One in three lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people within the UK experience mental health difficulties, compared to one in eight young people within the general population (NHS Digital, 2018). Additionally, LGBTQ+ people are less likely to access mental health services due to reasons such as perceiving services as discriminatory and experiencing higher levels of dissatisfaction with such services (Hudson-Sharp & Metcalf, 2016). As such, many LGBTQ+ young people may feel forced to self-manage their mental health difficulties.

Self-management can be defined as taking responsibility for personal wellbeing and behaviour (Oxford English Dictionary, 2020), e.g., using unguided self-help interventions (Bennett et al., 2019), self-care approaches (Wolpert et al., 2019), or strategies to cope with and regulate emotions (Stapley et al., 2019).

However, research on self-management of mental health difficulties within LGBTQ+ young people is limited. Thus, we do not know much about, e.g., how self-management can be better facilitated. As such, Town et al., (2021) aimed to explore the experiences and opinions of LGBTQ+ young peoples’ use of self-management strategies regarding their mental health, and what helps them and stops them from self-managing, and what their challenges are.

Methods

This study was qualitative and included telephone or video call semi-structured interviews due to Covid-19 restrictions. Initially focus groups were also included; however, this was scrapped following the pilot study due to the emerging rich and highly personal data. The questions explored participants’ perceptions of self-management, types of self-management strategies, what stopped them or helped them self-manage, and self-management challenges. Following the pilot study, questions also included potential follow-ups regarding the first UK Covid-19 lockdown to better understand how this may have impacted self-management.

Participants

20 LGBTQ+ young people aged 13-24 were recruited online via a Google search from 12 LGBTQ+ University Societies, three post-graduate student cohorts, 85 LGBTQ+ youth groups or associated organisations, one participation group, and the primary researcher’s existing organisational contacts via email.

Regarding participants’ gender identity, 12 were female, three were male, one preferred not to say, and four preferred to self-describe which included gender queer, asexual, and non-binary. The rest of the sociodemographic data that was reported by the majority were that their gender identity was the same as the sex assigned at birth, and most were White – British. Participants’ sexual orientation was mixed, with most stating they were bisexual.

Four participants participated across two focus groups, and 16 participated in one-to-one interviews.

Data analysis and epistemological stance

Data were analysed using reflexive thematic analysis as proposed by Braun & Clarke (2019). The initial coding structure was cross-checked by the project team, and codes were refined. A realist ontological and relativist epistemological stance was taken and the data were analysed inductively, meaning the results were driven by the data (Braun & Clarke, 2006).

Results

Following data analysis, three themes and 15 subthemes emerged.

Theme 1: Self-management strategies and process

• 51 self-management strategies were found, with ‘speaking to or meeting up with friends or a partner’ being the most common
• It is important to notice the signs of good or poor mental health, prevent deterioration of mental health, and use self-management strategies when needed.

Theme 2: Self-management barriers

• Self-management can be difficult when feeling too low or tired, and unsuccessful self-management leads to disappointment and discouragement
• Self-management can be time-consuming and tiring, and it can be difficult to know where to start or what to do
• There are unhelpful self-management strategies, e.g., drinking alcohol and self-harming. Some unhelpful factors also include negative feedback loops when speaking about mental health difficulties with others
• The ‘self’ can prevent self-management, e.g., when an individual wants to wallow in their negative emotions
• Feeling responsible to self-manage is a double-edged sword: while participants can rely on themselves, this also creates pressure
• Although social support is perceived as important and can help participants work on themselves, factors preventing participants from reaching out to others included others being worried
• Culture affects treatment access, and the understanding of the word ‘self-management’, as not everyone may use this word
• The environment can affect self-management, e.g., it can be more difficult to self-manage in public
• Covid-19 negatively affected self-management and general wellbeing, e.g., due to longer waiting lists and not being able to attend LGBTQ+ youth groups
• Some forms of self-management, more so referred to as self-care, e.g., bullet journals, are perceived to centre on profit, making it harder to find ‘actual self-care’
• Online resources, e.g., videos and online groups, are used to help self-manage; however, these can sometimes be unhelpful or overwhelming
• Not being ‘out’ as LGBTQ+ posed self-management challenges due to having to self-manage alone, and challenges accessing judgment-free spaces and therapy for LGBTQ+-related difficulties
• Societal or cultural intolerance of LGBTQ+ people negatively impacted self-management ability
• LGBTQ+ specific self-management strategies are scarce
• Family members rejecting participants’ LGBTQ+ identity negatively impacted self-management ability
• Participants avoid opening up to others due to their LGBTQ+ identity for fear of discrimination.

Theme 3: Self-management facilitators

• Self-management strategies are easier if they are a habit
• It is helpful to have a quiet place to self-manage
• Successful self-management has intrinsic benefits, e.g., freedom, ownership, and confidence. It helps participants feel present and connected
• Self-management can be enjoyable, particularly as it can involve doing fun activities and help participants live better lives
• Good mental health is perceived to be associated with interacting socially with others, e.g., speaking to friends or contributing to society. In contrast, poor mental health can be perceived as by isolating and taking other peoples’ comments personally
• Social support and motivation are important for self-management, e.g., via listening, encouragement, and reminders to self-manage
• Participants acknowledged the importance of engaging in help-seeking behaviour from others, e.g., professionals, despite efforts to self-manage independently, and doing so means being vulnerable and opening up
• Covid-19 had some benefits, e.g., more time to self-manage, developing closer relationships with family members, and developing consistent routines
• Having access to LGBTQ+ communities helps participants self-manage via a sense of togetherness and safe spaces.

Conclusions

LGBTQ+ young people use various mental health self-management strategies. However, there are some barriers to this. These findings, thus, warrant further exploration developing research-informed support that can be tailored for specific groups such as gender diverse people, as some groups of people may find some self-management strategies more helpful than others (Puckett et al., 2020). Future research should investigate LGBTQ+ community support or youth groups as key facilitators for self-management, as this was noted by participants and is perceived to have implications for policy and intervention development. Moreover, future research should consider digital interventions for LGBTQ+ young people and how this can facilitate self-management to improve mental health.

 

Strengths and limitations

One study strength was the diverse participant pool regarding various factors including LGBTQ+ identities and geographical location, which allowed access to a wider range of views and better transferability of findings. However, some geographical locations within the UK were less covered, e.g., Scotland; thus potential geographic variation in such areas was unlikely captured.

Another study strength was that the inductive data analysis enabled wider themes to be found outside the research questions, such as ‘wanting to wallow’, making the findings data-driven and holistic. Additionally, cross-checking codes during data analysis led to increased trustworthiness of the findings. This is because this ensured that the interpretations were grounded in the data (Korstjens & Moser, 2018) and limited researcher bias, therefore increasing study validity.

Moreover, although the participant pool was diverse regarding LGBTQ+ identities, this may have been skewed favouring those who are ‘out’. Thus, it is difficult to understand potential differences in self-management, e.g., more anonymous self-management strategies, between those who are ‘out’ and those who are not. This is further perpetuated by the necessary parental consent for participants under the age of 16, and those living with individuals who are unsupportive of the LGBTQ+ community, as such individuals were unlikely to have participated. Additionally, participants may have been those with better financial means due to the necessary access to computers or mobile phones as a result of Covid-19 lockdown restrictions, which may impact the type of self-management strategies used.

Implications for practice

This study suggests that there are many ways LGBTQ+ young people self-manage their mental health and that social support and safe spaces are important factors. However, there are barriers, e.g., not being ‘out’ and consequently having less access to LGBTQ+-related support, and not having specific LGBTQ+-related self-management strategies. Therefore, future research should look into ways to help such people self-manage. Specifically, researchers could implement and evaluate digital interventions, given that this was mentioned by participants. Although it should be acknowledged that this would require a computer or mobile phone access, which not everyone has, thus impacting who might benefit.

Moreover, whilst social support is considered to be crucial, unfortunately, LGBTQ+-related discrimination still exists. This poses the question of how to best mitigate this, which future research could also consider. It may be that more inclusivity, education, and normalisation on LGBTQ+-related topics could be helpful, as suggested by Stonewall (2021). Mental health practitioners should thus be encouraged to consider inclusion and diversity and the impact this has on service users’ quality of care. Internal events and training for staff could help to facilitate this, perhaps even including LGBTQ+ service users on their experience of accessing mental health services and ways the experiences can be improved. This is particularly important given the findings that LGBTQ+ young people may not access mental health services due to discrimination, suggesting more work on making mental health services anti-discriminatory is necessary.

Statement of interests

None.

Links

Primary paper

Town, R., Hayes, D., Fonagy, P., & Stapley, E. (2021). A qualitative investigation of LGBTQ+ young people’s experiences and perceptions of self-managing their mental health. European Child & Adolescent Psychiatry, 1-14.

Other references

Bennett, S. D., Cuijpers, P., Ebert, D. D., McKenzie Smith, M., Coughtrey, A. E., Heyman, I., … & Shafran, R. (2019). Practitioner review: Unguided and guided self‐help interventions for common mental health disorders in children and adolescents: A systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 60(8), 828-847.

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Hudson-Sharp, N., & Metcalf, H. (2016). Inequality among lesbian, gay bisexual and transgender groups in the UK: a review of evidence. London: National Institute of Economic and Social Research.

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NHS Digital (2018) Mental Health of Children and Young People in England, 2017: behaviours, lifestyles and identities. Accessed 19 Apr 2021

Oxford English Dictionary (2020) “self-management, n.“. Oxford University Press. Accessed 19 Apr. 2021

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Stonewall (2021, August 17). “This is how LGBT-inclusive education can change lives”.

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Photo credits

• Photo by Yingchou Han on Unsplash