Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Realist Methodology
2.2. Realist Causation
2.3. Young People’s Involvement
2.4. Ethics
2.5. Sample Recruitment and Demographics
2.6. Data Collection
2.7. Data Analysis
3. Results
3.1. Programme Theory
3.2. Context Factors
3.2.1. Whole School Approach
“We had LGBTQ displays, maybe one pride assembly a year, and an LGBTQ club, but little to none of it helped with understanding, much [of] those displays only really felt like they were doing it to help their image, instead of just doing it out of pure support and the support groups, since the location was plastered around, the homophobic guys tended to lurk near the room and just point and laugh, really.”(LGBTQ+ young person)
3.2.2. Collaborative Leadership
“I went to the Head, and I said “look, this is something that I want to do a lot more of in school in terms of this” and she just gave me absolute carte blanche which has been brilliant. […] I think the really, really strong thing is that there’s one person that leads it. It’s like that go to.”(School Staff)
3.2.3. Intersectionality
“I need celebrity representation of LGBT people from BME faith communities to make me feel empowered. My community and culture is part of my identity—I have not lost that.”(LGBTQ+ young person)
“We know that LGBTQ young people have experienced poorer mental health than their non-LGBTQ peers, but that is more so for those who access free school meals, for those who are Black, for those who are disabled. It is suggested that the multiple experiences of isolation and knowing that the world is still a place that discriminates, then when the world is changing through stuff like COVID, the fear must be magnified, mustn’t it? So, I think doubly impacted by isolation plus anxiety about the state of the world.”(Intervention Practitioner)
3.2.4. Legal, Policy, Economic and Discursive Factors
“COVID has seen that actually schools haven’t prioritised these spaces, so therefore actually now we don’t really have focus on HBT bullying and or equally necessarily a commitment to creating LGBTQ+ safe spaces. Actually, it feels like regression, in that sense.”(Intervention Practitioner)
“Some of the responses that we have seen, in the last two years, I guess, to trans inclusive initiatives have been reminiscent of the run up to Section 28 back in 1988, absolutely. And so I think the fear of some kind of replies from parents or the community is greater than what actually does happen when they actually do something.”(Intervention Practitioner)
3.2.5. Causal Pathway 1: Interventions That Promote LGBTQ+ Visibility
3.2.6. Causal Pathway 2: Interventions for Talking and Support
“I need to speak to someone like a teacher. Who can understand me and offer support. My mates in school I would not speak to as they can judge quickly. Signposting is good but if you’re in a bad place it’s too much Information. Counselling would be good but guided and supported. It hard being yourself, I come from a religious family and my community does not accept of LGBT equality at all. I think mentally the struggles can be hard no doubt.”
3.2.7. Causal Pathway 3: Interventions That Change Institutional School Culture
“Inclusion policies is very important, having policies that consider is a long-term strategy [...] the LGBTQ+ people in the school won’t feel shy/alone in the school. We would feel recognized and even empowered. Issues like bullying won’t happen anymore.”(LGBTQ+ young person)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Classification | Young People (N = 10) | Intervention Practitioners (N = 9) | School Staff (N = 3) |
---|---|---|---|---|
Age | 13–16 | 4 | - | - |
17–18 | 6 | - | - | |
21–30 | - | 1 | 2 | |
31–40 | - | 5 | - | |
41–50 | - | 2 | 1 | |
51–60 | - | 1 | - | |
Gender | Male | 5 | 3 | - |
Female | 1 | 4 | 2 | |
Non-binary | 3 | 1 | 1 | |
Other | 1 | 1 | - | |
Are you trans? | Yes | 4 | 2 | - |
No | 4 | 7 | 3 | |
Unsure | 2 | - | - | |
Ethnicity | English/Welsh/Scottish/Northern Irish/British | 7 | 7 | 2 |
White (Other) | - | 1 | - | |
European | - | 1 | - | |
African | 2 | - | - | |
Pakistani | 1 | - | - | |
Jewish European | - | - | 1 | |
Sexual orientation | Lesbian | 2 | - | 1 |
Bisexual | 3 | 1 | - | |
Gay | 3 | 3 | - | |
Pansexual | 1 | - | - | |
Queer | - | 3 | 1 | |
Heterosexual | - | 1 | 1 | |
Other | 1 | 1 | - | |
Education level | No qualifications | 4 | - | - |
GCSE | 4 | - | - | |
AS Levels | 1 | - | - | |
A Levels | 1 | - | - | |
First Degree | - | 6 | 2 | |
Higher Degree | - | 3 | 1 | |
Occupation | Student | 8 | - | - |
Unemployed | 2 | - | - | |
Full-time Employment | - | 6 | 2 | |
Part-time Employment | - | 3 | 1 | |
Do you have a disability? | No | 7 | 6 | 2 |
Yes | 3 | 3 | 1 |
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McDermott, E.; Kaley, A.; Kaner, E.; Limmer, M.; McGovern, R.; McNulty, F.; Nelson, R.; Geijer-Simpson, E.; Spencer, L. Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach. Int. J. Environ. Res. Public Health 2023, 20, 4274. https://doi.org/10.3390/ijerph20054274
McDermott E, Kaley A, Kaner E, Limmer M, McGovern R, McNulty F, Nelson R, Geijer-Simpson E, Spencer L. Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach. International Journal of Environmental Research and Public Health. 2023; 20(5):4274. https://doi.org/10.3390/ijerph20054274
Chicago/Turabian StyleMcDermott, Elizabeth, Alex Kaley, Eileen Kaner, Mark Limmer, Ruth McGovern, Felix McNulty, Rosie Nelson, Emma Geijer-Simpson, and Liam Spencer. 2023. "Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach" International Journal of Environmental Research and Public Health 20, no. 5: 4274. https://doi.org/10.3390/ijerph20054274