Dr Hilary Cass: Ban on conversion therapy risks criminalising clinicians

The author of the Cass Review into gender identity services for children and young people has raised concerns about the impact of a conversion therapy bill.

Giving evidence to MSPs, Dr Hilary Cass said she had been "surprised" about the level of homophobia and transphobia in society.

And she said there is a "big problem" with "fearfulness" amongst clinicians treating children seeking medical help with gender identity.

She said that has led to young people being "more disadvantaged" than other patient groups because health professionals are "worried about doing or saying the wrong thing" and as a result, make referrals to gender identity clinics rather than using mental health pathways to address "distress and anxiety".

When asked about the impact of a conversion therapy ban on this, Cass said: "I'm glad I'm doctor, not a litigator, because it's a really difficult problem." 

Cass's four-year review on gender identity services in England raised serious concerns about the use of puberty blockers and hormone treatments and highlighted major gaps in child and adolescent mental health services.

It recommended "extreme caution" in the use of hormone treatments and said that while there is evidence that these cause harm to bone density and sexual function in adulthood, the impact on long-term gender identity and wellbeing is not fully known.

Prescriptions of such treatments to under-18s in Scotland have now been paused and a group has been set up to examine the implications of the Cass Review for Scottish services.

Separately, the Scottish Government is consulting on plans to ban conversion therapies which impact LGBTQI+ people.

Cass said: "Everyone should be protected from conversion therapy. It's a completely unacceptable practice. 

"Thinking about the legislation, the issue has been about intent. If a therapist engages with a young person, 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 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 frightened professionals in this, so walking that path is very difficult."

Cass was appearing before the Health, Social Care and Sport Committee. She told members: "No credible professional body would support conversion therapy so if any practitioner is deemed to be practising conversion therapy it should, in the first instance, be a matter for their professional regulator before it would be a legislative issue.

"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 may end up having an appropriate exploratory conversation with a young person."

Asked by Labour's Carol Mochan if the conversion therapy bill should consider the impact on discussions around same-sex attraction and trans identity, Cass said: "You can see how the two things could get conflated.

"This may have been naive, but one of the things that I was surprised about in conducting this review is how much homophobia there still is as well as transphobia. So we do have to support people in being able to express their and understand their sexuality as well as their gender identity."