There is nothing therapeutic about so-called conversion therapies.
These are the words of a transgender (trans) person and activist who spoke with me at a recent gathering for civil society. This simple sentence reveals the insidious nature of interventions which claim that one can, and should, change a person’s sexual orientation, gender identity or expression (SOGIE). Such a notion is dangerous and has no place in a human rights-based society. Yet these interventions continue to take place across Europe, often lawfully and commonly under the guise of medical or religious tenets. Despite the profound and long-lasting harmful effects that these practices can have, many victims are left with neither recognition of the harms that they have endured nor redress. This must end.
Nature, prevalence, and impact of SOGIE conversion practices
At their core, SOGIE conversion practices (also known as so-called “conversion therapies”) purport to change, or suppress, a person’s sexual orientation, gender identity or expression when it does not conform to the perceived dominant norm. Although it takes many forms, these practices commonly occur through the following methods:
- Psychotherapy – including behavioural and cognitive therapy and aversion-based practices (such as electro-shock and nausea-inducing drugs), premised on the belief that a person’s SOGIE is the result of some past, abnormal experience;
- Medical intervention – including pharmaceutical approaches, such as the use of hormones or steroids, in order to correct a supposed biological imbalance; and
- Faith-based interventions – attempts to rid an individual of a supposed evil which is the cause of their SOGIE, through “guidance” from a spiritual adviser, and that can include subjection to slurs, beatings or exorcism.
These practices are sometimes run as business enterprises, actively promoting harmful messages and services to vulnerable individuals through advertisements and making profit from those same individuals. Recent reports suggest that some of these businesses have taken advantage of legislative discrepancies on SOGIE conversion practices in Europe and relocated where they are still legal.
The prevalence of SOGIE conversion practices across Europe is not known, since they often take place under secretive conditions. It is estimated that 2% of LGBTI persons in the EU have undergone such practices and that 5% have been offered them, although actual figures may be much higher. According to most recent data available in the United Kingdom (UK), around one fifth of LGBTI people there have experienced SOGIE conversion practices, and trans people are disproportionately targeted by these interventions. I am also particularly troubled by findings that, globally, children and young adults are at far greater risk of being subjected to them.
The effects of these practices can be devastating. Individuals subjected to them may suffer from significant psychological harm, including depression and anxiety, shame or self-hatred, suicidal thoughts, or suicide attempts, post-traumatic stress disorder, as well as physical health consequences such as stomach ulcers, sexual and eating disorders and migraines. The interventions themselves may also result in permanent physical harm.
A clear message from international human rights standards: no place for SOGIE conversion practices
These practices conflict with an overwhelming consensus of international human rights and scientific bodies. In 2020, the United Nations Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity (IESOGI), Victor Madrigal-Borloz, called for a global ban on conversion practices, without distinction between coercive and abusive practices versus supposedly “non-coercive” and “non-abusive” ones. That same year, a group of members of the European Parliament, following-up on a 2018 resolution, called on the European Commission to propose an EU-wide ban. The European Commission’s current LGBTIQ equality strategy further classifies such practices as harmful to LGBTI people’s bodily and mental health. At the Council of Europe, such practices have been criticised by several bodies, including its Parliamentary Assembly and the Congress of Local and Regional Authorities.
The international trend towards depathologisation of LGBTI persons is a key development for recognising that SOGIE diversity is not an illness, and therefore cannot be “cured” through conversion practices. The World Health Organization (WHO) has declassified homosexuality as a pathology or disease since 1990. Almost thirty years later, I praised the removal of gender identity disorder from the list of mental illnesses within the 11th edition of the International Classification of Diseases (ICD-11) as a welcome and overdue development, while noting that work remains to be done in fully depathologising SOGIE diversity. Professional associations of psychologists in Europe and beyond have also firmly condemned SOGIE conversion practices, stressing that they are medically unjustified, unethical and cause significant harm.
It is vital to recognise that SOGIE conversion practices interfere with several human rights. In particular, I am convinced that these practices are irreconcilable with several guarantees under the European Convention on Human Rights (ECHR). As clarified by several international bodies, including the UN Committee Against Torture and Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, SOGIE conversion practices are capable of reaching the threshold of ill-treatment, which is prohibited under Article 3 ECHR. These practices are degrading, insofar as they humiliate the persons subjected to them, diminish their human dignity, and can result in significant physical and mental suffering. In particularly egregious cases, for instance where violence or sexual abuse is used, such conversion practices may amount to torture. Since these acts can be detrimental to a person’s mental and physical health, they may also interfere with their physical or psychological integrity and personal autonomy, which is protected by Article 8 ECHR (right to respect for private and family life). Furthermore, the UN Committee on Economic, Social and Cultural Rights has found that SOGIE conversion practices violate LGBTI people’s right to sexual and reproductive health. Importantly, since these practices treat people differently on the basis of characteristics such as sexual orientation or gender identity, and lack objective and reasonable justification, they hardly seem compatible with the prohibition of discrimination enshrined in Article 14 ECHR and Article 1 of Protocol No. 12 to the ECHR.
In the case of children, their best interests must be a primary consideration in all actions which concern them (Article 3 of the UN Convention on the Rights of the Child). I join the IESOGI in finding that the subjection of a child to SOGIE conversion practices can never be in their best interests. With regard to adults subjected to these practices, the fact that they may have supposedly consented is a misnomer. SOGIE conversion practices falsely claim to be able to cure something which is not an illness. The persons who seek such practices are often also driven by prevalent anti-LGBTI prejudice and hatred in their community or family. These are factors which may affect individuals’ ability to give free and fully informed consent.
While SOGIE conversion practices are often carried out by private actors, this does not exempt member states from their positive obligations to secure the rights and freedoms of everyone in their jurisdiction. Among other things, states are obliged to ensure that there is an appropriate legal framework in place, that claims of breaches are effectively investigated and that remedies are effective and accessible.
I also wish to address the argument, often spuriously made, that the rights to freedom of religion or expression (Articles 9 and 10 ECHR) of those who carry out and support SOGIE conversion practices are violated by state actions to prevent and address such interventions. It is important to underscore that properly drafted conversion practice bans should not interfere with the right to hold a belief or express an opinion on LGBTI issues. However, as opposed to the freedom to have a religion and to hold a belief or not, the right to manifest one’s religion or belief may be subjected to limitations in order to protect the fundamental rights of others, if these limitations are prescribed by law, necessary in a democratic society and proportionate.
Recent momentum in tackling SOGIE conversion practices in Europe
I have observed an increased awareness of SOGIE conversion practices in our region, and a recent impetus toward confronting them. Several member states and local authorities have adopted criminal or administrative bans, which vary in scope, with the vast majority covering sexual orientation and gender identity and/or expression. Malta was the first European country to adopt a ban on SOGIE conversion practices in 2016. The Maltese law prohibits SOGIE conversion practices conducted by anyone on children and vulnerable adults, involuntary or forced conversion practices, and the advertisement of such practices. Malta is currently considering amendments to the law that would introduce a definition of advertising of conversion practices. Germany adopted a ban on the advertisement and conducting of conversion practices on minors in 2020. In Spain, while there is no ban at the national level yet, numerous regions and cities have introduced administrative bans on SOGIE conversion practices conducted by anyone, against anyone. In January 2022, France prohibited conversion practices conducted by anyone on both children and vulnerable adults, including through the use of electronic communication tools, furthermore making it an aggravating circumstance if the practice is conducted by someone with authority over a minor victim. Greece followed suit in May 2022 with a ban on all conversion practices carried out on children. Albania, for its part, has adopted medical guidelines that prohibit conversion practices by psychologists.
Several additional bans are currently under consideration by governments or parliaments in Belgium, Cyprus, Finland, Ireland, the Netherlands, Norway, Spain, Switzerland and the UK. I hope these bills will make swift progress and be adopted in coming months. It is notable that this trend also exists at the global level, with several countries across the world now having adopted legislation which prohibit these practices.
I am also encouraged in noting that several national human rights structures (such as Ombudsman institutions, National Human Rights Institutions, and Equality Bodies) have started working on this issue, taking a firm position and in some cases providing human rights guidance to their governments on the need to combat SOGIE conversion practices. This is the case, for example, in Poland, Scotland and France.
Despite a clear positive momentum, I am aware that progress is not straightforward, and some proposed bans have stalled. I recently highlighted the fact that, in the UK, the process of adopting a ban on SOGIE conversion practices has been marred by discussions about excluding trans people from it. As stressed in the report of my visit to the UK in June-July 2022, all victims suffer equally from conversion practices and excluding trans people would be harmful and discriminatory. As such, I welcome the UK government’s recent announcement that the ban it is working on would include them.
Moving forward: the need for a comprehensive, human rights-based approach to eliminating SOGIE conversion practices
Current efforts by member states to adopt legal bans on SOGIE conversion practices are a welcome development. These bans must be drafted with care and be as precise as possible, so that they respect the principle of legal certainty and are in line with the human rights framework. Legal bans are an essential first step, but they, alone, are unlikely to effectively put an end to these practices. When considering their legal and policy framework on this issue, I call on member states to adopt a comprehensive, human rights-based approach:
Mapping the problem
Member states should collect data about SOGIE conversion practices happening on their territories, in order to fully understand their prevalence, by whom they are conducted and the profile and age of the victims. This information will ensure that bans and policy responses are designed based on factual reality and can be as effective as possible.
Accountability
Precise and enforceable bans: Legal bans are important on several levels. First and foremost, they send the right signal to society that SOGIE conversion practices are unacceptable. Legal bans also ensure that it is possible to hold perpetrators accountable. Bans must include a clear and comprehensive definition of conversion practices, covering practices targeting sexual orientation as well as gender identity and expression. Given the variety of settings in which these practices are carried out, the bans should prohibit conversion practices carried out by anyone. Based on states’ positive obligations under the ECHR, and the dubious nature of consent in this context, there is ground for states to prohibit SOGIE conversion practices affecting adults and minors.
At the same time, the bans should specify that they do not target counselling genuinely aimed at supporting a person to explore their sexual orientation and gender identity. Well-drafted bans will make clear that they target efforts to change, repress, or eliminate someone’s SOGIE, and thus do not affect the free and lawful expression of views related to LGBTI matters. Criminal and/or civil liability can be considered, notably regarding health professionals. Punishment should be proportionate to the acts and harm done. National authorities could usefully consider drafting guidelines to facilitate the effective implementation of these legal bans.
Advertisement: To prevent those carrying out conversion practices from continuing to target people, member states should prohibit the advertisement of conversion practices. This is crucial given the rapid development of internet and information technologies with wide reach. In this regard, I take note with satisfaction of the decision by the social media platform Instagram to ban advertisement of SOGIE conversion practices.
Participation, support, and rehabilitation of victims
In addition to preventing SOGIE conversion practices from happening and bringing the perpetrators to justice, it is essential not to forget the needs of victims. Victims and their support organisations should be consulted when designing states’ policies to combat SOGIE conversion practices. Victims should have facilitated access to justice and reparations. In addition, public funding should be allocated for psychosocial support and rehabilitation measures.
Delegitimising SOGIE conversion practices in society
It is essential for states to address political or social anti-LGBTI discourse presenting LGBTI people as deviant or abnormal, because such rhetoric is likely to foster a culture in which LGBTI people are forced or feel pressured to undergo SOGIE conversion practices. Member states should take steps to raise awareness in society about the harm caused by SOGIE conversion practices. In this regard, official statements by authorities’ representatives can play an important role, together with public information campaigns and comprehensive sexuality education in schools. Science-based information about sexual orientation and gender identity, and the impact of SOGIE conversion practices, should also be included in the education and training of mental health and other relevant medical practitioners.
Diverse sexual orientations and gender identities or expressions are not to be repressed or changed. They are an expression of the rich diversity of human beings. I call on Council of Europe member states to take decisive measures to eliminate SOGIE conversion practices. We should all continue to work for a world free of discrimination and prejudices against LGBTI people, so that conversion practices are finally recognised for what they are: a harmful fraud.
Dunja Mijatović