School's out for stigma: Understanding the mental health needs of LGBTQ+ youth

Posted by Liam Spencer, Fuse Associate and Research Assistant at Newcastle University

February is LGBTQ+ History Month, an annual month-long observance of lesbian, gay, bisexual and transgender history, and the history of the gay rights and related civil rights movements. The 2024 theme celebrates LGBT+ peoples’ contribution to science and medicine both historically and today. 

In this blog, Liam reflects on his research of LGBTQ+ young people’s mental health.

As LGBTQ+ History Month unfolds, it offers us an opportunity to reflect on the strides we’ve made, the challenges we still face, and the incredible diversity within our communities. This month holds particular significance for me – a chance to not only honour the struggles of those who came before us, but also to celebrate the progress we’ve achieved and recommit to the work that lies ahead.

With a background in youth and community work practice, my research interests are primarily focused on children and young people’s mental health, particularly early and preventative interventions, and school-based interventions. My journey as a member of the LGBTQ+ community and as a researcher has been intertwined with a deep sense of purpose – to shed light on the unique mental health challenges faced by LGBTQ+ individuals. This is a mission born out of personal experience, and a desire to contribute meaningfully to the wellbeing of this community. 

I have recently been involved in several Fuse projects funded by the NIHR School for Public Health Research (SPHR) Public Mental Health programme, and I’ve had the privilege of being able to delve into the complex dynamics of LGBTQ+ mental health, particularly in school environments. One of these projects, led by Professor Liz McDermott, aimed to investigate the impact of school-based interventions on LGBTQ+ young people’s mental health.

In the first phase of our study, we did a realist review (a type of evidence review that assesses the specific contexts in which a certain intervention may or may not work) 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 processes. The second phase of our study aimed to develop a theory that explained how, why, for who, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders.

We interviewed LGBTQ+ young people aged between 13 to 18 years attending secondary schools; intervention practitioners; and school staff in the UK. We then analysed this data to identify relationships across different interventions that improved mental health outcomes. The theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. Specifically, our theory proposes three interventions that may improve these outcomes:

1. Interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition.
2. Interventions for talking and support that develop safety and coping.
3. Interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety.

Ultimately, our research underscores the importance of providing a school environment that affirms and normalises LGBTQ+ identities, promotes school safety and belonging, and addresses systemic issues within educational institutions. By implementing evidence-based interventions informed by our theory, we can pave the way for improved mental health outcomes for LGBTQ+ pupils.

This month serves as a powerful reminder of our collective resilience, our shared struggles, and our unwavering commitment to justice and equality. Let us continue to push boundaries, challenge norms, and advocate for a world where difference is celebrated and all are embraced for who they are – within academia, our personal lives, and beyond.

Adapted with thanks to the PHSI EDI Committee Newcastle University

Images:

Image 1: courtesy of Schools OUT LGBT+ History Month 2024

Beyond stats and diseases: my summer internship in Public Health

Posted by Bethany Henshaw, NIHR School for Public Health Research (SPHR) Intern in Fuse, undergraduate at Newcastle University

The NIHR School for Public Health Research (SPHR) recently asked its members (including Fuse) if we would like to host an internship this summer. The summer internships are aimed at undergraduate students with an interest in a career in public health research. The internships offer support for 6-8-week projects supervised by SPHR Early Career Researcher (ECRs), Fellows and PhD students. 

In this post, Beth (pictured right) tells us about her internship experience last year at Gateshead Council. 

When you think of the term ‘public health’ what comes to mind? According to the World Health Organization, it is:

“the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society.” 

If you had asked me this question in early 2023, I would probably have given a very general, slightly muddled answer which was focused on the disease aspect of the field. What my answer would have highlighted was that I had very little understanding of just how broad and wide ranging the field of public health is.

Last year I undertook a NIHR School for Public Health Research (SPHR) summer internship in Fuse, looking at the perspectives of social prescriber link workers (who connect people to community-based support) on the promotion of active travel. Active travel refers to modes of travel that involve a level of physical activity such as walking and cycling. I was interested in understanding how social prescriber link workers felt the prescription of this to their patients would impact them.

The findings will be used to inform the development of an active travel pilot in Gateshead. The internship was a fantastic experience in many ways: it enabled me to develop my qualitative research skills, for example, I developed a topic guide for the social prescriber link worker focus group, and gave me valuable insight into professional working life. However, my biggest take-away was the insight it gave me into career options within public health.

Behind the stats are real people with their own unique story

As a biomedical science undergraduate, I spent two years studying topics like physiology, pharmacology, and immunology largely at the molecular level. I understand how many different diseases invade the body and make a patient ill. However, for a while now I have been interested in understanding disease at a population level. Rather than the cellular mechanisms of disease, I have grown more interested in why some people are more susceptible, and how we can reduce this disparity and prevent further people from becoming ill in the future. Before my internship, I mainly considered public health from a disease related perspective and thought that health protection covered the vast majority of the field. However, by speaking to both researchers and members of the Public Health team at Gateshead Council, it became clear to me that it covers significantly more than this! Issues such as environmental health, health services and health improvement are all things I previously wouldn’t have thought about when trying to define what I considered public health to be.

Something that surprised me during my internship was just how central recognising the individuality of each patient’s situation is in public health. I came to the realisation that when I had read research papers on disease outbreaks or rates of chronic disease as part of my degree, I had been overlooking this important detail: that behind the stats are real people with their own unique story. Talking to members of the active travel social prescribing team at the Council, made me realise just how individual and unique the journey is for each patient. Summarising, for example, how many patients continued to regularly use active travel for the time period they were prescribed it as a percentage does not reflect the reality of what these patients go through, something that will only be understood by talking to the patients to understand their experience. I found this outlook on viewing patients as people and not just statistics to be incredibly refreshing, and it has provided me with a new perspective to take into my final year of university and beyond.

My internship offered me a view of what life could be like working within public health research and the broader field. My understanding of what public health is, has been challenged and has been significantly changed from the disease focused perspective I had before. However, one of the main things I will take away is that behind all the statistics we see in the news and read in research papers regarding rates of disease, it is vital to remember that each statistic is a patient whose own unique experience should not be undermined.

Image:

2. Photo by cottonbro studio: https://www.pexels.com/photo/woman-with-red-light-on-face-5473950/

How can we fail more intelligently?

Posted by Peter van der Graaf, Northumbria University; Amanda Purington Drake, Cornell University; and Ien van de Goor, Tilburg University

We don’t like talking about failures, as it signals loss of time, resources and reputation, but failures present opportunities for learning in knowledge exchange. 

However, this requires a ‘failure culture’ in academia and policy, in which failures are no longer avoided but actively encouraged. To learn how to turn failures into successes, we need to share and publish our failures, have early engagement with all stakeholders in the knowledge exchange process, and make more use of boundary spanners.

There are plenty of academic papers celebrating successes in knowledge exchange, but not many researchers and policy makers talk openly about their failures. But learning from failures is just as important, if not more crucial, than celebrating successes. Allowing partners to reflect in a safe space on knowledge exchange practices and research projects gone wrong, in which communication broke down, partners did not engage or dropped out, and evidence was not taken up or ignored, will provide important lessons on how knowledge exchange practices and research can be improved.

Paul Iske. Chief Failure Officer, speaking at the Fuse conference in 2022  

At the 5th Fuse Conference on Knowledge Exchange in Public Health in 2022, we created such a space in Newcastle by bringing together over 100 academic researchers, policy makers, practitioners, and community members to share and reflect on their failures and how to turn them into success. Don't miss the 6th conference in the US ! 

Our Special Issue: Learning from failures in knowledge exchange published this month in journal Evidence & Policy brings together selected papers from the conference and papers that were submitted in response to an open call afterwards. From 23 original submissions from 14 different countries (including the UK, USA, Canada, Norway, Switzerland, Kenya, Chile, South Korea, and Portugal) and from a range of disciplines and areas of focus (Public Health, Primary Care, Oral Health, Sociology, Anthropology, Public Management, Policy-Making, and Community and Voluntary Sector), we invited four research papers and three practice papers for full submissions.

This includes a paper from Fuse Associate Mandy Cheetham and her practice colleagues on the challenges of co-production. They reflect on the failed performance of a theatre play to mobilise the research findings of a qualitative study into the health and wellbeing effect of major social security reforms (Universal Credit) in the North East of England. They argue that academics fail to appreciate emotional engagement of stakeholders in knowledge exchange.

The point about emotional labour in knowledge exchange and research is further developed (and flipped) by Louise Warwick-Booth, Ruth Cross and James Woodall. They reflect on data generated from three evaluation studies across different Voluntary, Community and Social Enterprise (VCSE) interventions in the North of England. In their paper, they expose the conflict between the research teams and evaluation partners, structured around five key features of co-production to highlight the emotional costs and labour involved for researchers.

The seven papers highlight different ways of defining and conceptualising failures in knowledge exchange, ranging from mis-implementations, to setbacks, pitfalls, unproductive interactions between stakeholders, conflicts in co-production, and deviations from expected and desired results. Using different theories and frameworks, the papers in this special issue demonstrate that failures are complex problems, involving many actors at different levels across various organisations and networks. These organisations and networks are in turn influenced by a range of determinants, from workforce instability, leadership challenges, and lack of adequate funding to practical, everyday issues, such as logistical, technical, and buy-in considerations.

Each paper offers a different perspective on relational barriers and structural stressors contributing to failures, but all authors agree that failures offer opportunities for learning, particularly small failures. We tend to focus on large catastrophic failures, but small failures are often the early warning signs, which can help to avoid larger failure in the future. To support this learning, we need to talk more openly about failures and create a culture where talking about and sharing of failures is more accepted and, even better, actively encouraged. Therefore, we argue for more deliberate experimentation in organisations and partnerships to allow for failures that provide rich insight and learning. How can we fail more intelligently? And how do we create spaces and time for reflection on failures between evidence producers, brokers and users to share this learning and support them in turning failures into successes?


This blog post is based on the article, ‘Learning from failures in knowledge exchange and turning them into successes’, which introduces the Special Issue: ‘Learning from Failures in Knowledge Exchange’. Adapted with thanks to Evidence & Policy.

Authors

Peter van der Graaf is an Associate Professor in Public Health at Northumbria University and Research Manager of AskFuse - the responsive research and evaluation service run by Fuse. Peter is interested in the interface between research, practice and policy making and how this interface facilitates (or hinders) social improvement processes at local, regional, national and international levels. He conducts research on knowledge mobilisation in public health, with a focus on the wider determinants of health (e.g. housing, health landscapes, urban regeneration) and how they affect people’s health and wellbeing.

Amanda Purington Drake, PhD, is the Director of the ACT for Youth Center for Community Action at the Bronfenbrenner Center for Translational Research and a research collaborator with the Social Media Lab, both at Cornell University, USA. Amanda has a passion for using research and evaluation to help communities to promote and support the health and wellbeing of youth. Her work in the Bronfenbrenner Center has focused on promoting positive youth development, investigating non-suicidal self-injury in general populations of adolescents and young adults, and evaluating the effectiveness of large-scale adolescent sexual health initiatives. She has co-developed and evaluated interventions to develop youth social media literacy and to promote parent-teen communication about sexual health. Amanda works to bridge research and evaluation with practice and policymaking to prevent youth risk-behavior and promote healthy development.

Ien van de Goor (MSc, PhD) works as endowed professor and program leader in Public Health and Prevention at Tranzo, Faculty of Social and Behavioral sciences, Tilburg University, in the Netherlands. She has a background in health sciences with many years of research experience in evidence-informed public health. Central areas of interest are healthy behaviour in relation to the environment, poverty and vulnerable groups, and monitoring and public health policy.

The views and opinions expressed by the authors are those of the authors and do not necessarily reflect those of Fuse, the Centre for Translational Research in Public Health.