Lesbian, Gay, Bisexual Youth Suicide Prevention

Lesbian, Gay, Bisexual Youth Suicide Prevention Toolkit

Lesbian, Gay, Bisexual Youth Suicide Prevention

Acknowledgments

We are grateful to the following people who have assisted in the development of this document by sharing their knowledge and expertise:

Dr Justin Varney, Dominic Walsh, Seamus Watson, Joanne Bosanquet.

Prepared by: Luis E. Guerra
For queries relating to this document, please contact:

This toolkit is a collaboration between the Royal College of Nursing (RCN) and Public Health England (PHE) to support and develop the role of nurses in the prevention of lesbian, gay and bisexual adolescent suicide.

The Royal College of Nursing (RCN) is the voice of nursing across the United Kingdom and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape the healthcare policy by working closely with the UK government and other national and international institutions, trade unions, professional bodies and voluntary organisations. To join the RCN please call RCN Direct (24 hours) on 0845 772 6100 or visit our website at www.rcn.org.uk

Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. www.phe.gov.uk

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or email e we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to [insert email address].

Published January 2015
PHE publications gateway number: 201XXXX

This document is available in other formats on request. Please call xxx xxxx xxxx or email xxxxxxxx@xxxxxx

Contents

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Acknowledgments 2

Introduction 4

Audience 5

Aim 5

Using the Toolkit 5

What this Toolkit does not include 6

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Definitions 7

Statistics and the Current Landscape 9

What does the law say? 10

Developing a LGB identity 10

Suicide Risk and Protective Factors 12

Other Factors to Consider 13

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Working with LGB Young People 16

Motivational Interviewing Techniques 18

Effective Communication 19

Sample Questions for Effective Communication 21

Confidentiality and Consent 23

Next Steps and Moving Forward with the Young Person 24

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Resources for LGB Young People 25

Resources for You 27

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Reflective Checklist 28

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Bibliography 30

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Lesbian, Gay, Bisexual Youth Suicide Prevention Toolkit

Introduction

In our society, nurses have always played a crucial role in health care by providing caring, compassionate and inclusive care to all. As nurses, there is a duty to be constantly aware for those who may be vulnerable, regardless of their demographic and symptoms that they initially present with. Because most people who take their own lives are not in touch with mental health services [1], the potential to come into contact with a suicidal person inside or outside of the health care arena is significant.

Because of time spent with clients/patients, a trusting relationship can develop, which may encourage the disclosure of sensitive information regarding an individual’s sexual orientation.

While someone’s sexual orientation by itself is not a risk factor for suicide or self-harm, current evidence shows that lesbian, gay and bisexual (LGB) young people have a greater risk of suicidal behavior than their heterosexual peers. The discrimination and stigma from other people that individuals experience in their everyday lives, whether at home, work or school is one of the main reasons behind this. This stigma and discrimination, and the fear of it happening, can prevent individuals from reaching out for help when they need it, and those in a position to help, from asking questions about an individual’s sexual orientation and identity. This can result in further stress that all contributes to higher levels of mental illness, isolation, depression, victimization and stressful interpersonal relationships with family, peers and community.

Young people are often more affected by the impact, and the fear of, discrimination and rejection from family, peers and society and as their sexual orientation and identity develop that sense of ‘otherness’ can make them particularly vulnerable to depression and suicidal thoughts. Lesbian, gay and bisexual young people need staff and services which recognise their unique life journey and experience and take into account their unique and specific risk factors for suicide [2]. Most young LGB people who are distressed and contemplating suicide haven’t reached specialised mental health services and may well first present to a service in crisis. Consequently, all health care staff should have an understanding of how to assess and address the emotional wellbeing of young LGB people. Everyone should be able to recognise if a young person may be suffering from a mental health problem and liaise with the appropriate services [1]. Services should also be working to promote positive mental health and resilience to young people, especially amongst those most at risk, including LGB youth.

The good news is that suicides are not inevitable and several things are being done to prevent suicide and support LGB young people achieving their potential for happy, fulfilling and healthy lives.

The Royal College of Nursing Congress passed several motions over the last five years highlighting the importance of addressing inequalities affecting lesbian, gay and bisexual people, including specific reference to the need to support nurses to effectively act when supporting these patients and prevent suicide and promote wellbeing. At the same time, our national Department of Health has implemented a cross-government outcomes strategy to prevent suicide in England [1]. In working towards these aims this toolkit is part of efforts to improve the support and training for frontline nurses in responding to the needs of LGB youth.

As nurses, we can help develop an inclusive clinical environment that makes it clear that we welcome diversity, support young people, explicitly including LGB youth and makes sure that we are not marginalising and putting off people who most need our support at times of personal crisis to help prevent suicides [1]. We also have a duty to ensure that vulnerable people in our care are supported and kept safe from preventable harm. We need to be prepared to intervene quickly when someone is in distress or in crisis and this toolkit provides a basis for this potentially life-saving support.

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Lesbian, Gay, Bisexual Youth Suicide Prevention Toolkit

Audience

This toolkit is designed primarily for nurses who work with children and young people in different community and hospital settings, including practice nurses and accident and emergency nurses.

Aim

This toolkit aims to help you develop your skills and knowledge to support lesbian, gay, bisexual young people who are at risk of suicide and recognize the wider context of their mental health in relation to their sexual orientation and identity.

This toolkit provides a general outline for health professionals looking to increase their skills and knowledge around LGB adolescent’s suicide prevention strategies.

Using the Toolkit

Identifying mental health problems and responding appropriately can prove challenging for anyone working with LGB youth. The toolkit is divided into two main sections to help practitioners understand the theory as well as sharing practical skills and tools to better support LGB youth.

This toolkit was developed with the latest available research and published studies from England and the world, in order to help identify those who might be at risk of suicide in the LGB community and to educate themselves at the same time. Suicide prevention is most effective when it is combined as part of wider work addressing the social and other determinants of poor health, wellbeing or illness [1].

By including in this toolkit, theoretical and practical approaches, we are looking to increase frontline comfort and better engagement with a key high-risk group for suicide and self-harm.

What this Toolkit does not include

This toolkit is not aimed to be a replacement for trainings on youth mental health, LGB communities or any other training.

Definitions

The terms lesbian, gay, and bisexual are often used without much consideration of the complexities of sexuality and gender. How and why sexual orientation develops and changes over time remains the subject of both research and debate. At an individual level it is always important to ask a young person how they identify and what term they feel most comfortable with describing their identity. This is an important part of building rapport with a young people and understanding how they view themselves in the world.

The following is an overview of terms and related definitions to help us all better understand the complexities of sexuality and gender:

Be aware that language is dynamic and evolves over time. Therefore, terms, definitions, and how LGB individuals identify varies based upon a number of factors, including geographic region, race/ethnicity, immigration background, and socioeconomic status, among others.

Statistics and the Current Landscape

Lesbian, Gay and Bisexual self-identified individuals constitute an estimated 6.7% of the 16-24yrs old population in the United Kingdom (UK) [3]. But the real picture is uncertain because some individuals do not disclose their sexuality in some of the national surveys. We are working towards including better sexual orientation monitoring across the NHS and part of this is supporting both staff and patients to feel more comfortable asking the question about sexual orientation.

The population of lesbian, gay and bisexual people is broad and diverse, just like the black and ethnic minority community. However research shows that LGB people experience significant inequalities relating to health, wellbeing and broader social and economic circumstances, despite the significant improvement in social attitudes and laws that protect [4] and uphold the rights [5] [6] [7] [8] of gay, lesbian, bisexual and trans people.

We know that LGB people are at higher risk of suicidal behaviour, mental disorder and substance misuse and dependence than heterosexual people [2] [9] [10] [11]. This gap is even greater for ethnic minority LGB people and those with disabilities.

The most reliable indicators of suicide risk are self-harm, suicidal ideation and prior suicide attempts. Self-harm remains one of the leading causes of acute medical admissions in the UK being one of the highest in Europe [11]. Amongst LGBT youth in the UK, 1 in 2 reported self-harming at some point in their life and 44% reported having ever thought about suicide [12], these are all young people at risk of suicide.

LGBT young people are at greater risk for depressive symptoms and suicidal ideation compared with young people in general [13]. This is often because of homophobia at home or in school. A British survey in 2012 [14] found 99% of the LGB youth surveyed had heard the term “gay” being used in a derogatory way or heard other homophobic language. Within the same survey, 55% reported homophobic bullying. Of those who had been bullied, 44% reported deliberately missing school as a consequence.

Poor levels of mental health among gay and bisexual people have often been linked to experiences of homophobic discrimination and bullying. The research into youth suicide prevention highlights the importance of supporting young people during the adolescent years as it is a particularly vulnerable period as young people form their identity in the world [15].

Substance misuse is strongly associated with homophobic and bi-phobic bullying (discrimination and stigma faced by bisexual people), lack of supportive environments, negative and disclosure reactions. Research [16] has shown that LGB young people were almost twice as likely to use drugs and alcohol compared to heterosexual peers. They were also more likely to use harder drugs such as cocaine and to inject drugs.

A recent analysis of one of the large cohort studies of young people and health behaviours in the UK found lesbian and gay young people aged 18-19 years were 2.2 times more likely to smoke and almost twice as likely to drink alcohol twice a week or more, compared to heterosexual young people of the same age, bisexual identity was associated with similar increased likelihood but to a lesser degree [17].

There is a strong evidence base which demonstrates the negative impact of discrimination and stigma on lesbian, gay and bisexual young people and this resulting in substance misuse, depression, self-harm and suicide. Although it is harder for nurses to play a role in preventing this discrimination and stigma happening, you can play and important role in mitigating its effects and helping LGB young people find happy and fulfilling lives despite it.

What does the law say?

The 2010 Equality Act [4] makes ‘sexual orientation’ a protected characteristic which means that everyone, whether they are lesbian, gay bisexual or heterosexual is protected from discrimination because of their sexual orientation. Any service provided for young people, whether funded by public money or not, provided free or for a charge cannot discriminate against LGBT people when providing services – this means that refusing a young person from a service because they are LGBT would be unlawful.
It is also important to remember that all nurses are bound to promote and protect the rights and best interests of all their patients. This includes ensuring that staffing levels and skill-mix are appropriate to meet their needs, including the needs of LGB adolescents [18].

Developing a LGB identity

Developing and adopting an identity should be a positive and empowering experience for everyone; it is a normal part of growing up through adolescence and finding our way in the world. However growing up and realising that you are ‘different’ from those around you can be incredibly isolating, scaring and difficult. Society and institutions like schools and health services don’t always help because they can surround young people with just one vision of what ‘normal’ looks like and this can make growing up an even more isolated experience [19]. While no generalisations can be made about the overall experience of LGB people, building an identity where being heterosexual is the norm remains a challenging experience due to stigma, marginalisation, and reconciling a multi-faceted identity [20] [21] [22].