Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour Final Report Queer Futures Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour Elizabeth McDermott (Lancaster University), Elizabeth Hughes (University of Huddersfield) & Victoria Rawlings (Lancaster University) 6/30/2016 Department of Health Policy Research Programme Project Understanding Lesbian, Gay, Bisexual and Trans (LGBT) Adolescents' Suicide, Self-Harm and Help-Seeking Behaviour- 023/0168 Contents Acknowledgements............................................................................................................................. 4 Tables and figures .............................................................................................................................. 5 Executive summary ............................................................................................................................ 7 Background ...................................................................................................................................... 7 Aim ................................................................................................................................................... 7 About the study ................................................................................................................................ 7 Key findings ..................................................................................................................................... 7 Understanding LGBT youth self-harm and suicide ..................................................................... 7 LGBT youth and help-seeking ..................................................................................................... 9 Mental health staff knowledge, attitudes and practice ............................................................... 10 Conclusions .................................................................................................................................... 10 Section 1: Study aims and background .......................................................................................... 11 1.1 Introduction .............................................................................................................................. 11 1.2 Background .............................................................................................................................. 12 1.2.1 Risk factors associated with suicide and self-harm .......................................................... 12 1.2.2 Help-seeking behaviour .................................................................................................... 13 1.2.3 Mental health services ....................................................................................................... 13 1.2.4 Public health policy and preventing suicide and reducing self-harm ............................... 14 1.3 Aims and objectives ................................................................................................................. 14 Section 2: Methods ........................................................................................................................... 16 2.1 Study design ............................................................................................................................. 16 2.2 Ethics ........................................................................................................................................ 16 2.3 Stage 1: Qualitative semi-structured interviews ...................................................................... 17 2.3.1 Method .............................................................................................................................. 17 2.3.2 Sampling ........................................................................................................................... 17 2.3.3 Data analysis ..................................................................................................................... 17 2.4 Stage 2: Youth questionnaire ................................................................................................... 18 2.4.1 Method .............................................................................................................................. 18 1 2.4.2 Sampling ........................................................................................................................... 19 2.4.3 Data analysis ..................................................................................................................... 19 2.5 Stage 2: Mental health service staff questionnaire ................................................................... 19 2.5.1 Method .............................................................................................................................. 20 2.5.2 Sampling ........................................................................................................................... 20 2.5.3 Data analysis ..................................................................................................................... 20 2.6 Limitations ............................................................................................................................... 20 2.7 Public and patient involvement ................................................................................................ 21 Section 3: Sample ............................................................................................................................. 22 3.1 Stage 1: Qualitative semi-structured interviews ...................................................................... 22 3.2 Stage 2: Youth questionnaire ................................................................................................... 22 3.3 Stage 2: Mental health staff questionnaire ............................................................................... 27 3.4 Sample summary ...................................................................................................................... 28 Section 4: Results: Understanding the elevated rates of LGBT youth suicide and self-harm .. 29 4.1 Suicide and self-harm ............................................................................................................... 29 4.2 Homophobia, biphobia and transphobia .................................................................................. 31 4.3 Sexual and gender norms ......................................................................................................... 35 4.4 Managing sexual orientation and gender identity across multiple life domains ...................... 37 4.5 Being unable to talk ................................................................................................................. 41 4.6 Other life crises ........................................................................................................................ 43 4.7 The relationship between self-harm and suicidality ................................................................ 45 4.7.1 Predicting suicidality......................................................................................................... 48 4.9 Key findings ............................................................................................................................. 49 Section 5: Results: LGBT youth help-seeking ............................................................................... 53 5.1 Asking for help ......................................................................................................................... 53 5.1.1 Predicting help-seeking ..................................................................................................... 56 5.2 From who and where do LGBT youth seek help? ................................................................... 57 5.3 Internet use and suicide ............................................................................................................ 59 5.4 Experiences of support and help .............................................................................................. 62 5.4.1 Informal support ................................................................................................................ 62 5.4.2 Health services .................................................................................................................. 64 5.4.3 Schools .............................................................................................................................. 66 2 5.5 Preferred sources and modes of help ....................................................................................... 66 5.6 Key findings ............................................................................................................................. 68 Section 6: Results: Mental health service staff knowledge, attitudes and practice.................... 71 6.1 Staff knowledge and attitudes .................................................................................................. 71 6.2 Staff practice and training ........................................................................................................ 73 6.3 Engaging LGBT youth in mental health services .................................................................... 75 6.4 Key findings ............................................................................................................................