Children should receive care that first, does no harm. Set out below is an initial draft of proposed legislation to ensure Georgia’s children are safe and supported. The proposed legislation prohibits mental health professionals licensed in Georgia from providing conversion therapy to minors.
Conversion therapy has no scientific basis, contradicts the medical community’s understanding of sexual orientation and gender identity, and puts young people at risk of serious harm, including severe depression, anxiety, and substance misuse, which contribute to an elevated risk of suicide.
While this document provides a basis from which to consider drafting appropriate legislation to regulate conversion therapy in Georgia, the legislation will be modified to work in concert with Georgia law.
Draft of Legislation
A BILL TO BE ENTITLED
To amend Part __ of Article __ of Chapter __ of Title __ of the Official Code of Georgia Annotated concerning the protection of minors from attempts to change sexual orientation, gender identity, or gender expression, so as to prohibit licensed mental health professionals from providing conversion therapy to minors; to provide for penalties; to provide for related matters; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF GEORGIA:
This act shall be known and may be cited as the “Youth Mental Health Protection Act”.
The General Assembly finds that:
Research demonstrates that sexual orientation and gender identity change efforts can pose critical health risks to lesbian, gay, bisexual, and transgender persons;
Contemporary science recognizes that being lesbian, gay, bisexual, or transgender is part of the natural spectrum of human identity and is not a disease, disorder, or illness;
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 American Medical Association Council on Scientific Affairs has stated: “Aversion therapy (a behavioral or medical intervention which pairs unwanted behavior, in this case, homosexual behavior, with unpleasant sensations or aversive consequences) is no longer recommended for gay men and lesbians. Through psychotherapy, gay men and lesbians can become comfortable with their sexual orientation and understand the societal response to it”;
The American Counseling Association Governing Council has stated: “We oppose ‘the promotion of “reparative therapy” as a “cure” for individuals who are homosexual’”;
The American Psychiatric Association has stated:
“Psychotherapeutic modalities to convert or ‘repair’ homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of ‘cures’ are counterbalanced by anecdotal claims of psychological harm. In the last four decades, ‘reparative’ therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, [the American Psychiatric Association] recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to first, do no harm”;
“The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian is not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed”; and
“Therefore, 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 or her sexual homosexual orientation”;
The American Psychological Association convened a Task Force on Appropriate Therapeutic Responses to Sexual Orientation in 2009. The task force conducted a systematic review of peer-reviewed journal literature on sexual orientation change efforts and concluded that sexual orientation change efforts can pose critical health risks to lesbian, gay, and bisexual people, including confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, suicidality, substance abuse, stress, disappointment, self-blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners, problems in sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a feeling of being dehumanized and untrue to self, a loss of faith, and a sense of having wasted time and resources;
The American Psychological Association issued a resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts, which states: “[T]he [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 Psychoanalytic Association issued a position statement in June 2012 on attempts to change sexual orientation, gender identity, or gender expression, and in it the association states:
“As with any societal prejudice, bias against individuals based on actual or perceived sexual orientation, gender identity or gender expression negatively affects mental health, contributing to an enduring sense of stigma and pervasive self-criticism through the internalization of such prejudice”; and
“Psychoanalytic technique does not encompass purposeful attempts to ‘convert,’ ‘repair,’ change or shift an individual’s sexual orientation, gender identity or gender expression. Such directed efforts are against fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized attitudes”;
The American Academy of Child and Adolescent Psychiatry has stated: “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. There is no empirical evidence adult homosexuality can be prevented if gender nonconforming children are influenced to be more gender conforming. Indeed, there is no medically valid basis for attempting to prevent homosexuality, which is not an illness. On the contrary, such efforts may encourage family rejection and undermine self-esteem, connectedness and caring, important protective factors against suicidal ideation and attempts. Given that there is no evidence that efforts to alter sexual orientation are effective, beneficial or necessary, and the possibility that they carry the risk of significant harm, such interventions are contraindicated”;
The Pan American Health Organization, a regional office of the World Health Organization, has stated: “These supposed conversion therapies constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements.” The organization also noted that reparative therapies “lack medical justification and represent a serious threat to the health and well-being of affected people”;
The American Association of Christian Counselors (AACC) removed references to conversion therapy as an acceptable practice from its Code of Ethics in 2014. The intention of the AACC is “to equip clinical, pastoral, and lay care-givers with biblical truth and psychosocial insights that minister to hurting persons and helps them move to personal wholeness, interpersonal competence, mental stability, and spiritual maturity.”
The American School Counselor Association has stated: “It is not the role of the professional school counselor to attempt to change a student’s sexual orientation or gender identity. Professional school counselors do not support efforts by licensed mental health professionals to change a student’s sexual orientation or gender as these practices have been proven ineffective and harmful”;
The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) has stated: “[H]aving a non-heterosexual sexual orientation, [ ] being transgender and [ ] being gender non-conforming [ ] are not mental disorders. We oppose any ‘reparative’ or conversion therapy that seeks to ‘change’ or ‘fix’ a person’s sexual orientation, gender identity or gender expression. AASECT does not believe that non-heterosexual sexual orientation or being transgender or gender non-conforming is something that needs to be ‘fixed’ or ‘changed.’ The rationale behind this position is the following: Reparative therapy (for minors, in particular) is often forced or non-consensual[;] Reparative therapy has been proven harmful to minors[;] There is no scientific evidence supporting the success of these interventions[;] Reparative therapy is grounded in the idea that non-heterosexual orientation, transgender gender identity and gender non-conforming expressions are ‘disordered[‘; and] Reparative therapy has been shown to be a negative predictor of psychotherapeutic benefit”;
The American College of Physicians has stated: “The College opposes the use of ‘conversion,’ ‘reorientation,’ or ‘reparative’ therapy for the treatment of LGBT persons. . . . Available research does not support the use of reparative therapy as an effective method in the treatment of LGBT persons. Evidence shows that the practice may actually cause emotional or physical harm to LGBT individuals, particularly adolescents or young persons”;
The Substance Abuse and Mental Health Services Administration has concluded that:
“Conversion therapy perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development. Most importantly, it may put young people at risk of serious harm.”
“Conversion therapy—efforts to change an individual’s sexual orientation, gender identity, or gender expression — is a practice that is not supported by credible evidence, and has been disavowed by behavioral health experts and associations.”
“Same-gender sexual identity, behavior, and attraction are not mental disorders. Same-gender sexual attractions are part of the normal spectrum of sexual orientation. Sexual orientation change in children and adolescents should not be a goal of mental health and behavioral interventions.”;
In 2016, the American Medical Association issued policy statement H-160.991, which expressly opposed the use of “reparative” or “conversion” therapy for sexual orientation or gender identity;
The World Psychiatric Association issued a policy statement in 2016 on Gender Identity and Same-Sex Orientation, which stated, “There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful. The provision of any intervention purporting to ‘treat’ something that is not a disorder is wholly unethical;”
The National Association of Social Workers (“NASW”) issued a 2015 policy statement stating that “no data demonstrate that [ ] reparative or conversion therapy is effective” and that these practices are “an infringement of the guiding principles inherent to social worker ethics and values;”
The Agency for Healthcare Research and Quality issued a clinician’s guideline for practitioners who work with children and adolescents based on research provided by the American Academy of Child and Adolescent Psychiatry. It stated that “There is no empirical evidence that adult homosexuality can be prevented if gender nonconforming children are influenced to be more gender conforming. Indeed, there is no medically valid basis for attempting to prevent homosexuality, which is not an illness. On the contrary, such efforts may encourage family rejection and undermine self-esteem, connectedness, and caring, which are important protective factors against suicidal ideation and attempts;”
The Centers for Disease Control and Prevention (CDC) states that “While many sexual minority youth cope with the transition from childhood to adulthood successfully and become healthy and productive adults, others struggle as a result of challenges such as stigma, discrimination, family disapproval, social rejection, and violence. Sexual minority youth are also at increased risk for certain negative health outcomes.” According to the CDC’s 2017 Youth Risk Behavior Surveillance survey, as compared to heterosexual high school students, those students self-identifying as lesbian, gay, or bisexual are:
2 times more likely to be bullied at school or electronically;
More than 2 times more likely to feel sad and hopeless;
3 times more likely to have seriously considered suicide;
More than 3 times more likely to have made a suicide plan;
4 times more likely to have attempted suicide; and
More than 4 times more likely to have been injured in a suicide attempt;
In 2009, The Family Acceptance Project found that “gay and transgender teens who were highly rejected by their parents and caregivers were at very high risk for health and mental health problems when they become young adults (ages 21-25). Highly rejected young people were:
More than 8 times as likely to have attempted suicide
Nearly 6 times as likely to report high levels of depression
More than 3 times as likely to use illegal drugs, and
More than 3 times as likely to be at high risk for HIV and sexually transmitted diseases
compared with gay and transgender young adults who were not at all or only rejected a little by their parents and caregivers – because of their gay or transgender identity.” The same report also stated that LGBT youth experience attempts to change their sexual orientation or gender identity as rejection or abuse;
A 2018 study by The Family Acceptance Project found the following:
Rates of attempted suicide by LGBT young people whose parents tried to change their sexual orientation were more than double (48%) the rate of LGBT young adults who reported no conversion experiences (22%). Suicide attempts nearly tripled for LGBT young people who reported both home-based efforts to change their sexual orientation by parents and intervention efforts by therapists and religious leaders (63%).
High levels of depression more than doubled (33%) for LGBT young people whose parents tried to change their sexual orientation compared with those who reported no conversion experiences (16%) and more than tripled (52%) for LGBT young people who reported both home-based efforts to change their sexual orientation by parents and external sexual orientation change efforts by therapists and religious leaders.
Sexual orientation change experiences during adolescence by both parents / caregivers and externally by therapists and religious leaders were associated with lower young adult socioeconomic status: less educational attainment and lower weekly income; and
Imposing a requirement that minor clients give their informed consent before undergoing conversion therapy with a licensed mental health professional was considered and rejected because minors constitute an especially vulnerable population and may feel pressured to receive conversion therapy by their families and their communities despite their fear of being harmed.
Limiting the prohibition on conversion therapy only to aversion therapy and allowing non- aversive, “speech-only” therapy” for minors was considered and rejected. because the harms associated with conversion therapy are not limited solely to aversion therapy. Aversion therapy associates negative stimuli with homoerotic pictures. Aversive therapies include, without limitation, the application of electric shock to the hands and/or genitals and nausea-inducing drugs. Our minors are also harmed by non-aversive therapy. As noted above, a 2018 study by the Family Acceptance Project found that LGBT young people exposed to non-aversive therapy experienced suicide attempt rates almost three times higher than LGBT young adults who reported no conversion therapy exposure and rates of depression more than three times higher.
Talk therapy is not speech, it is the treatment of emotional suffering, including anxiety, depression, self-harming, and suicidality. To the extent that talk therapy implicates speech, it stands on the same First Amendment footing as other forms of medical or mental health treatment.
The authority of the States to regulate the practice of certain professions is deeply rooted in our nation's jurisprudence. Over 100 years ago, the Supreme Court in Watson v. State of Maryland deemed it "too well settled to require discussion" that "the police power of the states extends to the regulation of certain trades and callings, particularly those which closely concern the public health.”
In Prince v. Massachusetts, the Supreme Court held that “[t]he state’s authority over children’s activities is broader than over like actions of adults . . . A democratic society rests, for its continuance, upon the healthy, well-rounded growth of young people into full maturity as citizens, with all that implies.” Consequently, in New York v. Ferber, the Supreme Court “sustained legislation aimed at protecting the physical and emotional well-being of youth even when the laws have operated in the sensitive area of constitutionally protected rights.”
Article 1, Section 1 of the Constitution of the State of Georgia states, in part, that “[p]rotection to person . . . is the paramount duty of government and shall be impartial and complete. No person shall be denied the equal protection of the laws.”
Georgia has a compelling interest in protecting the physical and psychological well-being of minors, including lesbian, gay, bisexual, and transgender youth, and in protecting its minors against exposure to serious harms caused by conversion therapy.
Part __ of Article __ of Chapter __ of Title __ of the Official Code of Georgia relating to ____________ is hereby amended by adding a new subsection as follows:
As used in this section, "conversion therapy" means any practices or treatments that seek to change an individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender. Conversion therapy shall not include counseling that provides assistance to a person undergoing gender transition, or counseling that provides acceptance, support, and understanding of a person or facilitates a person's coping, social support, and identity exploration and development, including sexual-orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, as long as such counseling does not seek to change an individual’s sexual orientation or gender identity.
Part __ of Article __ of Chapter __ of Title __ of the Official Code of Georgia relating to ____________ is hereby amended by adding a new subsection as follows:
A person who is licensed to provide professional counseling under [CITE TO RELEVANT GEORGIA LAW], including, but not limited to, a psychiatrist, licensed practicing psychologist, certified social worker, licensed clinical social worker, licensed social worker, licensed marriage and family therapist, certified psychoanalyst, or a person who performs counseling as part of the person’s professional training for any of these professions, shall not engage in conversion therapy with a person under 18 years of age.
Any conversion therapy practiced by a licensed professional, as defined in section _(a), on a patient under 18 years of age shall be considered unprofessional conduct and shall subject them to discipline by the relevant licensing entity.
If some provisions of this act, or certain applications of those provisions, are found to be unconstitutional, the remaining provisions, or the remaining applications of those provisions, will continue in force as law.
All laws and parts of laws in conflict with this Act are repealed.
This act shall take effect immediately.