A public health perspective on lgbt young people and lifecourse development 2014
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This presentation is for the "Completing the Inclusion Matrix" conference for educators in March 2014. It takes a public health approach to development of young LGBT people, the impact of......

This presentation is for the "Completing the Inclusion Matrix" conference for educators in March 2014. It takes a public health approach to development of young LGBT people, the impact of homophobia, and reducing it

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  • 1. Resilient, confident, safe: a Public Health perspective on LGBT young people and Lifespan development (Full version with references) Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FCIEH, FRSPH Director of Public Health, Hertfordshire County Council Visiting Senior Clinical Fellow, University of Hertfordshire Visiting Research Fellow, Dept of Pastoral Theology, Heythrop College University of London Completing the Inclusion Matrix: delivering anti-homophobia and LGBT equality Conference - 21st March 2014
  • 2. This Presentation • This presentation tries to integrate a public health perspective on physical and psychological health of LGBT young people with psychological science on LGBT young people • This version is the fuller version for background reading. A much shorter version will be delivered at the conference • This work is done as part of the public mental health work at Hertfordshire Public Health Service and as a contribution to the Hertfordshire Diversity Board • A full bibliography of all works relied on is at the end of this version
  • 3. Transgender citizens • Hertfordshire completed a needs assessment on the needs of transgender citizens in 2013 • This work is being progressed • There are specific issues which warrant Trans issues being given their own proper consideration • So important to remember they need to be addressed, and I cant begin to do justice to them in this presentation • But anti-homophobia work must begin to address trans issues too
  • 4. Issues • Why is being resilient, confident and safe a public health issue? • LGBT Development across the Lifespan • The tasks of acceptance and integration • How do we get to resilient, confident, safe?
  • 5. Biographical Note • • • • • • • • • • Jim McManus is Director of Public Health for Hertfordshire, and leads the Hertfordshire Public Health Service, which is part of Hertfordshire County Council He is a Chartered Psychologist, Chartered Scientist and Associate Fellow of the British Psychological Society, He co-authored a toolkit on reducing homophobic violence for the Home Office with Professor Ian Rivers, He was a co-author of the Meads et al 2009 systematic review of LGBT health in the West Midlands http://www.birmingham.ac.uk/Documents/collegemds/haps/projects/WMHTAC/REPreports/2009/LGBThealth030409finalversion.pdf He co-authored with Prof Ian Rivers a guide for community safety partnerships on LGBT communities https://www.nacro.org.uk/data/files/nacro-2004120604-165.pdf He is a Visiting Senior Clinical Fellow at the University of Hertfordshire and a Visiting Research Fellow in the Dept of Pastoral Studies at Heythrop College, University of London Between 2001 and 2004 he held appointment from the Lord Chancellor to the committee of the Judicial Studies Board for England and Wales which advised the judiciary on equal treatment and diversity before the Courts and Tribunals of England and Wales and contributed to the Equal Treatment Bench Book for judges, magistrates and Tribunal Chairs. In 2011 he was awarded the Good Samaritan Award for excellence in Healthcare by Pope Benedict XVI (previous holders include Sir Andrew Fleming) He undertakes pro bono teaching on public health and leadership with students and professionals from developing countries In his spare time he cycles, reads (theology and Scottish economic and social history), enjoys the cinema and does weight-lifting and volunteers at his local church
  • 6. Resilient,confident, safe: WHY A PUBLIC HEALTH ISSUE?
  • 7. http://www.lgf. org.uk/phof?fo r-professionals
  • 8. A public health meets psychology perspective on human development • Human behaviour and health is the outcome of interactions of persons operating within social systems. • Biological, psychological, social, spiritual influences • Clearly follows that homophobia and integration of LGBT identities impacts and is impacted upon by these systems • This creates an avoidable burden of ill-health on parts of our population (LGBT and questioning young people) • 86% of young people are aware of their sexual orientation while at
  • 9. Some data... (Meads et al,2009) • 86% of young people aware of their sexuality at school (YouthNEt,2003) • Higher rates of suicide, self-harm (young gay men ten times the UK population rate) • Worse access to appropriate services (lesbian women told they don’t need smears) • Higher rates of smoking, risk-taking • 1 in 3 gay men have had a bad experience of healthcare (Stonewall, 2008) • Higher for lesbian women (Stonewall, 2012) www.healthylives.stonewall.org.uk
  • 10. If you have some time • Read through the slides from the plenary presentations on the LGBT Health Summit 2012 • A range of survey and research data is presented there which sends a stark message • https://www.metrocentreonline.org/pdfs/LGB THealthSummitPlenaryPresentationsWeb.pdf
  • 11. LGBT identify development ACROSS THE LIFESPAN
  • 12. Influence on Health status across the lifecourse
  • 13. Influence on Health status across the lifecourse • The impact of homophobic settings • Homophobia, like racism, has deleterious impacts on health and flourishing • Disrupts identity integration process • Influence on allostatic load and therefore added work for resilience/added vulnerabilities
  • 14. Influence on Health status across the lifecourse • If homophobic attitudes and settings can be conceptualised as vulnerability factors to psychological morbidity and stressors • Where are the protective factors?
  • 15. Life course LGBT thinking • Boxer and Cohler, 1989 • 1994. Plume (Penguin) New York • Hammack and Cohler, 2009 • Life course non LGBT Thinking – Bengston, 1993 – Mayer, 2009
  • 16. Vivienne Cass’s model (1979) • Stage 1: Identity Awareness/confusion -The individual is aware of being “different.” • Stage 2: Identity Comparison -The individual compares their feelings and emotions to those they identify as heterosexual. • Stage 3: Identity Tolerance -The individual tolerates their identity as being non-heterosexual. • Stage 4: Identity Acceptance -The individual accepts their new identity and begins to become active in the “gay community.” • Stage 5: Identity Pride -The individual becomes proud of their identity and becomes fully immersed in “gay culture.” • Stage 6: Identity Synthesis -The individual fully accepts their identity and synthesizes their former “heterosexual life” and their new identity.
  • 17. Psychological and health demands made by coming out Halpin, S. A., & Allen, M. W. (2004).
  • 18. One study as an example • Kappler et al (2013) • 156 RC priests • Internalised homophobia – Negatively correlated with psychological wellbeing – Associated with depression
  • 19. D’Augelli’s model of lifecourse LGBT identity development http://safezone.uncc.edu/allies/theories
  • 20. Suggestions.... • Not a linear but a dynamic process • Requires work across the lifecourse • Is “added work” on the development task because of homophobia and “difference” • Identity integration and resilience is a process • Making the process less like “added work” and more like “being me, just different to you” is a crucial objective
  • 21. Getting to resilient, confident, safe A LIFECOURSE FORMATION APPROACH
  • 22. If this is all you take in 1.... • Think FORMATION not just development – A concept borrowed from other disciplines of how we shape people for life/vocation – Has good application here – preparing people for specific challenges – Integration of psychological, social, spiritual, physical and competence development – How do we help people on the Cass/D’Augelli journey • Important to think whole person for all young people, salient for LGBT young people • FORMATION for life can be a good concept
  • 23. If this is all you take in...2 • Role of education and public services is to help form resilient, confident and well-adjusted adults • Homophobia has insidious long term psychological sequelae and good formation can be a way of addressing this • Need to understand the specific tasks of LGBT identity development and affirmation • Not doing this seems to result in increased suicide, self-harm, mental ill-health and ongoing problems into adulthood • Largely avoidable burden of ill-health (human cost) – Social and economic cost could be quantified if we had enough good data
  • 24. Levels and tasks: A suggested population approach Levels • System • Group • Interpersonal • Intrapersonal High Level Tasks • Policy, training, monitoring, content to remove homophobic attitudes • Building social norms which support and accept – role models • Behaviours and attitudes • Role models, tailored support, confidence building, resources Educators can and do already excel at this and know how to do it with young people. Do not feel deskilled by this.
  • 25. A case in point: Children of same sex couples in faith schools (Pope Francis speaking to religious superiors, 2013) • "I remember a case in which a sad little girl confessed to her teacher: 'my mother's girlfriend (fidanzata) doesn't love me'," he was quoted as saying. • The pontiff said educational leaders should ask themselves "how can we proclaim Christ to a generation that is changing?" . . . • “We must be careful not to administer a vaccine against faith to them.” Pope was speaking in Italian and used term fidanzata http://www.ncregister.com/blog/jimmy-akin/what-did-pope-francis-say-about-the-children-of-homosexual-couples-8-things
  • 26. Conclusions • Being resilient, confident and safe will reduce the avoidable burden of morbidity and mortality in LGBT young people and across the lifecourse • This is important to ensure LGBT people can develop safely and confidently – And get on with the process of acceptance and integration • There are many resources but we need to address it at system, group/class, interpersonal and intrapersonal levels
  • 27. Some top resources • Stonewall www.stonewall.org.uk • Prof Ian Rivers – http://ianrivers.wordpress.com/ • The American Psychological Association’s Division 44 on LGBTQ issues resource page – http://www.apadivision44.org/resources/ • APA Division 44 anti-bullying resources – http://www.apadivision44.org/resources/antibullyingresources. php • British Psychological Society Psychology of Sexualities Section http://pss.bps.org.uk/ • The Stand up foundation http://www.standupfoundation.com/
  • 28. For Educators • 2013, Thousand Oaks, Corwin (Sage) • ISBN 9781452241982 Also a fantastic FREE Irish guide http://www.youth.ie/sites/youth.ie/ files/Chapter%203%20%20working%20with%20young%20 people%20who%20are%20LGBT%20 -%20all%20Ireland.pdf
  • 29. For Social Workers • Julie Fish (2012) Social work with lesbian, gay, bisexual and trans people. Bristol: Policy Press • ISBN 9781847428035
  • 30. For the Health care system • Chichester – John Wiley and Sons (2013) • ISBN 9781118065600
  • 31. “Just the facts” on sexual orientation and youth http://www.apa.org/pi/lgbt/resources /just-the-facts.pdf
  • 32. Bibliography 1 : Top Reads • • • • • • • • • • • • • Alderson, K (2012) Breaking Out II : The complete guide to building a positive LGBTI identity. London, Ontario: Insomniac Press. Bayley, M (Ed) (2007) Creating Safe Environments for LGBT Students: A Catholic Schools Perspective. Binghampton: Haworth Press (Now routledge) Blau, G, Poirier J and Fisher, S (2012) Improving Emotional and Behavioral Outcomes for LGBT Youth: A Guide for Professionals (Systems of Care for Children's Mental Health) Baltimore: Paul H Brookes Publishing Edser, S (2012) Being Gay Being Christian: Hunter Valley NSW : Exisle Publishing Fish, J (2012) Social Work and Lesbian, Gay, Bisexual and Trans People: Making a Difference (Social Work in Practice Series). Bristol: Policy Press Fisher, E and Komosa-Hawkins, K (2013) Creating Safe and Supportive Learning Environments: A Guide for Working With Lesbian, Gay, Bisexual, Transgender, and Questioning Youth and Families. London: Routledge Fisher, E and Kennedy, K (2012) Responsive School Practices to Support Lesbian, Gay, Bisexual, Transgender, and Questioning Students and Families. London: Routledge Fruhauf , C and Mahony D (Eds) (2009) Older GLBT Family and Community Life. London: Routledge MEADS C, Pennant M, McManus J et al. (2009) . A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research. Birmingham: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham Patterson, C and D’Augelli, A (2012) Handbook of Psychology and Sexual Orientation. New York: Oxford University Press Rivers, I., & Ward, R. (2012) (Eds.). Out of the ordinary: Representations of LGBT lives. Newcastle-Upon-Tyne: Cambridge Scholars Publishing. ISBN-13: 978-1-4438-3743Rivers, I., Duncan, N., & Besag, V.E. (2009). Bullying: A handbook for educators and parents. Lanham: Rowman & Littlefield ISBN 978-1-57886-799-8 Schenider, J and Silenzio V (2014) The Gay and Lesbian Medical Association Handbook on LGBT Health [2 vols] . Westport: Praeger
  • 33. Bibliography 2: Works Consulted • • • • • • • • • • Alderson, K (2012) Breaking Out II : The complete guide to building a positive LGBTI identity. London, Ontario: Insomniac Press. Bengston, V. L., & Allen, K. R. (1993). The life course perspective applied to families over time. In P. G. Boss, W. J. Doherty, R. LaRossa, W. R. Schumm, & S. K. Steinmetz (Eds.), Sourcebook of family theories and methods: A contextual approach (pp. 469-499). New York: Plenum Press. Blau, G, Poirier J and Fisher, S (2012) Improving Emotional and Behavioral Outcomes for LGBT Youth: A Guide for Professionals (Systems of Care for Children's Mental Health) Baltimore: Paul H Brookes Publishing Boxer, A and Cohler, B (1989) The life course of gay and lesbian youth: an immodest proposal for the study of lives. Journal of Homosexuality 17(3-4):315-55. Cohler, B (2000) The Course of Gay and Lesbian Lives: Social and Psychoanalytic Perspectives (Worlds of Desire: The Chicago Series on Sexuality, Gender & Culture). Chicago: University of Chicago Press Goldber, A E and Allen K R (2012) LGBT-Parent Families: Innovations in Research and Implications for Practice New York: Springer D’Augelli, A. R., Grossman, A. H., Starks, M. T., & Sinclair, K. O. (2010). Factors associated with parents’ knowledge of lesbian, gay, and bisexual youths’ sexual orientation. Journal of GLBT Family Studies, 6(2), 1-21. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1-21. D’Augelli, A. R., & Grossman, A. H. (2006). Researching lesbian, gay, and bisexual youth: Conceptual, practical, and ethical issues. Journal of Lesbian and Gay Issues in Education 3 (213), 35-56. D’Augelli, A. R. (2005). Stress and adaptation among families of lesbian, gay, and bisexual youth: Research challenges. Journal of Gay, Lesbian, Bisexual, and Transgender Family Studies, 1(2),115-135.
  • 34. Bibliography 3: Works Consulted • • • • • • • D’Augelli, A. R., Grossman, A. H., Salter, N. P., Starks, M. T., Vasey, J. J., & Sinclair, K. O. (2005). Predicting the suicide attempts of lesbian, gay, and bisexual youth. Suicide and Life-Threatening Behavior, 35, 646-660. D’Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry, 7, 439-462. D’Augelli, A.R. (1995) Lesbian, Gay, and Bisexual Identities Over the Lifespan: Psychological Perspectives. New York: Oxford University Press D'Augelli, A. R. (1994). Identity development and sexual orientation: Toward a model of lesbian, gay, and bisexual development. In E. J. Trickett, R. J. Watts, & D. Birman (Eds.), Human diversity: Perspectives on people in context (pp. 312-333). San Francisco: Jossey-Bass. D'Augelli, A. R., & Hershberger, S. L. (1993). Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems. American Journal of Community Psychology, 21, 421-448. Descrescenzo, T (2014) Helping Gay and Lesbian Youth: New Policies, New Programs, New Practice. Binghampton: routledge Drescher, J and Hellman, R (2004) Handbook of LGBT Issues in Community Mental Health: Binghampton: Haworth Park Press
  • 35. Bibliography 4 : Works Consulted • • • • • • • • • • • • • Fisher, E and Komosa-Hawkins, K (2013) Creating Safe and Supportive Learning Environments: A Guide for Working With Lesbian, Gay, Bisexual, Transgender, and Questioning Youth and Families. London: Routledge Goldber, A E and Allen K R (2012) LGBT-Parent Families: Innovations in Research and Implications for Practice New York: Springer Guindon, M (Ed) (2009) Self-Esteem Across the Lifespan: Issues and Interventions. London: Routledge Halpin, S. A., & Allen, M. W. (2004). Changes in psychosocial well-being during stages of gay identity development. Journal of Homosexuality, 47(2), 109-126 Hammack P and Cohler, B (2009) The Story of Sexual Identity. New York: Oxford University Press Harris, B (2013) School Experiences of Gay and Lesbian Youth: The Invisible Minority , Journal of Gay & Lesbian Social Services Series, Vol 7, No 4, special issue. Herd, G and De Vries, B (2003) Gay and Lesbian Aging: Research and Future Directions .New York: Springer Kappler, S, Hancock, K and Plante, T (2013) Roman Catholic Gay Priests: Internalized Homophobia, Sexual Identity, and Psychological Well Being , Pastoral Psychology, 62, 805 – 826 Kimmel, M et al (2014) Sexualities. New York: Oxford University Press Lewis, M and Marshall I (2014) LGBT Psychology: Research Perspectives and People of African Descent . New York: Springer McCormack,M (2013) The Declining Significance of Homophobia (Sexuality, Identity, and Society). New York: Oxford University Press Mayer, I H and Northridge, M E (Eds) (2010) The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Mayer, Karl U. (2009). "New Directions in Life Course Research". Annual Review of Sociology 35: 423–424
  • 36. Bibliography 5 : Works Consulted • • • • • • • • • • Mayo, C (2013) Lgbtq Youth and Education: Policies and Practices (Multicultural Education) (Multicultural Education Series) New York: Teachers College Press, Columbia University Nadal, K (2013) That's So Gay! Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community (Perspectives on Sexual Orientation and Gender Diversity). Washington: American Psychological Association Press Nynas, P and Kam-Tuck Yip, A (2012) Religion, Gender and Sexuality in Everyday Life. Farnham: Ashgate Omoto, A and Kurtzman, H (eds) (2006) Sexual Orientation and Mental Health: Examining Identity and Development in Lesbian, Gay and Bisexual People (Division 44) Washington DC, American Psychological Association Press Pennant ME, Bayliss SE, MEADS C (2009) . Improving lesbian, gay, and bisexual healthcare: a systematic review of UK qualitative literature.Diversity in Healthcare vol. 6, (3) 193-203. Peterson, D and Panfil, V (Eds) (2013) Handbook of LGBT Communities, Crime, and Justice. New York: Springer Rivers, I., & Ward, R. (2012) (Eds.). Out of the ordinary: Representations of LGBT lives. Newcastle-UponTyne: Cambridge Scholars Publishing. ISBN-13: 978-1-4438-3743Rivers, I., Duncan, N., & Besag, V.E. (2009). Bullying: A handbook for educators and parents. Lanham: Rowman & Littlefield ISBN 978-1-57886-799-8 Robinson, P (2013) Gay Men's Relationships Across the Life Course. London: Palgrave macmillan Rossi, A (1999) Sexuality Across the Life Course (John D. and Catherine T. MacArthur Foundation Series on Mental Health and Development). Chicago: University of Chicago Press
  • 37. Bibliography 6 : Works Consulted • • • • • • • Sanlo, r (2004) Lesbian, Gay, and Bisexual College Students: Risk, Resiliency, and Retention. Journal of College Student Retention: Research, Theory and Practice, 6(1) (4 May 2004) Scott Carpenter, C (2013) The prevalence of Gay Men and Lesbians in Baumle, A (2013) International Handbook on the Demography of Sexuality (International Handbooks of Population). NewY ork: Springer pp 217-228 Shankle, M (2006) The Handbook of Lesbian, Gay, Bisexual, and Transgender Public Health: A Practitioner's Guide to Service Binghampton: Routledge Troiden, R (1993) The formation of Homosexual Identities in Garnets, L and Kimmel, D (1993) Psychological Perspectives on Lesbian and Gay male experiences. New York: Columbia University Press pp 191- 217 US Health and Human Services Dept (2013) Top Health Issues for LGBT Populations: Information & Resource Kit. Washington DC: US Public Health Service Vaccaro, A, August, G and Kennedy M (2011) Safe Spaces: Making Schools and Communities Welcoming to LGBT Youth New York: Praeger Publishing YouthNet (2003) ShOUT: Research into the Needs of young people in Northern Ireland who Identify as Lesbian, Gay, Bisexual and/or Transgender. Belfast: YouthNet.
  • 38. Thank you Jim.mcmanus@hertfordshire.gov.uk Director of Public Health Hertfordshire County Council Postal Point CH0231 County Hall Pegs Lane Hertford Hertfordshire SG13 8DE