Using a youth rights approach to improve LGBTQ+ young people’s mental health

The consensus from the UN, UNICEF and the WHO is that there is a fundamental relationship between human rights and mental health.  Importantly, the UN has recognised that young people are often forgotten in the human rights framework and specific approaches should be used to ensure their rights are upheld because they differ significantly from those of younger children. They advocate that the most effective human-rights approach to young people’s mental health care should be based on public health and psychosocial support rather than overmedicalization and institutionalization.

The UN also recognise that LGBTQ+ young people and ethnic minority/indigenous young people commonly face difficulties because their age and identities that can expose them to discrimination, social exclusion, marginalization, bullying and social injustice. This increases their vulnerability to poverty, mental health issues, including disproportionately high suicide rates, homelessness, poor educational outcomes and high levels of detention within the criminal justice system.

 

What is the problem?

There is now a large amount of international evidence that LGBTQ+ young people report significantly higher rates of depression, self-harm, suicidality, and poor mental health than cisgender and heterosexual youth, that they underuse mental health services and they have difficulties accessing appropriate mental health support. Unfortunately there is very little research on how to support LGBTQ+ young people’s mental health effectively, and globally, governments have done little in terms of policy or practice to address this mental health inequality. There are three key problems that need to be addressed by nation states/governments and mental health systems to address LGBTQ+ young people’s mental health, these are: 

  1. LGBTQ+ young people have poor mental health outcomes and marginalisation, isolation and hopelessness are major factors that contribute to this inequity

  2. LGBTQ+ young people underuse mental health services due to a lack of trust in services, fear of being judged, and past experiences of discrimination

  3. LGBTQ+ young people have poor experiences when using mental health services, including that being LGBTQ+ may be dismissed or treated like a ‘problem’, direct discrimination, and having to educate those providing them with support about the needs of LGBTQ+ young people

 

What works best to improve LGBTQ+ young people’s mental health?

In the Queer Futures 2 study https://queerfutures2.co.uk  we aimed to produce a model of what works for early intervention mental health support for LGBTQ+ young people and increase understanding of LGBTQ+ young people’s access to, navigation of, and engagement with mental health support.

We found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for LGBTQ+ young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation, and stigmatisation that LGBTQ+ young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld.

An intersectional approach to mental health provision is important because LGBTQ+ young people can experience multiple forms of discrimination and marginalisation. Across the research, experiences related to age, different LGBTQ+ identities, chronic illness, disabilities, racism and colourism, neurodiversity, homelessness and poverty, and being in the care system were relevant to the type of support LGBTQ+ young people needed.

 

Queer Futures 2 Study for ‘What works?’

Figure: The Queer Futures 2 Study

The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. These principles of support are designed to guide mental health services/policy in a variety of setting – education, clinical, community – and can be operationalised in a number of ways. Our model of mental health support aims:

  • To reduce poor mental health for LGBTQ+ young people through developing services that support connectedness, self-expression and hope for the future on young people’s own terms 

  • To increase access to mental health services for LGBTQ+ young people by ensuring services are safe, knowledgeable and affirming, and that fit into LGBTQ+ young people’s lives.

  • To improve LGBTQ+ young people’s experiences of using mental health services by ensuring that young people feel ownership of support spaces and can trust the people providing support. Services should support LGBTQ+ people’s informed decision making and centre their feelings rather than focus on diagnosis when offering support.

 

What is needed now?

In the UK, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, LGBTQ+ young people are facing active legislative and policy attacks on their human rights. This study provides the first large scale evaluation of early intervention mental health support for LGBTQ+ young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence for practice and policy on ways of improving LGBTQ+ young people’s mental health. We now need governments and states across the world to take action to tackle this inequity.

 

Resources

This post was contributed by Professor Liz McDermott: e.mcdermott.1@bham.ac.uk

Creating using evidence, Policy and governance, AccessibilityPower to Persuademental health, young people, co, Commissioning