The Dangers of Conversion Therapy

On February 6, 2016, Governor Andrew Cuomo announced a series of regulations to prevent the use of conversion therapy on lesbian, gay, bisexual, transgender, and questioning (LGBTQ) minors. The regulations went into effect on June 15, 2016

The policy change makes New York the fifth state to restrict the treatments. Use of conversion therapy on minors is banned in the states of Vermont, California, New Jersey, Illinois and Oregon, as well as the District of Columbia.

In August 2016, Suffolk County resolved to establish a public information campaign on the dangers of conversion therapy. Below is information for healthcare providers and the public.

Conversion therapy is a practice aimed at changing an individual's sexual orientation or gender identity. It aims to transform gays and lesbians into heterosexuals. Conversion therapy is proven to have significant negative effects on the mental health of individuals subjected to this treatment and has been denounced by several leading medical groups, including the American Psychological Association, which says efforts to change sexual orientation through therapy have "serious potential to harm young people because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder."

The practices used in conversion therapy are sometimes referred to as Reparative Therapy, Ex-Gay Therapy, Psychological Abuse or Sexual Orientation Change Efforts (SOCE). All of the nation’s leading professional medical and mental health associations have rejected conversion therapy as unnecessary, ineffective, and dangerous. These groups have cautioned that the practices do not work and have warned patients that they may be harmful.

The American Psychological Association “advises parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support, and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth.”

The American Psychiatric Association “opposes any psychiatric treatment such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation.”

The American Academy of Pediatrics has stated: “Therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.”

The Pan American Health Organization, a regional office of the World Health Organization, has stated that these practices “lack medical justification and represent a serious threat to the health and well-being of affected people.”

New York State regulations regarding conversion therapy on LGBT minors.

Department of Financial Services (DFS) Insurance Coverage Ban on Conversion Therapy for Minors.

Under new regulations, (available here), New York insurers will be barred from providing reimbursement for conversion therapy services provided to an insured under the age of 18 years. In addition, such insurers are advised to inform participating behavioral health providers that conversion therapy should not be provided to minors and that the insurers will not provide reimbursement for such services. Additionally, as part of the insurers’ provider credentialing or application and re-credentialing processes, insurers are advised to require behavioral health providers to certify that they will not provide conversion therapy to minors or seek reimbursement from the insurer for such services.

Office of Mental Health Regulations Prohibiting Conversion Therapy for Minors. Under new regulations OMH will issue (available here), it will be unlawful for any mental health facility licensed, funded or operated by the New York State Office of Mental Health to provide conversion therapy to minors. Failure to comply with these new regulations could result in the revocation of license and/or funding for any entity found to have engaged in these practices.

Department of Health Medicaid Ban on Conversion Therapy Coverage.

The New York State Department of Health prohibits (notice available here) Medicaid coverage for conversion therapy, as Medicaid only covers care, services, and supplies necessary to prevent, diagnose, correct, or cure recognized medical conditions. Since there is no medical necessity for conversion therapy and because it has been repudiated and discredited by virtually every relevant medical and professional organization, Medicaid cannot cover it.

Note: Conversion therapy does not include counseling or therapy for an individual seeking to transition or transitioning from one gender to another gender, that provides acceptance, support, and understanding of an individual or the facilitation of an individual’s coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, provided that the counseling or therapy does not seek to change sexual orientation or gender identity.

Organizations that recognize the harmfulness of conversion therapy

American Medical Association American Psychological Association American Psychiatric Association American Anthropological Association American Academy of Pediatrics Child Welfare League of America National Association of Social Workers North American Council on Adoptable Children American Psychoanalytic Association American Academy of Family Physicians American Association for Marriage and Family Therapy Council on Child and Adolescent Health American Academy of Child and Adolescent Psychiatry American Counseling Association American Sociological Association American School Health Association National Association of School Psychologists World Health Organization International Association of Counselors and Therapists Pan-American Health Organization

Major Recommendations from the American Academy of Child and Adolescent Psychiatry

Principle 1. A comprehensive diagnostic evaluation should include an age-appropriate assessment of psychosexual development for all youths.

Principle 2. The need for confidentiality in the clinical alliance is a special consideration in the assessment of sexual and gender minority youth.

Principle 3. Family dynamics pertinent to sexual orientation, gender nonconformity, and gender identity should be explored in the context of the cultural values of the youth, family, and community.

Principle 4. Clinicians should inquire about circumstances commonly encountered by youth with sexual and gender minority status that confer increased psychiatric risk.

Principle 5. Clinicians should aim to foster healthy psychosexual development in sexual and gender minority youth and to protect the individual's full capacity for integrated identity formation and adaptive functioning.

Principle 6. Clinicians should be aware that there is no evidence that sexual orientation can be altered through therapy, and that attempts to do so may be harmful.

Principle 7. Clinicians should be aware of current evidence on the natural course of gender discordance and associated psychopathology in children and adolescents in choosing the treatment goals and modality

Principle 8. Clinicians should be prepared to consult and act as a liaison with schools, community agencies, and other health care providers, advocating for the unique needs of sexual and gender minority youth and their families.

Principle 9. Mental health professionals should be aware of community and professional resources relevant to sexual and gender minority youth.

The guidance listed above was taken from the National Guideline Clearinghouse Guideline Summary, NGC:009316, September 2012. American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameters are developed to assist clinicians in psychiatric decision making. These Parameters are not intended to define the sole standard of care. As such, the Parameters should not be deemed inclusive of all proper methods of care or exclusive of other methods of care directed at obtaining the desired results. The ultimate judgment regarding the care of a particular patient must be made by the clinician in light of all of the circumstances presented by the patient and that patient's family, the diagnostic and treatment options available, and other available resources.

Recommendations from the American Academy of Pediatrics

• Pediatricians’ offices should be teen-friendly and welcoming to all adolescents, regardless of sexual orientation and behavior; this includes training all office staff and ensuring that office forms do not presume heterosexuality of patients (or parents).
• If a pediatrician does not feel competent to provide specialized care for sexual minority teenagers and their families, he or she has the responsibility to evaluate families and then refer for medically appropriate care.
• Pediatricians who provide care to sexual minority youth should follow prevention and screening guidelines as outlined in Bright Futures.19
• All adolescents should have a confidential adolescent psychosocial history. Verbal histories and/or written questionnaires should use a gender-neutral approach. Screening and referral for depression, suicidality, other mood disorders, substance abuse, and eating disorders should be included.
• Lesbian, gay, bisexual, transgender, and questioning adolescents, men who have sex with men, and women who have sex with women should have sexual behaviors and risks assessed and should be provided STI/HIV testing according to recommendations in the most recent sexually transmitted diseases treatment guidelines from the Centers from Disease Control and Prevention (CDC).
• Contraception, including use of emergency contraceptives, should be offered to women regardless of their stated sexual orientation, and the importance of consistent condom/dental dam use should be discussed.
• Strengths, resources, and risks should be assessed, and targeted behavioral interventions should be implemented to allow the adolescent to maximize strengths and acknowledge and minimize risky behaviors.
• Pediatricians should be available to answer questions, to correct misinformation, and to provide the context that being LGBTQ is normal, just different.
• Transgender adolescents need to be supported and affirmed; they need education and referral for the process of transition and about avoiding the pitfalls of using treatments that were not prescribed by a licensed physician.
• Pediatricians should support parents in working through adjustment issues related to having a child who is LGBTQ while continuing to demonstrate love and support for their children.
• Pediatricians should support or create gay-straight alliances at schools and support the development and enforcement of zero-tolerance policies for homophobic teasing, bullying, harassment, and violence.
• Pediatricians should educate themselves about organizations that serve sexual minority youth and families in local communities and national organizations with information, support Web sites, and hotlines.

The guidance listed above was taken from an article in Pediatrics, July 2013, Volume 132, Issue 1. It does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.