Improving LGBTQ+ youth mental health through integration of care: a Foucauldian Discourse Analysis of qualitative data from Queer Futures 2 study

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The mental health of children and young people is a global priority. In the UK, the new NHS policy that integrates care is proposed to improve services and tackle health inequalities. Understanding barriers and facilitators to integration will help support mental health service delivery in line with this strategy. Success here is important for LGBTQ+ young people who experience poor mental health compared to young people that are cis-gender (i.e. whose gender aligns with their sex assigned at birth) and heterosexual (i.e. 'straight'). This situation for LGBTQ+ young people's is an inequality. It is explained by the fact that LGBTQ+ young people experience discrimination and marginalisation that impact their mental health. Subsequently, they are often unable to use existing mainstream mental health support services due to fear of judgment or having their sexual orientation shared with their parents/carers without their consent. Despite the evidence, many providers are unaware of LGBTQ+ young people's needs and how to help them. The Queer Futures 2 study identified different types of service that provide mental health support for LGBTQ+ young people e.g. schools, NHS and LGBTQ+ youth services. However, we also identified these services can differ in the how they understand LGBTQ+ young people and their needs. For example, some NHS providers reported that they did not consider specialist care was necessary for LGBTQ+ young people as NHS services are 'open to all.' But we know this is not perceived to be the case from the perspective of LGBTQ+ young people. Further, LGBTQ+ youth services reported how statutory services like social services, lacked understanding about LGBTQ+ identities conflating being LGBTQ+ with safeguarding issues and thus responding in ways that can be damaging to LGBTQ+ youth. Successful integration of care requires shared organisational priorities and good communication. However, what this means in the context of LGBTQ+ young people's mental health is so far unexplored. This proposed secondary analysis presents an opportunity to understand the relationships, communication and power dynamics across the LGBTQ+ youth mental health support sector. This is important to ensure that the best type of mental health support is available to LGBTQ+ young people. This will help address this significant health inequity. The way this project will achieve this understanding is by using a research method called Foucauldian Discourse Analysis to analyse the Queer Futures 2 qualitative data set which includes:- 41 interviews with staff from LGBTQ+ youth mental health services;- 45 interviews with LGBTQ+ youth;- Document data from 12 services e.g. policy and referral forms; and- Non-participant observation data.This method is suitable because it will help us think about the different meanings and power dynamics across the support system. The analysis will be co-designed by the research team and project steering group. The research team comprises academics and staff from LGBTQ+ mental health support services from Queer Futures 2. The project steering group will involve individuals invited to reflect different types of support relevant to the conversation about integration of care for LGBTQ+ youth mental health including: the national LGBTQ+ campaigning organisation Stonewall, LGBTQ+ young people, NHS mental health providers and education providers.The findings about barriers and facilitators to LGBTQ+ youth mental health integration of care will be used to co-design a 'speaking the same language' digital resource (e.g. animation) that will focus on aligning understanding and communication about LGBTQ+ youth and their mental health needs. This resource will be shared via national LGBTQ+ and clinical networks e.g. Stonewall, LGBT Consortium; and on the Queer Futures 2 website for free. We will also write a report, two articles for academic journals and visit conferences to share what we lear