01 / LGBT Young People: Mental Health & Well Being in Europe

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David Farrington (30/07/2007)

- from: "IGLYO on... MENTAL HEALTH" / - issue n.1 - march 2007-

David Farrington has been working in the LGBT sector for over 10 years , working across many different cultural contexts and has been working extensively in the area of LGBT youth in the past few years.

IGLYO's 22nd Annual conference 'Beyond Coming Out' represented an extraordinary milestone in European LGBT cultural history and a political turning point for queer young people from all over the European Union in regards to mental health. Mental Health is now being seen as an integral and important part of how it affects and has a direct relationship in creating an equitable, healthy and prosperous society. It has been said that we judge the basis of a civilisation on how well it supports its most vulnerable of citizens. In many ways the well being of young LGBT people acts as a barometer of democracy, citizenship and an indicator of a just and fair European society. The mental health of LGBT young people therefore has important implications on the well being of all Europeans and the future success of new Europe itself.

So... what is Mental Health and or LGBT Youth Mental Health

The term 'mental health' can historically be one of the most vague, misunderstood and until recently, poorly defined words in the English lexicon. It is this, lack of clarity that has often created confusion or misunderstanding especially from inter-cultural perspectives. Internationally, the most widely used definition is that of the World Health Organisation (WHO). WHO describes mental health as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community. It is a resource for living and more than just the absence of mental illness.

From an LGBT young persons' perspective, while these definitions are important frames of reference, it's important to consider that we also construct our own definitions of what mental health means to us as a community and as a distinctive set of our own cultures. At this years conference, young people were invited to 'paint' what they felt 'mental health' meant to them. This proved an interesting experience as the mental health 'universe' was interpreted across many different dimensions - personal, organisational, cultural and social reflecting the complexity of the area and the need to consider our own cultures perceptions in creating definitions. At the conference young people collectively defined 'mental health' for them as being, and interaction between the social and individual together with the opportunity to find one's own identity and the ability to express such an identity and be respected and the actual ability to value yourself, and in so doing being valued by others. With the possibility of viewing such as being a fluid and changeable process that allows the individual to grow and have a meaningful life. To finally looking into the possibility to having resources in order to cope and the ability to access help both internally and externally. (IGLYO, 2006)

This is especially important considering heterosexist normativity and the imposition of alternative cultural values onto our own. Living a life free from the impact of homophobia and heterosexism would be a common sense definition of positive mental health. As a culture we have made incredible advances in for example sexual health approaches in LGBT communities; we expect to see the same in the area of mental health for our young people. LGBT culture and especially young LGBT people are sometimes particularly creative (FLAIRS, Farrington, 2007) for example. Being able to positively support and express that creativity may be an important aspect of an LGBT mental health definition and is an essential expression of good mental health. Highly creative people are also sometimes more at risk of mental illness as well as being often quite gifted. Therefore we should also consider the vulnerabilities and risks that may accompany such creativity in our young people as well as nurture their creative strengths (FLAIRS, Farrington, 2007).

Mental Illness vs Mental Health
One of the biggest issues to emerge both at the conference and in the field is the critical difference between mental illness and mental health. For many countries and health systems mental health means only one thing ; mental problems and mental illness. Referred to as the medical or deficit model this approach to mental health (the most common for the first part of the 20th Century) views mental health in the negative. A useful concept is that of the mental health continuum proposed by Mezak & Haggerty (1994)

Mental illness is what results when an individual loses their mental health and can no longer cope with demands and pressures of everyday life and experience major problems in their work, social and emotional lives. Much of thinking about mental health historically and professionally has focused on this area of the mental health continuum. What this means is that we think about mental health as something we repair when it breaks down and to do this we need specialist and professional help. The mental illness approach also tends to be more established and linked to class and narratives of power in society. Traditionally, the medical profession has defined and controlled the 'mental illness' agenda and the 'treatment' of mental illness has been biological through drugs, therapies and surgery. While medical and psychological approaches to treating mental illness are still critical the medical model is limited in its ability to explain or treat mental illness that has been created by social mechanisms such as poverty, social exclusion, discrimination and cultural dislocation and the dynamics of community psychology.

The illness model also has a damaging history in LGBT human rights, actually reinforcing the disempowerment of sexual minorities. For example, even today in first world countries mental health professionals still continue to pathologise sexual difference or at best interpret the causes of a LGBT young persons distress to them as individual vulnerability rather than to the broader powerful forces of homophobia and heterosexism in their lives. In many other countries, sexual orientation and gender identity remain a psychiatric diagnosis in their own right. Further the medical model potentially creates stigma and the social exclusion of young people within LGBT communities themselves because of fear of mental illness itself especially in disempowered minority cultures. Not surprisingly, a critical issue for many LGBT youth services in Europe when approaching the mental health universe is they have also fallen into the illness model, for example providing only individually focused support services, counselling and therapies. IThese services are critically important to have but it means focusing on young people who are already developing or have major problems and not addressing broader social and cultural approaches at the community level for maintaining wellness in all young queer people.

Positive Mental Health and Well Being in LGBT Youth People
A controversial aspect of the conference was that of the notion of positive mental health and what this means. If we examine the other end of the mental health continuum we discover a whole different universe of wellness, prevention and positive mental health. Positive mental health is being mentally, emotionally and psychologically well, the opposite of mental illness. From a health perspective there is now much interest in understanding what keeps people well rather than what makes them sick and designing services and projects that prevent mental illness from occurring. In the last decade there have been incredible advances in positive mental health and the prevention of mental illness. Indeed many advanced health care systems now fully fund illness and prevention-based approaches and in the era of health care cost blow outs prevention of mental illness makes even more sense though this varies across Europe considerably (Mental health promotion and mental disorder prevention across European Member States: a collection of country stories: IMPHA European Network on mental health promotion and mental disorder prevention)

Positive mental health fits well with the social model of mental health for LGBT young people. The social model of mental health views homophobia, heterosexism, stigma and the resulting social exclusion as the major social determinants of the mental health inequalities young queer people experience. If we use this critical approach then we better understand the reason for existing problems and especially how to prevent the development of mental illness in a very different way. Mental health promotion (using the principles of the OTTAWA Charter) and community development approaches to identity-based positive mental health have been proven to be effective, sustainable and relatively cheaper as a strategy to prevention. A 'risk and resiliency' prevention approach looks at decreasing the many things that place young people the most at risk for becoming ill and increasing the things make young people emotionally stronger, more resilient and maintain their positive mental health. Research convincingly indicates the major risk factors are most often family and parent rejections, school bullying and isolation in many forms be it from other young queer people (especially rural young people), from LGBT understanding services and through the isolating effects of mental health stigma to even seek help. Risk also occurs a times of major change such as during coming out or from stress of having to 'manage being 'closeted or out' all the time. Young LGBT people appear most at risk for suicide when they know their sexual identity but have not actually 'come out' or if come out at very early ages when there very family dependent. Homelessness or unemployed due to homophobia are also major risk areas. Self harm has been shown to be a way of coping and surviving with homophobia. Things that protect young queer people are being attached to a young LGBT culture and LGBT youth groups, having supportive parents and friends, sometimes faith in the case of ethnic young people, a positive and supported coming out, positive role models and images and being free from bullying and other forms of homophobia. There are also differences positively and negatively according to whether a young person is lesbian, gay, bisexual or transgender (the latter two young people are often most at risk).

LGBT Youth Practice, Participation and Peer Education in Communities
LGBT youth workers and young LGBT Activists are often the people closest and most trusted by young queer people. Consequently, as professionals or within the an activists role they have a critical first line role in several aspects of their mental health. At an individual level and with the right support & training, they can help in identifying early signs of illness i.e. early intervention and in specialist referring, thy can promote mental health awareness and challenging mental health stigma in queer youth culture. They can also strengthen protective factors such as social supports and create positive role models. The community principle of civic citizenship and especially participation - young people participating themselves in all aspects of their own community development including finding solutions for their mental illness and positive mental health is itself a major protective factor and is mental health promoting. Peer education in particular is a powerful social approach that youth workers and young LGBT activists can develop in consultation with young people. Peer education informally places young people's owns shared experiences at the heart of what best works for them in both preventing problems as well as what can be done if a young person is becoming unwell. It is also a way to spread strategic prevention messages about mental health, raise mental health awareness and support community development. It is an effective way to support young people sharing effective coping and resiliency skills especially in dealing with homophobia and social exclusion or teaching mental health 'first aid' to young LGBT people. Mental health promotion importantly means going beyond just the individual focus & tackling the broader causes of mental illness as well as promoting what naturally improves or maintains good mental health especially in at risk groups such as LGBT young people. This means working across multiple sectors where risk and promotion issues are such as in schools, in cyberspace, at work and with parents & families. It means addressing structural barriers in homophobic and heterosexist young peoples mental health services to improve access as well as strengthening communities to develop their own responses to specific issues such as suicide awareness & prevention. Designing services that are informal or not 'mental illness' identified is an important aspect to engage young LGBT people because of the effects of mental health stigma in reducing help seeking. At the end of the day, mental health & well being for LGBT young people requires a whole community approach for it to succeed

Beyond Coming Out meant addressing broader social issues for young LGBT people and the impact upon mental health. Young LGBT like any young person today have often higher pressured, faster and more complex lives than a generation ago and less time to simply 'be young'. The LGBT and mainstream media has a powerful influence on identity construction and pressures to conform to narrow, unrealistic stereotypes and images. Globalisation, overwork, changing employment and family patterns, technology, the commercialisation of young life and the Western 'me only' culture means social connection, a sense of community and things that preserve well being are becoming lost in many industrialised European countries for young people. These pressures only add and interact with homophobia and heterosexism and their impact and increase a possible need for a social and cultural approach to LGBT Youth mental health

References:

World Health Organisation (WHO) - "on mental health..." - www.who.int/mental_health/en/

OTTAWA Charter for Health Promothoion, First International Conference on Health Promotion (Ottawa, 21 November 1986) - www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

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