Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach

Elizabeth McDermott (), Alex Kaley, Eileen Kaner, Mark Limmer, Ruth McGovern, Felix McNulty, Rosie Nelson, Emma Geijer-Simpson and Liam Spencer
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Elizabeth McDermott: School of Social Policy, University of Birmingham, Birmingham B15 2TT, UK
Alex Kaley: School of Health and Social Care, University of Essex, Colchester CO4 3SQ, UK
Eileen Kaner: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
Mark Limmer: Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
Ruth McGovern: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
Felix McNulty: Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
Rosie Nelson: School of Sociology, Politics and International Studies, University of Bristol, Bristol BS8 1TU, UK
Emma Geijer-Simpson: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
Liam Spencer: Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK

IJERPH, 2023, vol. 20, issue 5, 1-16

Abstract: Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people. The aim of this UK study was to develop a programme theory that explained how, why, for whom, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders. Online realist interviews were conducted in the UK with (1) LGBTQ+ young people aged between 13–18 years attending secondary schools ( N = 10); (2) intervention practitioners ( N = 9); and (3) school staff ( N = 3). A realist retroductive data analysis strategy was employed to identify causal pathways across different interventions that improved mental health outcomes. The programme theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils’ mental health. We found that context factors such as a ‘whole-school approach’ and ‘collaborative leadership’ were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health: (1) interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition; (2) interventions for talking and support that develop safety and coping; and (3) interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety. Our theoretical model suggests that providing a school environment that affirms and usualises LGBTQ+ identities and promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils.

Keywords: mental health; LGBTQ+ youth; adolescence; sexual/gender minority (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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