The report, which SAMHSA released today, concludes that, in fact, such therapy can be “devastatingly harmful” to those who undergo its treatment.

SAMHSA and the American Psychological Association (APA) convened a panel of advisers in July to examine the scientific and clinical data behind conversion, or reparative, therapy—a treatment that aims to change an individual’s sexual orientation or gender identity.

The ensuing report, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” found that the therapy is based on pseudoscience and did not meet the professional and ethical standards of the mental health professions. At best, these therapies are ineffective, and at worst, they can be profoundly detrimental, said Fisher.

“These therapies can involve very harmful treatments such as shock therapy—that is, showing an individual [photos of]a particular gender and shocking the individual so as to prevent a sexual response,” said Fisher, the Marie Ward Doty Endowed Chair and a professor of psychology.

“It can also involve berating and focusing on the immorality of the sexual orientation or gender identity. Basically, it’s a punitive form of treatment that has no scientific or clinical basis.”

Experts were called upon to examine the controversial therapy following the suicide of transgender teenager Leelah Alcorn, 17, whose parents forced her to participate in conversion therapy. The public outcry following her death led to the drafting of Leelah’s Law, which would ban the therapy.

SAMHSA’s report is an important step in the White House’s commitment to expanding the number of states who enact the law, said Fisher. Some studies estimate as many as one-third of children and adolescents who identify as a sexual or gender minority has undergone some kind of conversion therapy.

“Children, youth, and even young adults can experience post-traumatic stress disorder as a result, because it’s so stressful to be under these punitive and harsh conditions. It can also lead to depression or can increase a sense of dysphoria and further alienate individuals from their families,” Fisher said. “And, as in Leelah’s case, it can result in suicide.”

The report indicates that variations in gender identity and sexual orientation are normal in children. However, because of the prejudice and stigma they face, LGBT youth are particularly vulnerable to depression, anxiety, and other mental illnesses.

“But it’s not because of these children’s identity [as LGBT individuals]—it’s because of the way they’re treated by their families, their schools, and society,” Fisher said. “These are the conditions… that any disenfranchised and marginalized group may experience.”

The way to support sexual and gender minority youth, she said, is to affirm and accept each individual and to support his or her need for self-expression. The idea is not to push young people in one direction or another, but rather to give them space to explore.

Moreover, mental health professionals, physicians, school personnel, and others who work with children and adolescents need additional training in LGBT issues to better understand the needs of these populations, Fisher said.

“The issues included in this report are intended to enhance the lives and well-being of sexual and gender minority youth by helping to ensure they receive informed, evidence-based, and bias-free services. The systematic elimination of conversion type therapies is critical to the goal of reducing the health disparities facing this vulnerable population.”

Read more on the Ethics and Society blog.

“Suicide is the second leading cause of death among college-age students,” said Jeffrey Ng, Psy.D., director of Fordham’s counseling and psychological services. “This period of life presents a unique set of stressors, including increased academic demands, financial pressures, identity struggles, increased autonomy, and so on.

“In addition, various mental health problems might be more likely to emerge during this age period, such as certain psychoses, bipolar disorder, and depression.”

The grant, Ng said, will allow Fordham to strengthen its existing infrastructure by engaging the entire campus community in mental health and suicide prevention efforts. In particular, increased awareness will help reach students who have historically underused mental health services or who the National Action Alliance for Suicide Prevention have identified as high-risk, including veteran, LGBT, international, and particular ethnic and racial minority students.

“The grant funding will allow us to augment what we’re already doing to support our students,” Ng said. “We’re working to communicate to our entire community of faculty, staff, administrators, coaches and others that suicide prevention and mental health promotion is everyone’s responsibility—we all have a role to play in the wellness of our student body.”

The grant has four overall objectives:

• Enhance students’ coping and resiliency skills by delivering stress reduction seminars and disseminating the Stressbusters mobile application.
• Increase identification, support, and referral of students in distress or at an increased risk of suicide by providing “gatekeeper” trainings and developing suicide prevention peer education programs;
• Increase help-seeking behaviors among students by enhancing partnerships with on- and off-campus constituencies and developing peer-driven public awareness campaigns to reduce stigma, shame, and misinformation about mental health;
• Improve student access to mental health services by increasing visibility of on- and off-campus mental health services and resources.

Engaging the community—especially students—will be among the most important elements of Fordham’s suicide prevention efforts, Ng said. Students can help with normalizing and de-stigmatizing the use of mental health services, which some students may hesitate to use due to fear or shame.

“The most effective way to decrease stigma is through peer-driven advocacy and promotion,” he said. “Messages and information about mental health and wellness are most powerful and effective when they come from our peers.”

The four-year grant will enable to the center to pursue an ambitious multipronged education program that aims to change the way that social workers treat clients suffering from trauma.

Virginia Strand, D.S.W., co-director of the center and the principal investigator for the grant, said that it will allow the center to continue to disseminate a curriculum model that emphasizes both an understanding of trauma and of evidenced-based practices.

Since its founding in 2009, the center, which is in partnership with Hunter College, has been promoting a case-based approach to training students about trauma and its impact on children, adolescents, and their families. It’s a technique that has been used by the medical field for years, and Strand said it has proven effective in social work too, as it helps develop critical thinking and clinical reasoning.

“This whole approach parallels an evidence-based practice, where you’re constantly asking, what’s out there that you need to know to bring in, in order to do your job better as a social worker?” she said.
“That’s what they should be doing in their practice with clients.”

For example, if a client has come from the border of Mexico and Arizona, what might social workers need to know about the area’s drug wars?

“We know that most of the children in child welfare in New Mexico at this point are from families that have been affected by violence and the drug wars.”

Recognizing how trauma can be a factor in so many societal ailments is the first goal of the program; adopting evidence-based practices is the second, said Strand.

“It’s not just practice as usual. You don’t just go in and do what your supervisor has been doing for 15 years. You really look at the empirical literature to see what practices have the most support for being effective with the client population that you’re working with,” Strand said.

“It’s a way to bring the research literature and results and understanding into practice, and it’s been a major theme in social work education over the last decade or so.”

In the center’s first three years, it focused on training individual field instructors. With the new grant, it is shifting the focus from individuals to institutions, with the idea that a top-down approach will be more successful.

“We’re going to work with individual agencies to develop a network around our school of social work that is really strong in the ability to provide evidence-based trauma treatment,” she said.

Since changing an organization’s culture can be challenging, the center is partnering with the North Carolina-based National Implementation Research Network to help ensure the success of the agencies that are chosen. Nine other schools of social work will join Fordham in the endeavor, which will have 10 sites nationwide.

“It’s going to be a real laboratory for studying what works, what are the best ways to do this, who the client populations are that this really works best with, and in what organizational setting,” Strand said.

As part of a focus on the bigger picture, the center has also been making available to the 200 U.S. colleges that offer a master’s of social work degree a stand-alone course on treating children affected by trauma. Forty-five schools have already signed on.

“By the end of this four years, if we continue as we’ve been, we may have half the schools of social work offering this course,” she said.

“It’s a big project, and we’re thrilled to have the opportunity to do this.”