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Mike Freer (Finchley and Golders Green) (Con)
I beg to move,
That this House has considered gay conversion therapies and the NHS.
It is a pleasure to serve under your chairmanship this afternoon, Mr Bailey.
I am conscious that this subject has been raised before; however, it remains possible for people in the UK to be referred by a national health service professional to a psychotherapist for gay conversion therapy—the so-called gay cure. Being gay is not a disease, it is not an illness and it is not something that I or any other gay man or woman can be cured of. To suggest otherwise is not only demeaning, but morally and medically wrong. Not a single medical body supports the concept of a gay cure. The Royal College of Psychiatrists, the UK Council for Psychotherapy, the British Association for Counselling and Psychotherapy and the British Medical Association have all concluded that such therapy is unethical and potentially harmful.
Various techniques and methods have been used, and I will list a few to give a bit of colour to the level of quackery available. Exorcism is one method—in The Times today is a story about a young man taken to a backstreet exorcist because his parents were concerned that he was gay. Cycling, too, was thought to be a cure for being gay, although as a keen cyclist I can tell colleagues that it does not work. Then there is prayer—pray away the gay, apparently—although that does not appear to work either. An Austrian doctor trialled testicular transplants: he took the testicles of a heterosexual man and transplanted them into a homosexual man to see whether that curbed his homosexual desires. Unfortunately, I could not find the outcome of the trial anywhere on the internet, although I am sure that it was of interest to both recipient and donor of the testicles.
I mention those as examples of how far from the mainstream some so-called cures can be. They are also a far cry from mainstream psychotherapy—I need to put that on the record. However, I want to focus on current techniques and to debunk the thought that so-called cure therapies might simply be gentle counselling, laying on the couch and talking about one’s feelings. They are not gentle therapies.
Such therapies purport to change a person’s sexual orientation or to reduce attraction to people of the same sex. Dr Christian Jessen, for a television programme in only 2014, underwent treatment for homosexuality, including one of the most extreme cures, aversion therapy, which looks to teach patients to associate same-sex attraction with pain or nausea. Patients are given a drug that makes them extremely ill and they are then played pornographic images and sound recordings while they vomit violently. That is not counselling. Usually patients experience a session every two hours, night and day, for three whole days. That is not counselling. Similarly, in electric-shock treatment, people who respond to same-sex stimuli are shocked so that their response is associated with pain. That is not counselling.
Imagine the outcry if Parliament were to give tacit approval to curing heterosexual men and women of their heterosexuality. There would be uproar. Allowing conversion therapy to try to turn our straight colleagues gay would not last a day, yet we allow therapists to peddle the myth that they can cure people of being gay.
If such views were held only by crackpots on the fringe of society, it would be laughable. It is not. Some psychotherapists and some NHS staff hold the view that a gay cure is possible. YouGov polling in 2014 for Stonewall, the excellent lesbian, gay, bisexual, and transgender organisation, found that one in 10 health and social care staff have heard other staff express a belief in gay cure therapy; in London that figure rose to one in five. Only six years ago the BMC Psychiatry journal surveyed over 1,300 accredited medical professionals and found that more than 200 of them—over 15%—had offered some form of conversion therapy. Those 200-plus professionals said that 35% of their patients had been referred to them by GPs, and 40% of the patients receiving the so-called treatment were treated in an NHS practice. For any health professional to refer someone for such therapy is fundamentally abhorrent and it is time to call a halt to it once and for all.
Where are we today? In spite of numerous calls for an outright ban, the practice continues, although I accept that there has been some progress. In January, the “Memorandum of Understanding on Conversion Therapy in the UK” was launched. It was developed by the UK Council for Psychotherapy and signed up to by some major organisations, including the NHS. It is welcome as far as it goes, but a number of regulators have not yet signed up to the memorandum—and it is voluntary. The memorandum seems to cover only sexual orientation, not gender identity—and it is voluntary. The memorandum states that practitioners need to be aware of the ethical issues relating to such cure therapies and that the public should be made aware of the risks of such therapies—and it is voluntary. The memorandum seeks to apply standards to a sector of therapy that has no statutory regulation—because it is voluntary. We regulate dentists, but we have no statutory regulation for psychotherapists.
My hon. Friend the Minister has an impeccable record on LGBT issues, especially in health, and I put on the record that on this issue and many others she has a deep commitment to helping to eradicate flaws in the system and to pursuing equality. So I have to ask: why we are allowing this abuse, this so-called cure therapy, to continue? Why are we allowing the practitioners, the psychotherapists, to have merely a voluntary code of practice—a memorandum of understanding?
I acknowledge that psychotherapy has a role to play for adults who need support when dealing with a range of issues connected with their sexuality and sexual identity. Dealing with conflicting feelings is difficult at the best of times and I do accept the role of proper, regulated counselling.
Ben Howlett (Bath) (Con)
I congratulate my hon. Friend on securing the debate. Does he agree that availability of such programmes would have a serious effect on the mental health of LGBT individuals?
Mike Freer
My hon. Friend makes a good point, given the evidence. I am about to quote the Royal College of Psychiatrists, which states that such therapies are damaging not only to the physical health, but to the mental health of individuals who have such therapies inflicted upon them.
Stuart Andrew (Pudsey) (Con)
I congratulate my hon. Friend on raising this important issue. Is he as disturbed as I am to see figures from the United States on people who have gone through conversion therapy showing that they are 8.9 times more likely to commit suicide, 5.9 times more likely to suffer depression and three times more likely to take illegal substances than their peers as a result of this frankly outdated and cruel method?
Mike Freer
My hon. Friend makes an extremely powerful point. I am not surprised to hear those figures.
Anyone who is conflicted and in need of support while coming to terms with their sexuality is experiencing some difficult feelings. If they are told that they can be cured—I am yet to find a case of the cure being proved successful—they then have to deal with those feelings as well.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I speak as a Member of Parliament and as a psychologist. In all my experience and practice in the NHS, this is not something I am familiar with, although the hon. Gentleman says that there are a number of cases. It is important to recognise that such therapy is without any evidential basis—not surprisingly, given that most of the research findings indicate an adverse impact on people’s mental health, rather than a cure per se.
Mike Freer
The hon. Lady makes a good point. I have to say that no one I know has come forward to support such psychotherapy, yet if there is such violent agreement, why are we struggling to get aversion therapy banned? There is this conundrum: we all agree that it is harmful and that it should not be done, yet we do not seem to be able to get it banned.
I accept that my hon. Friend the Minister has difficulty in regulating the sector in terms of setting legal definitions for what would constitute illegal therapies. The legal situation is fraught, but it is not acceptable to leave vulnerable men and women susceptible to aversion therapy. There can be no justification for pursuing therapies that put a person’s mental health and, in some therapies, their physical health at risk. It is time to say that such therapies have no place in our society and no place in our healthcare system. It is time to say simply that aversion therapy has no medical merit and can be harmful and it is time to say that it is going to be illegal. It is also time to ensure that psychotherapy has statutory regulation, so that those who do not comply and continue to perpetuate such cure therapies face stricter and harsher penalties than those currently available under a voluntary code.
The Royal College of Psychiatrists contacted me last week to reiterate that
“the college remains in favour of legislative efforts to ban such conversion therapies.”
In its letter, it said that
“there is no scientific evidence that sexual orientation can be changed.”
It also said that
“so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful.”
Wes Streeting (Ilford North) (Lab)
I am grateful to the hon. Gentleman for securing the debate and for all the work he does to champion LGBT equality. I am sure that many of us received the Core Issues Trust’s interesting briefing, which suggested a link between homosexuality and same-sex attraction and mental ill health and other forms of physical illness. Has it not got that the wrong way around? It is discrimination and the suggestion that there could be a gay cure that makes all LGBT people, and young people in particular, feel that they are different and somehow alien. That is what causes them mental ill health, not their homosexuality.
Mike Freer
The hon. Gentleman has a track record in this area even though he is new to the House and I am sure that he will be extremely vocal on these issues. He is absolutely right. It is the suggestion that homosexuality is a disease or illness that can be cured that drives mental health problems, not the other way around. Frankly, I wasted no time on reading the Core Issues briefing.
I will finish with a couple of comments from esteemed colleagues. On 29 April, in an interview with Pink News, the Prime Minister said, on banning such therapies,
“if we need to go further…we will.”
As far as I am concerned, we do need to go further. The Secretary of State for Education and Minister for Women and Equalities said a couple of weeks ago to Pink News:
“Let me be clear: gay cure therapies have no place in our countries and we must stamp them out.”
I ask my very good friend the Minister if she will agree to explore how stipulated aversion therapies can be banned and whether the voluntary memorandum of understanding should and can be reviewed to put it on a statutory footing.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for initiating this debate on this important issue. Let me start by wholeheartedly agreeing with his opening premise. The Government do not believe that being lesbian, gay or bisexual is an illness to be treated or cured. We are concerned, therefore, about the issue of so-called gay-to-straight conversion therapy and we have consistently spoken out against the need for that practice.
I will outline some of the background to the work my hon. Friend touched on and try to respond to some of his concerns, but I suspect that this is the beginning of an ongoing conversation—I am happy to say that at the outset. The UK Council for Psychotherapy first raised its concerns about the perceived increase in this type of therapy with the Department of Health in late 2013. Department officials met with the council to discuss those concerns and agreed to work with it and others to identify ways to eradicate the practice. At that time, we also welcomed the fact that the key professional counselling and psychotherapeutic bodies had already made public statements on the issue.
As a result of the UK Council for Psychotherapy’s approach, the Department agreed to support the publication of a statement that made clear that the major therapy bodies in the UK were united in speaking out against conversion therapy, because they believe that that particular approach is based on the assumption that homosexuality is a mental disorder or that it begins from the preconceived view that the client should change their sexual orientation. As homosexuality is not an illness, as my hon. Friend said, the professional bodies argue that it is both logically and ethically flawed to offer any kind of treatment. The House may be interested to know that the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders in 1973 and the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992.
A consensus statement was published in February 2014 as a result of the exercise we convened. It was initially signed by eight organisations and others added their support later on. The statement is clear: those bodies believe there is no good evidence that such therapy works and that, actually, it has great potential to cause harm. It goes on to say that such approaches are often based on religious interpretations of sexuality rather than on a researched and informed understanding of sexual orientation.
As my hon. Friend said, the Department agreed to host a roundtable event on 2 April 2014 to which we invited a range of interested organisations comprising signatories to the consensus statement as well as royal colleges, the Association of Christian Counsellors, regulators and other counselling bodies. The right hon. Member for North Norfolk (Norman Lamb), who was then the Minister responsible for equalities, was fully supportive of the work and attended and contributed.
I am pleased to say that the meeting was positive and that out of the discussions came agreement that more could and should be done by those present to prevent this kind of therapy from being offered. The participants agreed to develop the memorandum of understanding, which has been referred to. The UK Council for Psychotherapy agreed to lead on the work, in partnership with other bodies and the Department.
The memorandum was published in January and launched at a second roundtable event at the Department. Once again, my former colleague the right hon. Member for North Norfolk was present and publicly made clear his support for the memorandum and its commitments. Its purpose was to set out an agreed framework for activities for all the parties concerned to help address the issues raised by this practice. One such aim is to ensure that the public are well informed about the lack of evidence and the risks of so-called conversion therapy. There are a range of other important professional objectives.
Professionals from throughout the healthcare and psychological professions committed to work together to promote the public interest. Each of the signatory organisations committed to actions appropriate to their function and purpose. To give one example, those with practitioner members agreed to review their statements of ethical practice and consider whether there was a need to publish a specific ethical statement on conversion therapy. Secondly, those with a responsibility for training committed to work together to ensure that training prepares therapists sufficiently, so that they can work effectively with their lesbian, gay or bisexual clients.
The memorandum is owned by the organisations who signed it. They have continued to meet together and to work on those commitments throughout the year. The Department fully supports that work.
My hon. Friend drew attention to the NHS’s part in such therapies. Discussions with the sector uncovered the fact that there were no reliable, up-to-date figures on the use of conversion therapy. However, a 2009 survey of 1,300 mental health professionals found that more than 200 had tried to help at least one client to reduce the attraction they felt for someone of the same sex. A third of those clients were said to have been referred for therapy by a GP and 40% were reportedly treated in the NHS.
The Government are clear that moneys from the public purse should not be used to fund such therapy. Ministers in the previous Administration wrote to NHS England in March 2014 seeking confirmation that such treatment was not taking place on the NHS and I am pleased that we received a robust and supportive response from Simon Stevens. Not everyone in the House may be aware of his response, which was that
“so-called gay-to-straight conversion therapy is harmful nonsense and the NHS should never be funding it.”
Wes Streeting
Clearly, the memorandum has been effective since it was introduced, but it concerns me that the briefing from Stonewall suggests the Nursing & Midwifery Council, the Care Quality Commission, the General Medical Council and the Health and Care Professions Council are not yet signatories. Does the Minister agree that they should sign up? It has clearly been helpful for other organisations and is a powerful statement of intent.
Jane Ellison
The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.
Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.
Dr Poulter
I pay tribute to my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for securing the debate and to my hon. Friend the Minister for the work she does to raise awareness of the LGBT community’s needs. It is, of course, unacceptable for the NHS to sponsor these therapies. All registered medical professionals can be disciplined by their professional bodies, whether that is the Royal College of Psychiatrists or the GMC taking action against doctors in these cases for discriminating against certain patients. Is the real issue not, however, that the regulation is not there for some therapists? This is the issue that needs to be looked into: do we need to regulate more effectively some of the therapists in this field?
Jane Ellison
My hon. Friend speaks from a position of great knowledge. I am well aware of the challenges to the current position, which I will outline, from hon. Friends and other Members. I will try to respond to those.
I want to make this point, for the record: we are not saying that lesbians, gay men and bisexual people should not seek counselling or therapy if they are distressed about a particular aspect of their sexuality. It is important we recognise that family arguments over sexuality or hostility from other people might well be a reason for someone to seek support for that aspect of their life. That is obviously a core part of what many therapists do, so I want to be clear that there is a place for that in supporting people appropriately.
Ben Howlett
May I pick the Minister up on a point? She referred to lesbians, gay men and bisexual people, but it is transgender people as well.
Jane Ellison
I am duly chastised, having recently given evidence to the excellent inquiry being led by the Women and Equalities Committee, of which my hon. Friend is a member. The Chair of that Committee, my right hon. Friend the Member for Basingstoke (Mrs Miller), has just joined us in the Chamber. I duly correct myself and thank my hon. Friend for his intervention.
I fully understand the concerns about so-called gay conversion therapy, but the Government have no current plans to ban or restrict it via legislation, or to introduce statutory regulation for psychotherapists. I say that in the knowledge that that position is challenged, and I will go away and reflect on that after the debate.
The Health and Social Care Act 2012 introduced provisions to enable the accreditation of voluntary registers for unregulated healthcare professionals and healthcare workers across the UK, social care workers in England and certain students. We should not underestimate the fact that these voluntary registers are having an effect and can be effective. They are accredited by the Professional Standards Authority For Health and Social Care where statutory regulation would be neither proportionate nor an effective response to patient safety. These accredited voluntary registers already provide some safeguards for the public. We feel they are working, and we have examples of that.
Both the Government and the PSA recommend that when a patient or service user chooses to visit a health or care practitioner who is unregulated, only those on an accredited register are consulted. That ensures that organisations holding an accredited voluntary register have been thoroughly assessed by the PSA. The PSA also ensures that those organisations handle complaints fairly and thoroughly. If a practitioner is removed from one register, they are not allowed to join another. We have seen some recent examples. In one case, the British Association for Counselling and Psychotherapy removed a practitioner from its register for professional malpractice after they were associated with this sort of therapy. The Department is clear that it encourages employers and commissioners, when recruiting, to choose practitioners who are committed to the highest standards and who are on accredited registers.
Although we have decided at this stage not to take a legislative approach, I wholeheartedly agree with my right hon. Friend the Minister for Women and Equalities who my hon. Friend the Member for Finchley and Golders Green quoted at the outset of the debate as saying that these therapies must be eradicated. We want to keep up the momentum to do that. I suggest to the House that as we pass the anniversary of the MOU, we should convene another roundtable in the new year, at which we ask the original signatories to report on their progress and challenge them to identify where we can be more ambitious on ending conversion therapy. That would be an opportunity to pick up on some of the specific challenges mentioned by my hon. Friend in his opening speech, as well as one or two of the points made in interventions. I am open to discussing how we bring the concerns raised by Members to the attention of that group and to discussing who comprises it, although I think it originally included some organisations representing LGBT people, as well as professionals in this area. I commit to doing that.
As we work towards that event, I am happy to engage outside the Chamber with hon. Friends on where they think we can do more. I have taken on this brief since the election. Before that, I was a Minister for inequalities; I am now a Minister for inequalities and equalities—I think that makes me even. It is a brief I take extremely seriously and one that I have committed a huge amount of time to.
Nick Herbert (Arundel and South Downs) (Con)
I sense the Minister might be about to end, but I hope she will accept this point. While a ban might not be appropriate, a stronger statement of guidance from the Government, reflecting the comments of colleagues, to all parts of our national health service would be welcome, because of not only the harm these conversion therapies do to individuals but the signal their availability sends to the wider public that it is somehow abnormal to be gay and that being gay is a condition that can be cured. That is not acceptable in today’s society, and our major public service should not be allowing the promotion of that idea in any part of it.
Jane Ellison
I completely understand my right hon. Friend’s point, which he made extremely well. I am happy to talk to Simon Stevens at our next regular meeting about that, and it is perhaps an issue we can explore further at a roundtable. My right hon. Friend makes an extremely fair point about how we send those signals. I will reflect on what more I can do.
To conclude, I ask hon. and right hon. Members present, perhaps in anticipation of the next broad discussion of this issue, to seek the counsel and insight of their local LGBT communities. I regularly guest-chair my local LGBT forum in Wandsworth, which I find a useful opportunity to engage with the issues and get up-to-date insight. I encourage all colleagues to do that, because it will greatly inform our deliberations in the new year. I will take away all the points made and the continued challenge to the Government to go further on this issue. I know that all Members present look forward to a time when this practice is a thing of the past.
Question put and agreed to.
Resolved,
That this House has considered gay conversion therapies and the NHS.