Title: Identifying and evaluating mental health early intervention services and self-care support for lesbian, gay, bisexual and transgender young people: A mixed methods study.
Funder: Department of Health and Social Care

Abstract: Lesbian, gay, bisexual and transgender (LGBT) young people are more likely to suffer from depression, self-harm, suicidal thoughts and poor mental health than heterosexual young people. In the largest UK research study conducted so far, young people who were LGB and under 35 years old were two times more likely to have poor mental health compared to heterosexual young people. We also know that despite having more mental health problems, LGBT young people are reluctant to seek help from mental health services, and when they do, they often find them unhelpful. There is very little research on LGBT young people and mental health services and as a result we do not understand their mental health support needs. The aim of our study is to produce research that will improve the provision of mental health early intervention services and self-care support to LGBT young people in England and Wales. _x000D_ _x000D_ Our research study will have 3 stages. First, we will search for, and examine, all the international research on mental health services and support for LGBT young people. This will help us understand what type of services are acceptable to LGBT young people and will improve their mental health. Second, we will search for and locate mental health (early intervention and supported self-care) services in England and Wales that are aimed at, or have developed their service for, LGBT young people. Thirdly, we will choose 12 of the services we have found and ask LGBT young people, their family/carers and staff from these services about what works and what does not in improving LGBT young people’s mental health, and how we can improve mental health services. We will also collect information that will help us work out how much these services would cost._x000D_ _x000D_ Our study will involve service users and the public in three ways. A service user from OpenMinds, a LGBT mental health youth group, will be part of the research team. They will have direct experience and knowledge of mental health services and the issues faced by LGBT young people. This will help make sure the research study asks the right questions, in the right way, so that we can fully understand how to meet the mental health needs of LGBT youth. The second way we will involve the public and patients is through a LGBT Youth Advisory Group. This group will be made up of young people from 3 LGBT youth groups - The Proud Trust in Manchester, Leicester LGBT Centre, and Allsorts in Brighton. The group will be run online throughout the study using an online media format (e.g. twitter, Facebook) that will be decided by the young people at the start of the study. We have done this before with our research on LGBT youth mental health and the young people who were involved told us that using online media made it easier to take-part. Thirdly, the research study advisory group will include a range of LGBT young people stakeholders such as Gendered Intelligence and The Proud Trust. _x000D_ _x000D_ Our research will produce evidence, which is currently missing, on early intervention and self-care mental health services that are accessible and acceptable for LGBT YP with common mental health problems. We will produce guidance for the NHS about these mental health services so that the NHS can develop services that LGBT young people feel safe to use and that meet their mental health needs.

Lay abstract: BACKGROUND: Lesbian, gay, bisexual and transgender (LGBT) young people (YP) report significantly higher rates of depression, self-harm, suicidality and poor mental health (MH) than heterosexual youth [1-8]. In a pooled analysis of 12 UK population surveys, those who were under 35 and identified as LGB were twice as likely to report symptoms of poor mental health compared to their heterosexual counterparts [9]. Recent evidence suggests that although there is a greater mental health burden in this population, LGBT YP underutilize MH services, do not access them until crisis point and often find them unhelpful [10, 11]. The UK evidence-base examining LGBT YP’s mental health support needs and service preferences is very limited. Consequently, (and despite this manifest inequality and underutilization of MH services), there is no UK research on how to develop accessible and acceptable MH early intervention and supported self-care provision to this vulnerable group. Our application aims to deliver rigorous evidence to fill this gap and address this inequality._x000D_ _x000D_ AIM: To improve the provision of mental health early intervention services and self-care support to LGBT young people in England and Wales. _x000D_ _x000D_ RESEARCH QUESTIONS: _x000D_ 1. What evidence exists on MH early intervention services and supported self-care for LGBT YP?_x000D_ 2. What type of service models for MH early intervention and supported self-care to LGBT YP are currently provided? _x000D_ 3. How, why and in what context do MH early intervention services and supported self-care work for LGBT YP?_x000D_ 4. In what ways do LGBT YP access and navigate formal and informal MH early intervention services and self-care support?_x000D_ 5. How can LGBT YP be encouraged to access and engage with MH early intervention services and self-care support?_x000D_ _x000D_ METHOD: The research project is a mixed methods study and uses a theory-driven evaluation research strategy that is appropriate when there is little evidence on the effectiveness or acceptability of services [12]. The study design has 3 stages:_x000D_ 1) Evidence synthesis: A systematic review [13] of the literature on MH early interventions and self-care support for LGBT YP. _x000D_ 2) Service mapping: Will identify MH early intervention and supported self-care services that are aimed at, or have developed a focus on, LGBT YP._x000D_ 3) Case study evaluation: A collective case study consisting of 12 case studies selected from those services identified in stage 2 (service mapping). For EACH case study site multiple sources of data will be obtained through: i) semi-structured interviews with LGBT YP, family members, and service provider staff (n=10); ii) focus groups with LGBT YP (n=2); iii) documentary review; iv) virtual non-participant observation. We will also collect data on service cost. A purposive sampling strategy [14] will be used to select participants. Case study evaluation is a theory-driven evaluation methodology and therefore the data analysis strategy is theoretical using the ‘explanation-building’ analytical technique [12]._x000D_ _x000D_ OUTCOMES: The research will produce evidence, which is currently missing, on MH early intervention and self-care services and interventions that are accessible, acceptable and meet the needs of LGBT YP with common mental health problems. The study will produce commissioning guidance to enable NHS MH commissioners to make evidence-based decisions to improve local commissioning to address the MH of this disadvantaged group of YP.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH