Professionals working with LGBT Youth: A Twelve-Step Programme

Without support, LGBT young people are more likely to have mental health problems, misuse alcohol and drugs, experience homelessness, and continue risky sexual behaviour. How can we reduce this risk and help them develop resilience?

First read all the twelve steps then, if needed, click on underlined links for further information - this may take the form of a document, video or power point presentation.

Step 1. Acknowledge Vulnerabilities

We must first acknowledge these vulnerabilities and identify the risk factors. The attached paper, "Vulnerabilities" identifies the risk factors.

Step 2. Acknowledge Damaging Services

Next, we must acknowledge that some services, historically, made the situation facing LGBT young people worse; and some still do! The attached paper, "Damaging Services" gives REAL examples of how, in the recent past, agencies have harmed rather than helped young LGBT people. To understand the potential effects of services who are ignorant of the needs of young LGBT people, have a look at Julie's Story.

Step 3. Access Training

It is hardly surprising that most agencies do not meet the needs of LGBT young people because most professional training courses do not look at the needs of this group or how to respond to their needs. And only a few services have provided relevant in-service training - see Training Needs Assessments for evidence.

Here is a link to Supporting LGBT Young People in Education. This is a short on-line training course GALYIC developed. It can be used individually or with a group. It outlines the responsibilities of public services under the Public Sector Equality Duty and shows how other agencies can work in partnership with LGBT youth groups to meet the needs of young LGBT people.

Free Awareness Training on YouTube

Click here to access free, in-depth, homophobia awareness training. Session 5 looks specifically at the Effects of Homophobia on Services

Gender Variant Children and Adolescents
Click here to access GIRES.

Step 4. Inclusion in Strategies/Research

Historically national strategies and policies have not identified LGBT young people as vulnerable. It is, therefore, not surprising that local strategies and policies exclude them. This is partly because mainstream research rarely includes sexual orientation or gender identity and, therefore, LGBT young people remain invisible and their significant vulnerabilities are missed.

However, things are beginning to change; some strategies now acknowledge these vulnerabilities. For example, the government's 2010 drug strategy recommends targetted services are developed to meet the needs of LGB people.

Similarly, the government's mental health strategy not only includes LGB people but identifies LGB youth as one of eight vulnerable groups and states, "it is important to target children and young people at particular risk of developing mental health problems."

The Preventing suicide in England - a cross-government outcomes strategy to save lives highlights LGBT people as vulnerable and suggests mental health services are tailored to meeting the specific needs of this group. The strategy refers specifically to the PACE document Where to Turn?. This report highlights the work of Gay and Lesbian Youth in Calderdale, and in particular use of the Needs Assessment Tool, as an example of good practice.

Here is a link to a power point presentation on "Suicide Prevention Strategy and LGBTs."

In the House of Commons Health Committee's report, Children's and adolescent's mental health and CAMHS report published 5th November 2014, LGBT young people are mentioned as a vulnerable group (pages 12, 46, 51, 100 and reference is made to submissions by Jan Bridget and Metro.

The recommendations are that the new Department of Health/NHS England taskforce, whose task is to overhaul the way CAMHS is commissioned and to ensure young people are offered the most appropriate care both in the community and hospital, "takes full account of the submissions we have received, and the wealth of information they contain." This is specifically mentioned with regard to vulnerable groups.

It remains to be seen whether this taskforce, which does not appear to have representation from a specialist LGBT expert, will take on board the issues raised in the two submissions.

The Royal College of Nursing, in conjunction with Public Health England, have published two toolkits on preventing suicide amongst LGBT young people; one is about lesbian, gay and bisexual young people the other about trans young people

For the first time sexual orientation has been included in mainstream research on young people: What About YOUth? The WAY survey includes 120,000 15 year olds in England. The aim is to create a regular survey to collect local authority data on a range of different health behaviours of 15 year olds. It was commissioned by the Department of Health after the Children and Young People's Health Outcomes Forum highlighted gaps in the Public Health Outcomes Framework for young people. Unfortunately, the data visualisation tool (which included the findings on lesbian, gay and bisexual youth) is no longer available (surprise, surprise) but if you click here and scroll down to Health Behaviours in Young People - What About Youth? you will find the key points relating to LGB young people.

The Department of Health funded Queer Futures, a two-year research project designed to understand the experiences and perspectives of young LGBTQ people (16-25) to help reduce the risk of self-harm and suicide; the findings are now published: Full Report and Summary Report.

Mental health services were in the main found to be unhelpful.

The conclusion of this study is that in order to develop effective public health policy to prevent suicide in LGBT young people, the social factors that heighten risk need to be addressed. As a priority this would entail:

• Tackling homophobic, biphobic or transphobic abuse in schools
• Addressing and challenging the continuing sexual and gender norms which marginalise those who are not heterosexual and cisgender
• Providing support and space for LGBT youth to talk about their emotional lives in a safe and non-judgemental environment.

Key policy areas to focus upon are:

• Schools and education
• The role of the online forums and social media
• LGBT youth provision

As a priority mental health support and services for this vulnerable group need to be improved, this would entail:

• Mental health support and services provided outside the clinical environment.
• NHS mental health services developed so they are more appropriate for this at-risk population group.
• Gender identity services developed so they are more appropriate for this at-risk population group.

Key policy areas to focus upon:

• Online mental health support
• LGBT specific mental health support
• Mental health and gender identity (NHS) services

The National LGBandT Partnership published a report in June 2017 entitled, The Mental Health of Young LGBandT People.

Step 5. Inclusion in Monitoring

Very few children and young people's services include sexual orientation or gender identity within their monitoring procedures. They do not know, therefore, how many LGBT young people are accessing their services. This simply perpetuates their invisibility. However, under new equality legislation (and their mental health strategy) government are encouraging agencies to include sexual orientation and gender identity in their monitoring procedures.

Barnardo's now include sexuality in their monitoring form (e.g. which of the following best describes you: heterosexual (straight), gay, lesbian, bisexual, rather not say? They complete the monitoring form with the young person as soon as they access the service. Clearly, if a parent is present the young person is unlikely to admit to being gay. Here is a short, two-hour, training session adapted from a Barnardo's training programme, which looks at why we monitor and asks participants to identify and discuss their fears about including sexuality.

If you would prefer a less direct way of asking, here are some suggestions from Angela Hodgson, a Psychosexual Health Counsellor, who explains how to "Ask 'the Question', but don't Ask the Question."

Step 6. Introduce Targetted Services

Even if mainstream services tackle the homophobia of its users (and staff) and make concerted efforts to be LGBT-friendly there will still be a need to develop specific services which target the needs of LGBT young people. For example, LGBT youth support groups, and specialist workers or projects in housing, mental health, substance misuse, and family services.

This is not a difficult concept to understand given that, historically, agencies have provided specialist services to meet the needs of, e.g. black and minority ethnic young people; disabled young people; young women; young carers; etc.

Ask yourself, Why is there a need for a service which specifically targets young carers? Then ask yourself whether the answer to this question is not the same answer as to why there is a need for specialist services for minority groups, including LGBT young people.

The problem is partly that mainstream/generic services (one size fits all) rarely cater for the specific needs of minority groups and partly that minority groups need to come together to tackle isolation and provide peer support, acceptance and understanding, as well as accessing positive role models.

The other, more obvious, reason for targetted groups/space for LGBT young people is that in order to form meaningful relationships and experience a 'normal' adolescence, they need to meet other LGBT young people!

Another, more poignant, reason is that, unlike other minority groups, many LGBT young people do not have the support of their families!

Visit the Old Services section to see the range of projects and support GALYIC used to offer. Here are examples of other, specialist, services for LGBT young people, some are within LGBT specific agencies like Stonewall (housing), some are specifically for young LGBT people like the Albert Kennedy Trust (family services), whilst others are projects within specialist services such as Inside Out at 42nd Street (mental health).

Step 7. Assessing Needs

Few children and young people's services include sexual orientation or gender identity in their assessment procedures.

Even if staff are aware of some of the needs of this group, if the sexual orientation or gender identity of users is not included in the needs assessment process, how can services respond appropriately?

LGBT young people have the same needs as heterosexual youth but they also have specific needs over and above the needs of young people in general.

GALYIC developed a specialist, comprehensive, Needs Assessment Tool and a follow-up Impact Assessment Tool. This is now available on-line; click here. It was identified by PACE as an example of good practice.

Step 8. Coming Out

Because many LGBT young people have experienced homophobia, either at school or on the streets or in the home, they are unlikely to attend mainstream services for fear of experiencing homophobic abuse from either other users or staff. Or if they do access services, they are rarely out about their sexual orientation/gender identity. Again their invisibility is perpetuated, and their needs go unmet.

Once your agency has undergone training, includes sexual orientation and gender identity in the monitoring and assessment processes and has begun to provide services that can meet the specific needs of LGBT young people it is important that you 'come out' to LGBT young people. You can do this by publicising that your agency is LGBT-friendly and you are working towards delivering services that will meet their needs.

Of course, you need to ensure you use inclusive language and your resources are inclusive of the needs of LGBT young people. If you are not consistent in your approach it is unlikely that LGBT young people will trust you.

Step 9. Reducing Vulnerabilities

GALYIC proved that by providing targeted services which met the specific needs of LGBT young people their vulnerabilities could be significantly reduced, especially with regards to mental health.

But other agencies also need to play their part. The attached "Pathways to A & E" identifies the triggers, the role of agencies, and what agencies need to do to help reduce admissions to A & E.

GALYIC and Calderdale produced "10 Ways to Support LGBT Young People in Education," aimed at teachers but the advice is just as relevant to others who work with young people.

Families also have a huge part to play in reducing the vulnerabilities LGBT young people face and agencies can significantly help families to accept and understand their children. For more information see Parents webpage.

Step 10. Legal Requirements

The Equality Act became law in October 2010; it brings together six equality strands: race, gender, disability, age, sexual orientation, religion and belief.

The Public Sector Equality Duty was introduced in April 2011. For the first time, all public services should, by law, proactively:

• tackle homophobia
• ensure they are meeting the needs of LGBT young people

• include sexual orientation and gender identity within their monitoring procedures

• include sexual orientation and gender identity within their assessment procedures.

Step 11. Prioritise

Local authorities and services need to prioritise their equalities work.

Laws to challenge racism, sexism and disableism have existed for several years now whereas anti-discrimination legislation for sexual orientation and gender identity are relatively new.

The Equality and Human Rights Commission published a series of reports in October 2010 including "Equality and human rights in schools."

This included the findings of a survey with 1,700 secondary school teachers in England. Teachers identify LGBT young people as

• the group which are most bullied;
• the group which are least supported; and
• the group for which schools do least work to promote respect for.

The gap between LGBT young people and those who belong to the other equality strands is significant and shows that there is a lot of catching up to be done.

Step 12. Positive Actions

Here is a link to a presentation which identifies the key ten issues facing LGBT young people and the key ten positive actions that need to be taken to address their vulnerabilies.