Authors' objectives: Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people’s access to, navigation of, and engagement with mental health support. Lesbian, gay, bisexual, trans, queer/questioning, plus (LGBTQ+) young people report significantly higher rates of depression, self-harm, suicidality, and poor mental health than cisgender and heterosexual youth. Despite this mental health inequality, LGBTQ+ young people have elevated unmet mental health needs compared to their cis-heterosexual peers and underuse mental health services. In addition to the underutilisation of mental health services, studies suggest LGBTQ+ youth have poor overall experience of mental health services and school-based support. Problems highlighted are the limited staff understanding of LGBTQ+ issues and minority stresses, fear of being ‘outed’ and exclusion from the decisions made about their care. The UK evidence base examining LGBTQ+ young people’s early intervention mental health support needs and services is very limited. Consequently (and despite this manifest inequality and underutilisation of mental health services), there is no UK research on how to develop appropriate mental health early intervention and supported self-care provision to this vulnerable group. This study delivers rigorous evidence to fill this gap, address this inequality and fulfil the requirements of NHS mental health strategic direction. To produce a synthesis of the evidence on mental health early intervention services and self-care support to LGBTQ+ young people. To identify service models for mental health early intervention and supported self-care which are accessible and acceptable to LGBTQ+ young people. To develop a programme theory of how, why and in what context mental health early intervention services and self-care support work for LGBTQ+ young people. To increase understanding of LGBTQ+ young people’s access to and navigation of formal and informal mental health early intervention services and self-care support. To generate commissioning guidance (including service costs) on mental health early intervention and supported self-care services for LGBTQ+ young people.

Authors' results and conclusions: Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus 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. 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. In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people’s mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. Stage 1 In total, 2951 titles and abstracts were screened, and 200 full papers reviewed. Eighty-eight studies were included in the final review. Stage 1 synthesis identified three meta-narratives: psychological, psychosocial and social/youth work. Stage 2 synthesis resulted in a non-pathological theoretical framework for mental health support that acknowledged the intersectional aspects of LGBTQ+ youth lives and placed youth at the centre of their own mental health care. The study of LGBTQ+ youth mental health has largely occurred independently across a range of disciplines such as psychology, sociology, public health, social work and youth studies. The interdisciplinary theoretical framework produced indicates that effective early intervention mental health support for LGBTQ+ youth must prioritise addressing normative environments that marginalises youth, LGBTQ+ identities and mental health problems. In the UK, a rights-based approach to mental health service provision is not prominent or mainstream. There is very little evidence that young people’s rights are of concern in the realm of mental health services. Research suggests that current practice in CAMHS in the UK highlights some disparities in services which result in questions about human rights for young people. Key concerns have been identified around children’s rights to access mental health services, information, participation in decision-making and non-discrimination of vulnerable groups suggesting current practice approaches fall short of a rights-based framework. In addition, at the time of this report being written, LGBTQ+ young people are facing active legislative and policy attacks on their human rights. Legislative attacks have placed young people’s access to gender-affirming health care at risk. Within this uncertain landscape, it is more important than ever to centre and uphold children and young people’s human rights in mental health services and support. This study provides the first large-scale theory-led evaluation of early intervention mental health support for LGBTQ+ young people with common mental health problems. The resulting intersectional, youth-rights model directly provides the means to tackle the elevated prevalence of mental health problems in this group of young people. It provides evidence on ways of improving access to, navigation of, and engagement with mental health support, to improve LGBTQ+ young people’s mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for LGBTQ+ young people with mental health problems is required.

Authors' methods: This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. This research project was a multi-methods theory-led case study evaluation with three distinct stages. Stage 1: meta-narrative review This was a systematic review of existing literature concerning early mental health interventions and self-care support for LGBTQ+ young people. The meta-narrative review on mental health early intervention support for LGBTQ+ youth aimed to develop a theoretical framework to explain effective mental health support. Using the RAMESES standards for meta-narrative reviews, we identified studies from database searches and citation-tracking. Two research team members applied the inclusion/exclusion criteria and quality assessment tool. Data extraction and synthesis were conducted through conceptual coding in Atlas.ti in two stages: (1) conceptual mapping of the meta-narratives and (2) comparing the key concepts across the meta-narratives to produce a theoretical framework.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/17/09/04

Year Published: 2024

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/KYWA6382

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: United Kingdom

DOI: 10.3310/KYWA6382

Organisation Name: NIHR Health and Social Care Delivery Program

Contact Name: Rhiannon Miller

Contact Email: rhiannon.m@prepress-projects.co.uk