LGBT youth missing out on support
According to a Department of Health-funded study young LGBT people are at increased risk of self-harm and suicide. The Queer Futures project has also revealed that mental health professionals lack access to the training they need to support these young people.
Research reveals that mental health workers feel poorly prepared to deal with young LGBT people with problems
Many young lesbian, gay, bisexual and trans people are in need of mental health support. This cohort has higher rates of mental health problems, self-harm and suicide than their heterosexual counterparts, so it is vital that they can access the care they need.
But a new study has found that mental health staff feel they have inadequate training and skills to help them support LGBT youths. The data from around 100 members of staff is part of a research project called Queer Futures, which is exploring LGBT youth self-harm, suicidal feelings and help seeking.
Almost 800 young people aged 16 to 25 took part in the Lancaster University study, the vast majority of whom identified as lesbian, gay, bisexual, trans, queer, questioning or unsure. The first phase of the Department of Health-funded project, due for publication in March, found that 89% of participants had self-harmed, 98% had experienced suicidal thoughts and almost 60% had attempted suicide.
Senior lecturer in health research and lead researcher Elizabeth McDermott says it is encouraging that the mental health staff who participated in the study had a good level of knowledge about LGBT youth and self-harm and suicide. The majority believed that LGBT youth experienced more emotional distress because they felt isolated by their sexual orientation and gender identity.
But respondents also felt poorly prepared when these young people came to them for help. Half of the participants did not believe they had access to adequate or appropriate skills training. Almost half did not feel that they had adequate support and supervision from their organisation.
Dr McDermott also points out that staff who responded to the survey may be more interested in LGBT issues, and therefore be more likely to understand the issues and have accessed training than some of their colleagues.
‘It was clear those with training felt more confident and had also identified that this was important to them and part of providing a good service. Staff wanted the training and the subsequent effect it had on developing an appropriate and sensitive service.’
The study found that overall only one fifth of young LGBT people with mental health problems had contacted mental health services, and only half of those had found the service useful. A complex tangle of emotions prevented young people seeking professional help, including feelings of fear and shame both about their sexual orientation and gender identity, and about their mental health problems.
‘There is a perception that young people only think about themselves, but the research shows that they are concerned about the impact their mental health problems, sexual orientation and gender identity could have on their families,’ Dr McDermott says.
‘There is a perception that young people only think about themselves’
Dr Elizabeth McDermott
In particular, young people wanted to access specialist LGBT mental health services, but these are rare. While there are pockets of good outreach mental health services, with staff based in youth centres and non-clinical environments, they tend to be based in large cities and are often provided by charities.
Children and young adult mental health services did not come out well from the qualitative data, Dr McDermott says. Young people often talked about the importance of ‘connecting’ with the practitioner. ‘They wanted to feel that their practitioner had empathy, knowledge and understanding of sexuality and gender identity, but this often was not the case.
‘They felt that the practitioner focused on self-harm and suicidal thoughts, and not the wider underlying causes of their distress. They felt pathologised, that everything was about their “craziness”, and not about the fact that they were struggling with their sexuality,’ says Dr McDermott.
It is not an easy task for a mental health nurse to build a trusting relationship, she adds. ‘Often by the time a young person reaches mental health services, they are very closed down.’
When asked about the best way to engage LGBT youth in services, the largest proportion of the study sample chose ‘mandatory awareness training for staff’. The Queer Futures project is hoping to produce online training for mental health nurses in the next phase of the project. In the meantime, Dr McDermott says a toolkit produced by Public Health England and the RCN, Preventing Suicide Among Lesbian, Gay and Bisexual Young People, provides useful guidance (see
Questions you can ask young people about sexuality and mental health
- Some of my young patients are exploring new relationships. Do you have an interest in anyone? Are you dating or seeing anyone?
- Are you attracted to men, women, both or none?
- What do you do when you feel stressed or overwhelmed?
- Do you ever feel very sad, tearful, bored, disconnected, depressed or blue?
- Have you ever felt so sad that you feel life isn’t worth living? Do you think about hurting or killing yourself?
- Have you ever tried to hurt or kill yourself?
RCN mental health adviser Ian Hulatt says that while it is important that mental health staff understand LGBT issues, accessing training on any issue is increasingly difficult.
The state of mental health services for LGBT patients was discussed at last year’s RCN congress and delegates backed a resolution calling for improvements. ‘Improving LGBT mental health services is a big agenda that we are helping our members with,’ says Mr Hulatt.