latrobe.edu.au CRICOS Provider 00115M
The health and wellbeing of same-sex
attracted and gender diverse young
people
Willi...
2La Trobe University
• Introducing the framework
 Risk factors and triggers
• Rates and patterns of SSAGD youth mental
il...
3La Trobe University
Introducing the framework
4La Trobe University
Heterosexism or the wedding
cake model
Gay/Lesbian/Bisexual
Transgender
Intersex
Leonard, W. (2005) “...
5La Trobe University
• Systemic discrimination and harassment,
including:
 Social stigma
 Rejection by family, friends a...
6La Trobe University
Additional social factors that can contribute
to experiences of discrimination or abuse
• Sex/gender
...
7La Trobe University
Heterosexism
Other determinants
Risk factors &
triggers
Violence &
discrimination
Social isolation &
...
8La Trobe University
Risk factors and triggers
9La Trobe University
1. Violence and discrimination
2. Social isolation and exclusion
3. Reduced self-esteem
4. Coming out...
10La Trobe University
• In Victoria, one in seven GLBT people report living in
fear of heterosexist violence*
• In Queensl...
11La Trobe University
• Sixty-four per cent of SSAGD young Australians
report homophobic verbal abuse and 18 per
cent homo...
12La Trobe University
2. Social isolation and exclusion
• 44% of GLBT Australians aged 16-89 year olds
usually or occasion...
13La Trobe University
Social isolation and exclusion cont.
• US national survey reports much higher levels of
unemployment...
14La Trobe University
3. Reduced self-esteem
• Feelings of social worthlessness
• Guilt and shame – high risk groups
 Mem...
15La Trobe University
Shame, loss of face, respect…I would be much more out
if I didn’t have my…if my parents were dead…if...
16La Trobe University
Reduced self-esteem cont.
Increased risk of:
• Self-harm and suicide
• Body image issues
 Gay men –...
17La Trobe University
Reduced self-esteem cont.
• Issues relating to sexual and physical
intimacy
 Few positive environme...
18La Trobe University
4. Coming out and disclosure
• Coming out is never a once only event
• GLBT people have to decide wh...
19La Trobe University
Coming out and disclosure cont.
Coming out is a stressful time for SSAGQ
people
• Since 1998, rates ...
20La Trobe University
Coming out and disclosure cont.
Coming out can trigger a range of mental health
problems
• For SSAGD...
21La Trobe University
Coming out and disclosure cont.
Coming out can trigger a range of mental health
problems
• For SSAGD...
22La Trobe University
5. Relationship stress and breakdown
Intimate relationships
• Limited symbolic or public recognition...
23La Trobe University
Family relationships
• GLBT parents must consider the effects of being out
on their own and their ch...
24La Trobe University
6. Drug and alcohol misuse
• Research shows a link between drug and alcohol
misuse and increased ris...
25La Trobe University
• Research suggests two underlying causes
for increased rates of drug and alcohol
misuse among GLBT ...
26La Trobe University
Relationship b/w heterosexist abuse and drug &
alcohol misuse among SSAGD young people
Writing Thems...
27La Trobe University
That made me feel like I was evil and
there was something wrong so I started
cutting myself, pulling...
28La Trobe University
• Research shows links between mental health
problems, drug and alcohol use and sexual risk taking
a...
29La Trobe University
I would generally conduct myself in an unsafe
manner as well as doing dangerous things
such as drugs...
30La Trobe University
Rates and patterns of GLBT
mental-ill health
Mental disorders – Sexual orientation
Feeling queer and...
31La Trobe University
• 27% of gay/bisexual men, 42% of
lesbian/bisexual women, and 55% trans
people had seen a counsellor...
32La Trobe University
Age 16 to 24 years
Population High to very high
K10 scores (%)
PL2 females* 55
NHS females** 18
PL2 ...
33La Trobe University
• Rates of suicide amongst GLBT people are between 3.5%
and 14% higher than the general population*
...
34La Trobe University
Relationship b/w homophobic abuse &
self-harm and suicide – SSAGD young people
Writing Themselves in...
35La Trobe University
Protective factors
36La Trobe University
• The WHO (2005) has identified a number of protective
factors for the onset or recurrence of mental...
37La Trobe University
• Nearly 42% of women and 26% of men in a
national study of GLBT health reported
relationships as th...
38La Trobe University
• GLBT Australians rated ‘GLBT friends’ most
highly for emotional support (73%), higher than
their b...
39La Trobe University
• Research suggests that open, supportive
cultures are protective against mental ill-
health
• SSAGD...
40La Trobe University
GLBT-inclusive health
services
41La Trobe University
Heterosexism
Other determinants
Risk factors &
triggers
Sexual risk
taking
Coming out
& disclosure
R...
42La Trobe University
1. Organisational capability
2. GLBTI cultural safety
3. Professional development
4. Consumer consul...
43La Trobe University
It is possible to object to discrimination against
LGBTI people while nonetheless continuing to
find...
44La Trobe University
45La Trobe University
46La Trobe University www.glhv.org.au
Vision
•To improve the mental health and quality of life for
SSAGD young Victorians
...
47La Trobe University
Funded partner agencies
WayOut@Cobaw Community Health
www.cobaw.vic.gov.au; www.wayout.org.au
Safe S...
48La Trobe University
Place-based projects
Headspace Bendigo, Gateway Community Health
www.headspace.org.au/headspace-cent...
49La Trobe University www.glhv.org.au
Other support services for SSAGQ young people
• Gay and Lesbian Switchboard 03 9663 ...
50La Trobe University
www.glhv.org.au
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Liam Leonard

  1. 1. latrobe.edu.au CRICOS Provider 00115M The health and wellbeing of same-sex attracted and gender diverse young people William Leonard Director GLHV and Research Fellow Australian Research Centre in Sex, Health and Society La Trobe University 27 June 2014
  2. 2. 2La Trobe University • Introducing the framework  Risk factors and triggers • Rates and patterns of SSAGD youth mental ill-health • LGBT-inclusive mental health services  The Healthy Equal Youth (HEY) Project Outline
  3. 3. 3La Trobe University Introducing the framework
  4. 4. 4La Trobe University Heterosexism or the wedding cake model Gay/Lesbian/Bisexual Transgender Intersex Leonard, W. (2005) “Queer occupations” Gay and Lesbian Issues and Psychology Review 1:3, 92-97.
  5. 5. 5La Trobe University • Systemic discrimination and harassment, including:  Social stigma  Rejection by family, friends and work colleagues • High rates of homophobic, biphobic and transphobic physical and verbal abuse Heterosexism
  6. 6. 6La Trobe University Additional social factors that can contribute to experiences of discrimination or abuse • Sex/gender • Gender identity • HIV status • Ethnic or racial background • Religious affiliation • Geographic location • Disability (intellectual, physical, sensory etc.) • Age (vulnerabilities of youth and old age) Other determinants
  7. 7. 7La Trobe University Heterosexism Other determinants Risk factors & triggers Violence & discrimination Social isolation & exclusion Reduced self- worth Coming out & disclosure Relationship stress & breakdown Drug & Alcohol misuse Sexual risk taking
  8. 8. 8La Trobe University Risk factors and triggers
  9. 9. 9La Trobe University 1. Violence and discrimination 2. Social isolation and exclusion 3. Reduced self-esteem 4. Coming out and disclosure 5. Relationship stress and breakdown 6. Drug and alcohol misuse 7. Sexual risk-taking
  10. 10. 10La Trobe University • In Victoria, one in seven GLBT people report living in fear of heterosexist violence* • In Queensland, 92 per cent of trans women and 55 per cent of trans men report verbal abuse^ • 10.3 per cent of GLBT Australians report that they have been refused employment because of their sexuality or gender identity^^ *Coming forward, 2008, **Writing Themselves In 3, 2010 ^Speaking Out, 2010, ^^Private lives, 2006 1.Violence and discrimination
  11. 11. 11La Trobe University • Sixty-four per cent of SSAGD young Australians report homophobic verbal abuse and 18 per cent homophobic physical abuse** • SSAGD young people in Australia are more likely to drop out of school than their heterosexual peers** • SSA young people are over-represented among homeless young people aged12-20 in Melbourne* • Bisexual and lesbian women are 3 to 4 times more likely to have experienced sexual coercion before the age of 16 than heterosexual women.^ Violence and discrimination cont. **Growing up Queer, 2014; * Project i, 2003; ^Sex in Australia, 2003
  12. 12. 12La Trobe University 2. Social isolation and exclusion • 44% of GLBT Australians aged 16-89 year olds usually or occasionally hid their sexuality or gender identity in public for fear of homophobic violence or abuse • 35% of 16-24 year olds usually or occasionally hid their sexuality or gender identity at home • 50% of 16-24 year olds hid their sexuality or gender identity at an educational institution Private Lives 2, 2012
  13. 13. 13La Trobe University Social isolation and exclusion cont. • US national survey reports much higher levels of unemployment for trans people* • 52% of trans people in Scottish national survey had experienced problems at work (mainly discrimination and harassment)** • Social and economic exclusion and non-acceptance can lead to a vicious cycle of under-achievement for GLB people and, in particular, trans people * Injustice at Every Turn, 2010; **Trans Mental Health Study, 2012
  14. 14. 14La Trobe University 3. Reduced self-esteem • Feelings of social worthlessness • Guilt and shame – high risk groups  Members of particular ethnic or religious groups  HIV-positive gay men  SSAGD young people
  15. 15. 15La Trobe University Shame, loss of face, respect…I would be much more out if I didn’t have my…if my parents were dead…if I didn’t have a huge extended family.* I was raised in a Christian family so I was constantly embarrassed and disgusted with myself for feeling the way I did. I was constantly told it wasn’t natural…I got depressed and became suicidal Ruth, 18 years.** *double trouble? 2010 ** Writing Themselves in 3, 2010
  16. 16. 16La Trobe University Reduced self-esteem cont. Increased risk of: • Self-harm and suicide • Body image issues  Gay men – Increased rates of body eating disorders and use of body-enhancing drugs  Transgender people – Body image issues pre and post-gender affirmation surgery including, for some, physical and sexual functioning
  17. 17. 17La Trobe University Reduced self-esteem cont. • Issues relating to sexual and physical intimacy  Few positive environments where GLBT people, especially SSAGD young people, can experiment and learn about relationships  Internalised feelings of reduced self-worth may inhibit expressions of emotional intimacy • Risk-taking behaviour  Drug and alcohol misuse and sexual risk taking
  18. 18. 18La Trobe University 4. Coming out and disclosure • Coming out is never a once only event • GLBT people have to decide whether or not to come out in every new personal, social or work-related situation • They must decide in every encounter with new health care workers whether or not to disclose their sexual orientation or gender identity • The continuing stresses associated with being (or not being) out are compounded by a range of other factors including HIV status, ethnicity and religious affiliation
  19. 19. 19La Trobe University Coming out and disclosure cont. Coming out is a stressful time for SSAGQ people • Since 1998, rates of SSAGD young people aged 14-21 who had told at least one person has increased from 82% to 97.5%, and supportive responses have also increased • Friends continue to be the most popular choice of confidantes • Young men more likely to disclose, and more likely to be supported compared to young women Writing themselves in 3, 2010
  20. 20. 20La Trobe University Coming out and disclosure cont. Coming out can trigger a range of mental health problems • For SSAGD young people, rejection following disclosure is associated with higher rates of suicide attempts and self harm • Conversely, supportive response from family members at disclosure reduces risk of poor mental health outcomes • Young people who reported supportive school environments were less likely to harm themselves or attempt suicide, regardless of whether they had experienced abuse
  21. 21. 21La Trobe University Coming out and disclosure cont. Coming out can trigger a range of mental health problems • For SSAGD young people, rejection following disclosure is associated with higher rates of suicide attempts and self harm • Conversely, supportive response from family members at disclosure reduces risk of poor mental health outcomes • Young people who reported supportive school environments were less likely to harm themselves or attempt suicide, regardless of whether they had experienced abuse
  22. 22. 22La Trobe University 5. Relationship stress and breakdown Intimate relationships • Limited symbolic or public recognition (second class unions) • Couples may have reduced social supports and reduced access to appropriate relationship, intimate partner violence and counselling services.
  23. 23. 23La Trobe University Family relationships • GLBT parents must consider the effects of being out on their own and their children’s mental health and wellbeing • Children in GLBT families may be concerned that they will be stigmatized or bullied if the sexuality or gender identity of their parent or parents is publicly known • SSAGD young people may fear and experience rejection and violence if and when they come out to their family, especially if they are part of certain religious and cultural communities Relationship stress and breakdown cont.
  24. 24. 24La Trobe University 6. Drug and alcohol misuse • Research shows a link between drug and alcohol misuse and increased risk of mental health problems • Drug use in the GLBQ community is two to four times higher than in the general population* • Rates of smoking among both gay men and lesbians are higher compared with heterosexual men and women respectively* • Among young people, 7.8% of SSA students compared to 1.3% of opposite-sex attracted students had ever injected drugs** * Australian Drug Foundation, 2000 ** Smith, Agius et al., 2009
  25. 25. 25La Trobe University • Research suggests two underlying causes for increased rates of drug and alcohol misuse among GLBT people:  Symptomatic drug and alcohol use as a form of self-medication to deal with heterosexism and its effects – Associated with private use  The normalisation of recreational drug use on the commercial gay scene – A social or shared activity Drug and alcohol misuse cont.
  26. 26. 26La Trobe University Relationship b/w heterosexist abuse and drug & alcohol misuse among SSAGD young people Writing Themselves in 3, 2010
  27. 27. 27La Trobe University That made me feel like I was evil and there was something wrong so I started cutting myself, pulling out large quantities of my own hair…I also started mentally abusing myself and turning to drugs and alcohol to solve my problems. Brianna, 17 yrs Writing Themselves in 3, 2010
  28. 28. 28La Trobe University • Research shows links between mental health problems, drug and alcohol use and sexual risk taking among GLBT people • For some GLBT people increased sexual risk taking is linked to their experiences of heterosexism, feelings of reduced self esteem and difficulties in forming intimate relationships • Groups at increased risk include:  SSAGD young people  Bisexual men and women  HIV-positive men 7. Sexual risk taking
  29. 29. 29La Trobe University I would generally conduct myself in an unsafe manner as well as doing dangerous things such as drugs and sleeping with people without a condom. I have to commute a lot for work and study and on numerous occasions I considered veering off the highway into a tree or taking lots of different drugs and trying to overdose Sebastian, 20 yrs Writing Themselves in 3, 2010
  30. 30. 30La Trobe University Rates and patterns of GLBT mental-ill health Mental disorders – Sexual orientation Feeling queer and blue, 2008
  31. 31. 31La Trobe University • 27% of gay/bisexual men, 42% of lesbian/bisexual women, and 55% trans people had seen a counsellor, social worker or psychologist in previous 12 months • Most had done so for issues relating to depression/anxiety Mental health Private Lives 2, 2012
  32. 32. 32La Trobe University Age 16 to 24 years Population High to very high K10 scores (%) PL2 females* 55 NHS females** 18 PL2 males 40 NHS males 7 Non-specific psychological distress *Private Lives, 2012; **National Health Survey, 2011
  33. 33. 33La Trobe University • Rates of suicide amongst GLBT people are between 3.5% and 14% higher than the general population* • 15.7 per cent of GLBT respondents in a national survey report suicidal ideation** • 20 per cent of transgender respondents in a national survey report suicide ideation^ • Amongst young people Hillier et al. (2010) found strong links between suicide attempts/self harm and rejection at the time of disclosure^^ Suicide and suicide ideation * A Suicide Prevention Australia Position Paper, 2009; ** Private Lives, 2006; ^TranZnation, 2007; ^^We’re family too, 2011
  34. 34. 34La Trobe University Relationship b/w homophobic abuse & self-harm and suicide – SSAGD young people Writing Themselves in 3, 2010
  35. 35. 35La Trobe University Protective factors
  36. 36. 36La Trobe University • The WHO (2005) has identified a number of protective factors for the onset or recurrence of mental illness: Social networks Supportive relationships Sense of belonging • For lesbians and gay men research suggests that a sense of belonging to GLBTI community and the general community are linked to lower levels of depression* *McLaren, 2009; Carmen, Corboz and Dowsett, 2012 Community belonging
  37. 37. 37La Trobe University • Nearly 42% of women and 26% of men in a national study of GLBT health reported relationships as their first choice for ‘3 best things in life’* * Private Lives, 2006 Being in a relationship
  38. 38. 38La Trobe University • GLBT Australians rated ‘GLBT friends’ most highly for emotional support (73%), higher than their biological families (52.6%)* • GLBT Australians were more likely to name ‘biological family’ (60.5%) as carers when they were sick than GLBT friends (36%) • Lower rates of self-harm for SSAGD young people who are supported by family** * Private Lives 2, 2012; **Writing themselves in 3, 2010 Friends and family
  39. 39. 39La Trobe University • Research suggests that open, supportive cultures are protective against mental ill- health • SSAGD young people who reported their schools were supportive and had policies that protected them felt safer at school and were less likely to harm themselves or attempt suicide* Institutional support *Writing themselves in 3, 2010
  40. 40. 40La Trobe University GLBT-inclusive health services
  41. 41. 41La Trobe University Heterosexism Other determinants Risk factors & triggers Sexual risk taking Coming out & disclosure Reduced self- esteem Relationship stress & breakdown Social isolation & exclusion Drug & Alcohol misuse Assessment, Treatment & care GLBT-specific GLBT-sensitive mainstream Symptom recovery Self-care www.glhv.org.au Violence & discrimination
  42. 42. 42La Trobe University 1. Organisational capability 2. GLBTI cultural safety 3. Professional development 4. Consumer consultation and participation 5. Disclosure and documentation 6. Access and intake processes National Standards for GLBTI inclusive practice
  43. 43. 43La Trobe University It is possible to object to discrimination against LGBTI people while nonetheless continuing to find their sexualities, gender identities and intersex status problematic. In the absence of overt public affirmation many LGBTI people will continue to struggle to achieve that sense of personal and social worth on which improvements in their mental health depend. Leonard, W. and Metcalf, A. (2014) Going upstream: A framework for promoting the mental health of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people, p.6
  44. 44. 44La Trobe University
  45. 45. 45La Trobe University
  46. 46. 46La Trobe University www.glhv.org.au Vision •To improve the mental health and quality of life for SSAGD young Victorians Funding •The Victorian Government Aims •Increase the SSAGD capacity of the mainstream youth sector •Integration of 7 SSAGD youth-related agencies with mainstream youth services, including youth mental health services
  47. 47. 47La Trobe University Funded partner agencies WayOut@Cobaw Community Health www.cobaw.vic.gov.au; www.wayout.org.au Safe Schools Coalition Victoria (SSCV) www.safeschoolscoalitionvictoria.org.au Rainbow Network Victoria (RNV) www.rainbownetwork.net.au Zoe Belle Gender Centre (ZBGC) www.gendercentre.com Minus18 www.minus18.org.au Youth Affairs Council of Victoria (YACVic) www.yacvic.org.au Gay and Lesbian Health Victoria (GLHV) www.glhv.org.au
  48. 48. 48La Trobe University Place-based projects Headspace Bendigo, Gateway Community Health www.headspace.org.au/headspace-centres/headspace-bendigo Junction Support Service, Wodonga, www.cobaw.vic.gov.au Geelong Adolescent Sexuality Project (GASP) www.geelongaustralia.com.au Diversity Project, Greater Shepparton (Uniting Care Cutting Edge). www.ucce.org.au/index.php?page=diversity-project Mainstream youth mental health services Headspace www.headspace.org.au
  49. 49. 49La Trobe University www.glhv.org.au Other support services for SSAGQ young people • Gay and Lesbian Switchboard 03 9663 2939 • Y Gender www.ygender.com
  50. 50. 50La Trobe University www.glhv.org.au

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