring their gender identity while allowing health practitioners to provide necessary therapeutic interventions for these situations.
Vrouenraets, L.J.J.J., de Vries, A.L.C., Arnoldussen, M. et al. Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians. Eur Child Adolesc Psychiatry (2022). https://doi.org/10.1007/s00787-022-02076-6
Public Health Act 2005
Chapter 5B Conversion therapies
(2) Conversion therapy does not include a practice by a health service provider that, in the provider’s reasonable professional judgement— (a) is part of the clinically appropriate assessment, diagnosis or treatment of a person, or clinically appropriate support for a person; or (b) enables or facilitates the provision of a health service for a person in a manner that is safe and appropriate; or (c) is necessary to comply with the provider’s legal or professional obligations.
Queensland Health explanation
Conversion practices do not include “evidence-based and other reasonable clinical practices, even if these practices do not proactively affirm or support a person’s sexual orientation or gender identity and expression, including any practice that a health service provider reasonably believes will enable or promote the provision of safe and appropriate care, or is necessary to comply with the provider’s legal or professional obligation.”
Dr Philip Morris AM
MBBS, BSc(med), PhD, FRANZCP, FAChAM (RACP)