Debate over therapy limits for minors intensifies after Minnesota school shooting

Calls to repeal state laws that restrict mental-health professionals from discussing a child’s biological sex have intensified in the wake of a mass shooting at a Minnesota Catholic school and an accompanying public debate about the shooter’s gender identity, advocates and lawmakers said.

Minnesota state Rep. Drew Roach announced Aug. 30 that he will introduce legislation to repeal the state’s restrictions on therapists, saying the law “silences therapists, denies patients real options and imposes one political ideology on deeply personal medical decisions,” according to an opinion piece published by medical director Dr. Kurt Miceli of the advocacy group Do No Harm in the New York Post. Miceli and other critics say the laws prevent clinicians from offering patients a full range of therapeutic approaches, particularly to minors who are questioning their gender identity.

The debate pits proponents of the restrictions, who say the measures protect children from coercive practices and medical interventions, against opponents who argue the laws are overly broad and deprive vulnerable young people of exploratory talk therapy. At least one national civil liberties challenge and an impending Supreme Court hearing have elevated the issue to the federal level.

Supporters of the bans generally frame them as prohibitions on so-called conversion therapy — practices aimed at changing a person’s sexual orientation or gender identity — which many professional medical organizations oppose. Opponents, including some therapists and conservative advocacy organizations, say the statutes in some states extend beyond practices designed to force a change and instead bar clinicians from discussing or supporting a patient’s choice to accept their biological sex.

Do No Harm’s Miceli wrote that the Minnesota shooter identified as transgender and that his suicide note referenced depression and being “tired of being trans.” The op-ed argued that although Minnesota’s law took effect after the attacker became a young adult and therefore did not prevent him from seeking therapy, other minors in the state can now be barred from talking with therapists about their discomfort with identifying as transgender. The New York Post published Miceli’s column on Sept. 12.

Advocates on both sides have cited research and statistics to support competing policy claims. Miceli and others cited studies they say show high rates of anxiety and depression among young people who identify as transgender and contend that a majority of children who express gender-nonconforming feelings later come to identify with their natal sex. Supporters of the restrictions cite medical and mental health organizations that warn against practices intended to change a person’s gender identity and urge caution around medical interventions such as hormones and surgeries for minors.

Therapists and professional groups say the laws have had a chilling effect in some states. The New York Post opinion and the advocacy group Do No Harm described cases in which clinicians were investigated by state authorities after discussing gender identity with young patients. One such case involved a licensed therapist in Oregon who the group said was investigated and subsequently stopped seeing patients who identify as transgender in order to avoid risking her license.

At the federal level, the op-ed said the Trump administration required federal health-insurance plans to cover certain counseling services that some states bar, creating a potential avenue for federally covered employees and families to access therapies that state laws restrict. It also pointed to an impending Supreme Court review: the justices are scheduled to hear a challenge to Colorado’s law on Oct. 7, according to the op-ed, brought by a licensed counselor who says the statute violates her First Amendment rights to free speech and the free exercise of religion by forbidding particular kinds of therapeutic speech with minors.

Legal scholars and civil-rights advocates said the Supreme Court case could determine how narrowly or broadly states may regulate professional speech in the counseling relationship. If the court rules that such laws impermissibly restrict clinicians’ speech, it could affect statutes in multiple states. If the court upholds the laws, states will retain broader authority to set professional standards and prohibitions intended to protect minors, supporters said.

The issue has prompted sharp comment from elected officials and local leaders. In Minneapolis, the mayor publicly criticized some public commentary tying the shooter’s identity to the attack, saying such remarks amounted to attacks on the transgender community. Critics of that response argue that asking whether different therapeutic options might have helped troubled young people is a matter of public-health concern rather than a political attack.

The disagreement over therapy restrictions reflects a broader national controversy about the appropriate role of mental-health professionals, the rights of parents and minors, and state authority to regulate care. Advocates who favor repeal contend that allowing therapists to engage in conversations aimed at helping patients explore and, if appropriate, accept their biological sex is a compassionate, noncoercive therapeutic approach used in countries such as England, Sweden and Finland, as cited by critics of the bans. Those who support the laws counter that safeguards are needed to prevent harm from irreversible medical interventions and that prohibiting efforts to push young people toward a different identity or medicalization is a necessary protection.

Policy analysts said statutes vary widely across states, and some measures explicitly exclude certain types of gender-affirming care from prohibitions on conversion therapy. The patchwork of laws and the potential for federal review mean the legal landscape for clinicians, patients and families could change significantly in the coming months.

The issue remains politically charged and legally unsettled, with advocates on both sides saying their positions are rooted in concern for young people’s well-being. Dr. Miceli and other repeal supporters have urged legislators to restore what they describe as clinicians’ ability to discuss a full range of options with minors, while proponents of the restrictions say limiting certain therapeutic approaches is necessary to protect children from practices considered harmful by many medical authorities.

As the Supreme Court case approaches and state legislatures consider revisions, therapists, parents and advocacy groups on both sides are preparing for further legal and political battles over how mental-health care for gender-questioning youth should be regulated and delivered.