Over the last decade there has been a number a monumental legal changes in the United Kingdom (UK), which have promoted equality for Lesbian, Gay, Bisexual and Transgender (LGB&T) individuals. Nevertheless, the unique health vulnerabilities highlighted by Mayers (2001); suggesting LGB&T individuals to be exposed to particular health inequalities across the life course, remain a public health challenge today.

In a UK survey Stonewall (2011) found that 13% of gay and bisexual men were experiencing moderate to severe levels of anxiety and depression compared to 7% of men in general, suggesting gay and bisexual men to be disproportionally affected by anxiety and depression. Furthermore, in a separate survey Stonewall (2012) found that 55% of young LGB&T individuals had experienced bullying whilst attending school. The impact of the bullying on emotional health was also measured within the survey and 46% of those who reported to have experienced bullying reported to have low self-esteem. Another significant finding by Stonewall (2012) was that over 50% of (n=1616) young LGBT people reported to have deliberately self-harmed, which included cutting and overdosing. Ultimately, the evidence from Stonewall (2011, 2012) is suggestive that young LGBT individuals have a number of unmet emotional health needs, which unaddressed will significantly impact on their emotional health across the life course. In their role school nurses support a number of young people with their emotional wellbeing, how often are you offering a platform for young people to discuss sexuality? How confident are you in championing the health and wellbeing of LGB&T young people locally? 

A further challenge facing a large cohort of young LGBT people found by Stonewall (2012) is that they do not have an appropriate adult to talk to. The 54% who reported to not have an adult to talk to were also found to have more significant depression than the 36% of young LGBT people who had an adult to talk to. In a separate study Ryan et al. (2010) used a mixed method approach to evaluate the impact of having an appropriate adult to talk to for a family accepting of an LGBT young person’s sexuality. Family acceptance and accessing support from an appropriate adult were found to be associated with greater self-esteem, health status and an overall marked improvement in emotional wellbeing; suggesting that the essence of containment for LGBT young people to be central as a predictor in achieving positive public health outcomes. Findings by Ryan et al. (2010) also recognised that relationships with parents and other adults are often challenged at the time of disclosure of sexual identity; with the experience being noted as traumatic for young people and having a lasting impact on emotional health as a result of the profound feelings of guilt, rejection and fear. Therefore, access to an appropriate adult could be considered to positively enhance the emotional wellbeing of LGBT young people by actively offering containment throughout adolescence. Are school nurses in a prime position to offer such support to young people and in addition to offering containment; could school nurses in their public health role ensure LGBT young people receive an appropriate package of care to meet their individual group vulnerabilities? 

Recent Public Health England (PHE 2015) Sexually Transmitted Infection (STI) data identified how there have been large increases in STI diagnosis's amongst men who have sex with men (MSM). Such increases included a 21% increase in gonorrhoea and 19% increase in syphilis. Furthermore, over 129,000 chlamydia cases were found to be associated with young people aged 15-24. Whilst, data relating to young peoples sexual health are not specifically relating to MSM, consideration of the vulnerabilities of MSM added with the vulnerabilities facing young people as a population would suggest young MSM are an extremely vulnerable population in term of their sexual wellbeing. How can school nurses promote prevention and early intervention in this area? Are you delivering sexual education that is inclusive of the needs of LGB&T individuals? If not why not and how could you address this locally?

The LGB&T Foundation (2014) found LGB&T individuals more likely to misuse alcohol and other substances compared to non LGB&T individuals. In their survey of (n=6000) LGB&T individuals representative of all ages, 35% of respondents reported to have taken an illicit substance in the last month. This figure was seven times greater than that reported by the British Crime Survey (Office for National Statistics 2011) data around the time of the study taking place. The LGB&T Foundation (2014) study also found alcohol consumption to be remarkably higher amongst the LGB&T population; with individuals at any age to ‘binge twice as likely to ‘binge’ drink once weekly when compared with the general population. Overall, there is sufficient evidence to suggest that young LGB&T people are vulnerable to misusing substances which known to impact on their health across life course, in addition to increase the likelihood of risk taking behaviours. A brief intervention approach by school nurses working with LGB&T individuals a around smoking, alcohol and other substances will enhance care delivery to this vulnerable population. How would this brief intervention approach look in practice for you?

This #WeScNs discussion will explore the role of the school nurse in enhancing the health and wellbeing of this evidently vulnerable population. We will discuss best practice, current evidence and what else we can do to enhance the health and wellbeing of LGB&T young people across the life course. 

Pre Chat prepared by @mrdaniellucy

References and Further Reading:-

Devlin, C. (2014), How you can help us: How adults can help Lesbian, Gay, Bisexual, and Trans Youth, Manchester: LGBT North West. 

LGBT Foundation. (2014), Part of the Picture: LGB Alcohol & Drug use in England and Wales, Manchester: LGBT Foundation.

Meyer, I.H., ‘Why lesbian, gay, bisexual and transgender public health?’ American Journal of Public Health, Jun 2001, 91 (6): 856-9.

Office for National Statistics. (2011), Crime in England and Wales 2010-2011, London: Office for National Statistics. 

Public Health England. (2015), Health Protection Report: Sexually Transmitted Infections and Chlamydia Screening in England, London: DoH.

Ryan, C., Rusell, S.T., Huebner, D., Diaz, R., Sanchez, J. (2010), ‘Family acceptance in adolescents and the health of LGBT young adults’, Journal of Child and Adolescent Psychiatric Nursing, Vol. 23, no. 4, pp. 205-213. 

Stonewall, (2012), The Experience of Gay Young People in Britain’s Schools in 2012, London: Stonewall.

Stonewall. (2011), Gay and Bisexual Men’s Health Survey, London: Stonewall. 

Youth Chances. (2014), The Experiences of LGBT Young People in England, London: Youth Chances.