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

儿童和青年的心理健康是一项全球优先事项。在英国，提出了整合护理的国民保健制度新政策，以改善服务和解决保健不平等问题。了解融入社会的障碍和促进因素将有助于支持按照这一战略提供精神卫生服务。对于LGBTQ+年轻人来说，与顺性（即其性别与出生时的生理性别一致）和异性恋（即性别与出生时的生理性别一致）的年轻人相比，心理健康状况较差的LGBTQ+年轻人在这方面的成功很重要。“直”)。这种情况对LGBTQ+年轻人来说是一种不平等。这是因为LGBTQ+年轻人遭受歧视和边缘化，影响了他们的心理健康。随后，他们往往无法利用现有的主流心理健康支持服务，因为他们害怕受到评判，或者害怕在未经父母/照顾者同意的情况下将自己的性取向告诉他们。尽管有这些证据，但许多服务提供者并不了解LGBTQ+年轻人的需求，也不知道如何帮助他们。酷儿未来2研究确定了为LGBTQ+年轻人提供心理健康支持的不同类型的服务，如学校、NHS和LGBTQ+青年服务。然而，我们也发现这些服务在理解LGBTQ+年轻人及其需求的方式上存在差异。例如，一些NHS服务提供者报告说，他们认为LGBTQ+年轻人没有必要接受专科护理，因为NHS服务“向所有人开放”。但我们知道，从LGBTQ+年轻人的角度来看，情况并非如此。此外，LGBTQ+青年服务机构报告说，法定服务机构，如社会服务机构，对LGBTQ+身份缺乏了解，将LGBTQ+与保护问题混为一谈，从而以可能损害LGBTQ+青年的方式作出回应。成功的整合护理需要共享的组织优先事项和良好的沟通。然而，到目前为止，这在LGBTQ+年轻人的心理健康背景下意味着什么还没有被探索。这项建议的二次分析提供了一个机会，让我们了解LGBTQ+青年心理健康支持部门的关系、沟通和权力动态。这对于确保LGBTQ+年轻人获得最佳类型的心理健康支持非常重要。这将有助于解决这一重大的卫生不平等问题。这个项目将通过使用一种叫做福柯话语分析的研究方法来分析《酷儿未来2》的定性数据集，其中包括：41位来自LGBTQ+青年心理健康服务机构的工作人员的访谈；- 45位LGBTQ+青年的访谈；- 12项服务的文件资料，例如政策及转介表格；和-非参与者观察数据。这种方法是合适的，因为它将帮助我们思考整个支持系统的不同含义和权力动态。分析将由研究小组和项目指导小组共同设计。研究团队由来自酷儿未来2的LGBTQ+心理健康支持服务的学者和工作人员组成。项目指导小组将邀请个人来反映与LGBTQ+青年心理健康综合护理对话相关的不同类型的支持，包括：全国LGBTQ+活动组织石墙、LGBTQ+年轻人、NHS心理健康提供者和教育提供者。关于LGBTQ+青年心理健康整合护理的障碍和促进因素的研究结果将用于共同设计一个“说同一种语言”的数字资源（例如动画），该资源将侧重于协调对LGBTQ+青年及其心理健康需求的理解和沟通。该资源将通过国家LGBTQ+和临床网络共享，如Stonewall， LGBT联盟；以及《酷儿未来2》网站免费下载。我们还会写一篇报告，两篇学术期刊文章，参加会议，分享我们学到的东西

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