By Liam Spencer, Research Assistant and ARC NENC Mental Health Research Fellow, Newcastle University
Young people who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) experience significant mental health inequalities in comparison with their cisgender heterosexual peers (Fish, 2020). The school environment (or climate) is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people (Mackie, Lambert & Patlamazoglou, 2021; Poteat et al., 2021; Peter, Taylor & Campbell, 2016). The 2016 UN Convention for the Rights of Child Committee on the implementation of child rights during adolescence specifically emphasised the way that nation states should take effective action to protect LGBTQ+ young people from all forms of violence, discrimination or bullying, and to improve mental health (UN, 2016).
Funded as part of the SPHR Public Mental Health programme, the Creating LGBTQ+ Affirming School Environments (CLASS) research project, led by Professor Liz McDermott, aimed to investigate the mental health impact on LGBTQ+ young people of school-based interventions. In the first stage of our study, we undertook a realist review (a theory-driven approach) of published evidence, and identified positive interventions that supported LGBTQ+ mental health in school environments, however the focus tended to be upon outcomes and studies rarely detailed underlying mechanistic processes.
Realist enquiry aims to open the ‘black box’ of interventions, by unearthing the mechanisms (causal processes) which are triggered by particular contexts, in order to produce outcomes (Jagosh, 2019). We undertook realist interviews with 10 young people aged between 13 and 18 years, 9 intervention practitioners, and 3 members of school staff, and employed a realist retroductive data analysis strategy to identify causal pathways across different interventions that improved mental health outcomes. A retroductive approach employs both inductive; drawing conclusions from the specific to the general, and deductive reasoning; drawing conclusions from the general to the specific (Gilmore et al, 2019). We used this information to develop a programme theory model that aimed to explain how, why, for whom, and in what context school-based interventions can prevent or reduce mental health problems in LGBTQ+ young people, in collaboration with key stakeholders.
Our programme theory model (diagram above) has three levels of mechanisms to capture the multiple causal pathways at which interventions may work, on psychological, behavioural, emotional, cultural, and social levels. Our model includes contextual factors (context – red ring) that were crucial to the success of the interventions, and we aimed to make explicit and theorise how intervention resources (mechanism 1 – orange ring) makes possible opportunities for change (mechanism 2 – green ring), and how it changes (mechanism 3 – blue ring) in terms of individual cognitive processes, which can lead to improved mental health (outcome – purple centre).
Our programme theory explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. We found that contextual factors such as a ‘whole-school approach’ and ‘collaborative leadership’ were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health:
- Interventions that promote LGBTQ+ visibility and facilitate usualising (acclimatising people to the presence of LGBTQ+ identities), school belonging, and recognition
- Interventions for talking and support that develop safety and coping
- Interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety.
Our findings suggest that providing a school environment that affirms and usualises LGBTQ+ identities, and that promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils. The causal pathways we present are a starting point as theories, however more research to develop our understanding of how school interventions work to improve school climate and the mental health of LGBTQ+ young people is required. We now need the UK, and other countries, to take seriously LGBTQ+ young people’s rights and ensure they are afforded equal respect and protection as their peers in schools. We may then find that the mental health of LGBTQ+ young people improves.
Find out more about this research project – watch from 4.52