The post Newsletter #32: January 2022 appeared first on Pacific Public Health Foundation.

Q. How does Bill C-4 open the door to more active prevention of conversion therapy?

Bill C-4 is an amendment to the Criminal Code of Canada, making it an offense to cause someone to undergo conversion therapy, remove a minor from Canada to undergo conversion therapy elsewhere, promote or advertise conversion therapy, or financially benefit from conversion therapy. I am thankful to the survivors and activists who tirelessly fought for our government to take action on the issue of conversion therapy. This law creates an important legislative mechanism to support our work. However, we must not be complacent in assuming that the law will singlehandedly remove conversion therapy from the country. The limits and unintended consequences of Criminal Code enforcement, are well-documented in the context of other public health issues.

Perhaps the greatest benefit of Bill C-4 is the potential to activate broad public education about the issue of conversion therapy and related practices and ideologies. My colleague and conversion therapy survivor Michael Kwag has written, “as much as we need to rid our society of bad actors peddling harmful and fraudulent ideas, we also need to push for policies and initiatives that will create the affirming communities that we know queer and trans people need to thrive.” Michael’s comment opens the possibility of leveraging the core message of Bill C-4—that 2S/LGBTQ people and identities are valid and not in need of change—to double down on our efforts to make sure all Canadians receive this message repeatedly, and clearly.

Q. What can public health practitioners and administrators do to further the cause of 2S/LGBTQ health equity?

In my 2021 blog post, I introduced the notion of the “conversion therapy pyramid“—subsequently published by our research team in the Canadian Journal of Psychiatry. The pyramid reminds us that conversion therapy practices are held up by other pervasive practices that doubt self-determined 2S/LGBTQ identities or dissuade us from adopting or expressing these identities. These practices are often referred to as “sexual orientation and gender identity and expression change efforts,” or SOGIECE.

In the interest of promoting public health action in the wake of enactment of Bill C-4, I offer two practical examples of SOGIECE-related efforts that are sites of 2S/LGBTQ inequity and deserve our support, the interest of digging into the next ‘layer’ of the pyramid.

Gender-affirming healthcare: the importance of self-definition and autonomy

From interviews with conversion therapy survivors, our research team learned that the core premise of conversion therapy practices is someone in authority (e.g., a healthcare provider, counselor, religious leader) claiming to know the best course of action when it comes to the sexual or gender identities of others (e.g., patients, clients, adherents). My colleague Florence Ashley, a bioethicist and jurist, has explained how licensed healthcare providers become harmful anti-transgender gatekeepers when they insist upon medical transition models that do not center patients’ autonomy.

This month, Florence and I published a commentary for CMAJ, arguing that effectively ridding our medical system of conversion therapy will require regulatory enforcement that includes particular attention to denial of gender-affirming care. Of course, regulatory enforcement should be paired with “carrots” that incentivize the expansion of gender-affirming care access. Here in BC, we are fortunate to have TransCareBC leading these efforts. Other Canadian colleagues have demonstrated how practical, patient-centered gender-affirming care can be effectively taught through public health and other health professional education channels. These models must be scaled and fully funded to continue moving toward health equity for trans people.

2S/LGBTQ-inclusive comprehensive sex education

The delivery of sex education in Canada—and British Columbia—is inconsistent and patchwork, with little to no guarantee of inclusion of 2S/LGBTQ content. This is relevant to conversion therapy for two reasons. First, school-based sex education may be thought of as a ‘safety net‘—a place where 2S/LGBTQ youth who are otherwise stigmatized by families or communities may receive the unequivocal message that their sexual and gender identities are valid and healthy. Second, 2S/LGBTQ youth are disproportionately affected by sex education curricula, that fails to meet Canadian Standards. Without evidence-based, non-stigmatizing education, 2S/LGBTQ youth are left to make sexual decisions on their own, in the absence of clear, health-promoting guidance.

Q. How can you learn more about 2S/LGBTQ equity?

This is a good time to activate public health efforts to eradicate anti-2S/LGBTQ practices. Women and Gender Equality Canada is poised to launch a national LGBTQ2 Action Plan. Here at the BCCDC, the Two-Spirit Dry Lab—the first public health research group that focuses exclusively on Two-Spirit people—is preparing to conduct a three-year, CIHR-funded study to understand how Two-Spirit promotes health equity for Indigenous people. As my research team builds on what we’ve learned about conversion therapy, we will be launching a new survey that will explore all of the topics outlined here, working with Canadian youth and 2S/LGBTQ communities.

Consider checking out the following BC and Canadian organizations and efforts that are working hard for a bright future for 2S/LGBTQ people. They will appreciate your support:

• Path to Patient-Centred Care
• Action Canada for Sexual Health & Rights
• Community-Based Research Centre
• No Conversion Canada
• MindMapBC

If you want to do more to support survivors of conversion therapy, have a look at recommendations compiled by Reilla Archibald, a nurse and MPH student working with our team.

To keep updated about our team’s research, follow me on Twitter.

Acknowledgements:

Thank you to the BCCDC Foundation for Public Health, Andrew Beckerman, and CIHR for funding this work.

I am grateful to the courageous conversion therapy survivors who have tirelessly told and retold their stories so that the rest of us would finally take action to combat these traumatic practices.

Finally, the following students have contributed to this research: David Kinitz (University of Toronto), Trevor Goodyear (University of British Columbia), Elisabeth Dromer (Université de Montréal), Amrit Tiwana (Simon Fraser University, SFU), Reilla Archibald (SFU), Julia Schillaci-Ventura (SFU).

Publications from our team on the topic of CT:

• Ridding Canadian medicine of conversion therapy
• “Conversion Therapy” Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity Expression Change Efforts in Canada
• Experiences with sexual orientation and gender identity conversion therapy practices among sexual minority men in Canada, 2019-2020
• “They Want You to Kill Your Inner Queer but Somehow Leave the Human Alive”: Delineating the Impacts of Sexual Orientation and Gender Identity and Expression Change Efforts
• The scope and nature of sexual orientation and gender identity and expression change efforts: a systematic review protocol
• Prevalence of Exposure to Sexual Orientation Change Efforts and Associated Sociodemographic Characteristics and Psychosocial Health Outcomes among Canadian Sexual Minority Men

The post Beyond the Ban: A Public Health Strategy to Eradicate Anti-2S/LGBTQ Practices appeared first on Pacific Public Health Foundation.

In the fall of 2019, the BCCDC Foundation launched a campaign to give voice to the many Canadians who have endured so-called “conversion therapy.” Funds were used to support a unique and powerful Dialogue event where we heard from survivors and LGBTQ2 community leaders about research priorities for preventing future and ongoing trauma related to conversion therapy.

In this post, I reflect on what we have learned from the past year of active research, as well as advocacy efforts with the federal government, who first expressed interest in banning conversion therapy the month following our campaign and Dialogue event, when Prime Minister Trudeau mandated that his Ministers prepare a Criminal Code amendment that would prohibit conversion therapy across Canada.

Q. What have we learned about conversion therapy from Canadian research conducted in the past year?

In the spring of 2019, I was invited to give a statement to the House of Commons Standing Committee on Health about what further action the federal government could take to improve the lives of LGBTQ2 people, acknowledging that we continue to face disproportionately high rates of suicide, depression, and anxiety. When I commented on the need to tackle conversion therapy, MPs asked pointed and sensible questions:

Where is it happening?
Under what circumstances?
How many people are affected?

These questions launched a program of research that continues to this day. Working with the Community-Based Research Centre, we added questions to the national SexNow survey which includes data from over 9,000 gay, bisexual, Two-Spirit, and trans men from across the country—to estimate the prevalence of conversion therapy exposure.

We learned that 1 in 10, corresponding to tens of thousands of Canadians, have had direct experience with conversion therapy at some point in their lives. Many of these experiences were hidden from others, owing to the stigma of attending conversion therapy. In order to break through this silence, we conducted confidential in-depth interviews with 22 individuals of diverse genders and gender identities, asking them to give us more details about the circumstances of their experiences, as well as their suggestions for what more could be done to help them heal from trauma.

We learned that experiences of conversion therapy are varied and complex, but they shared a unifying feature of trying to reject LGBTQ2 outcomes—meaning the adoption of gender identities that differ from sex assigned at birth (for trans people) and/or the adoption of sexual orientations that differ from heteronormative expectations of opposite-sex marriage, etc. (for queer people).

Importantly, we also learned that despite numerous regulatory bodies (including, for example, the Canadian Psychological Association) discrediting conversion therapy, these practices continue to occur in licensed healthcare provider offices, as well as unlicensed settings, including religious organizations. Many attended services that were offered free of cost, while others paid handsomely to experience conversion therapy.

Finally, we learned that many people started conversion therapy as an adult, suggesting that efforts to ban conversion therapy for youth will not sufficiently remove the threat of harm for LGBTQ2 people.

Q. How can federal legislation stop conversion therapy from continuing to happen?

In this context, there was great enthusiasm for the federal bill (now labeled C-6), an Amendment to the Criminal Code to ban conversion therapy. Several researchers, survivors, and activists—myself included—gave testimony to the Justice Committee in December of 2020, urging legislators to expand the scope of the bill. My team made the following recommendations based on the research above:

• Improve the definition of conversion therapy to clarify that the defining feature is not “changing” intrinsic sexual orientations or gender identities, but rather indoctrinating attendees with the notion that certain (i.e., LGBTQ2) orientations, identities, and expressions are disordered, less desirable, or otherwise modifiable.
• Include specific language to address conversion therapy practices that target trans people. Here we drew examples from our interviews but also pointed to an open letter led by trans conversion therapy survivor and activist Erika Muse, signed by hundreds of individuals and organizations from across Canada.
• Include a provision to ban promotion of conversion therapy that may not include financial or material benefit (i.e., free services).
• Expand the ban to include adults.
• Advocate for the provision of federally funded supports for conversion therapy survivors, including trauma-informed and survivor-directed healing efforts (counseling, peer groups, etc.).

The Committee made some of these recommendations, though not all, and the bill is currently awaiting third reading on the floor of the House. Those of us working on this issue believe that it is important to continue pushing legislators and policymakers, federally and provincially, to clearly communicate to Canadians of all ages that LGBTQ2 identities are celebrated, and that conversion therapy practices are incompatible with Canadian values.

There is no silver bullet to stopping conversion therapy, and we therefore continue to insist that effective and holistic strategies will include, not only bans and similar deterrents, but also comprehensive, affirming education and support provided to LGBTQ2 people to clearly communicate alternatives to attending conversion therapy.

Q. What else can we do?

Many of the individuals we interviewed experienced intense and distressing messages of rejection before they even arrived at conversion therapy. I have previously referred to this layering of anti-LGBTQ2 messaging as the “conversion therapy pyramid.” It suggests that we have an opportunity to prevent the demand for conversion therapy by fervently and consistently delivering LGBTQ2-affirming messages to Canadians, starting with schools and other settings that serve our youth.

For example, Action Canada for Sexual Health & Rights has been advocating for federal and provincial consistency in guidelines that promote LGBTQ2 well-being within school-based sex ed. This initiative can have enormous ‘upstream‘ impact on LGBTQ2 populations, by reducing what researchers call “minority stress” thereby redressing some of the enormous inequities we continue to experience when it comes to mental health outcomes, including suicide.

Most importantly, all of us, LGBTQ2 or otherwise, need to listen carefully to the experiences of those who have endured conversion therapy. If you are like me, your first instinct may be to avoid the topic or even deny that such practices exist in our contemporary notion of a ‘progressive’ Canada. This is a disservice to those who have experienced these traumas.

Below, I have included some links to where you can start to read and listen to survivor stories. My hope is that the experience of story-telling will be meaningful and even healing for the survivors and that sharing these stories will lead more Canadians to reflect on how these practices have continued to operate, unchecked, for so long.

• Our research team’s brief to the federal Justice Committee (December 2020)
• Community-Based Research Centre
• Centre for Gender and Sexual Health Equity & open letter from survivor and activist Erika Muse
• No Conversion Canada
• Federal Bill C-6
• My reflections on previous legislative attempts

Acknowledgments:

This work was made possible due to the ground-breaking advocacy efforts of Canadian conversion therapy survivors. The research was supported by the BCCDC Foundation, the Community-Based Research Centre, Andrew Beckerman, and the Canadian Institutes of Health Research.

The post The Opportunity and Limits of a Federal Conversion Therapy Ban appeared first on Pacific Public Health Foundation.