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CHSA applauds RANZCP new position statement on “The role of psychiatrists in working with Trans & Gender Diverse people”

Countering Hate Speech Aotearoa (CHSA) endorses fully the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) new position statement on “The role of psychiatrists in working with Trans and Gender Diverse people.” The new RANZCP statement acknowledges the fact that human gender diversity has a strong history and cultural base, and the fact that being trans or gender diverse does not represent a mental health condition. Importantly, it recognises that “psychiatrists have a responsibility to counter stigma, discrimination and violence directed toward trans and gender diverse people.

The statement is unequivocally in favour of gender-affirming care for trans and gender-diverse people. CHSA is relieved that the College has now clarified its position, as some of the College’s earlier, less clear statements had been seized upon by a minority of professionals as support for their “gender-critical” position.

This puts on notice that small but dangerously vocal minority of health professionals who publicise their anti-trans prejudices under an assumed protection of professional identity and ‘free speech’ protections. Working with trans and gender diverse people as a psychiatrist and making public statements as a medical professional have clearly been put within an ethical framework and this is a great example of professional responsibility and self-regulation in the face of emerging societal pressures.

The statement emphasises the importance of trans and gender diverse people being provided with “person-centred, evidence-informed mental health care in a supportive, ethical, non-judgemental, and culturally safe manner should they seek and require it.”

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CHSA has been formed with the goal of promoting hate speech legislation in Aotearoa, providing support to organisations wanting to address the harm done by hate speech, and ensuring that professionals do not indulge in hate speech in their professional lives. We have a focus on LGBTQIA+ issues, with a particular interest in the rights of transgender, intersex, gender diverse, gender-queer and non-binary people.

Gender-critical narratives can descend into hate-speech, and the RANZCP has shown that restrictions on speech are necessary when working under a code of professional conduct. Free speech defences do not apply to professionals who seek to promote treatments with extremely low evidence bases, or that are inherently discriminatory.

Most importantly the statement asserts that “Gender Exploratory Therapy” as espoused by groups such as Genspect is, in fact, a form of conversion therapy. “Gender Exploratory Therapy” is a specific therapy model previously called "Gender Reparative Therapy". The statement says:

“The RANZCP opposes conversion therapy and any other attempts to restrict a person’s gender expression. In all settings, psychiatrists have a duty to ensure the rights and dignity of their patients are protected. Psychotherapy is not conversion therapy. In psychotherapy, the patient’s autonomy and self-determination is respected and the therapist does not impose predetermined notions of gender or sexual orientation on the patient.”

As Florence Ashley points out in her seminal paper “Interrogating Gender-Exploratory Therapy”[1] in “Gender-Exploratory Therapy”, the client’s autonomy and self-determination ARE NOT respected. The therapist instead forms a therapeutic alliance with the adolescent’s parents and their desired outcome. Additionally, the therapist imposes their gender-critical beliefs on the therapy process. Lastly, “Gender-Exploratory Therapy” has an extremely low-quality evidence base (if any at all) and contravenes the position statement’s exhortation that only evidence-based medicine is practised.

CHSA welcomes and endorses the RANZCP statement that there is no room in the treatment of adults and young people who are seeking support for gender identity issues to be given “Gender-Exploratory Therapy” or to be treated by gender-critical professionals.

Despite some commentary on the RANZCP statement from gender-critical and religious fundamentalist groups, it does not say that puberty blockers should not be used, or that gender-affirming care should be withheld in adolescents. It advises caution to be used in all care, but at a similar level to the caution applied when prescribing any treatment in a psychiatric setting. It implies that the use of puberty blockers is a decision for the multi-disciplinary team attending to each adolescent.

Once again, CHSA congratulates the RANZCP for being so responsive in producing a position statement that enhances, not diminishes, the mana of people seeking care for gender identity issues. The public can be confident that when seeing a member of the RANZCP, they will be treated with respect and the best evidence-based care. RANZCP has joined other bodies like NZAC, PBANZ, and NZPCC/NZPS in taking such a stance.

[1] https://journals.sagepub.com/doi/10.1177/17456916221102325

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