Exploring Heteronormativity in Mental Health Services: The Experience and Impact of Identity Disclosure for LGBTQ+ Young People who Self-Harm or Feel Suicidal

Background: Mental health services in the National Health Service (NHS) exist in a context of heteronormativity, where there are assumptions made within services and wider society about the expected nature of sexual and gender identity, implicitly and explicitly. LGBTQ+ (lesbian, gay, bisexual, transgender, queer, questioning and any other sexual minority identity) adolescents and young adults are at a stage of life where they are forming their identities. This group of young people experience elevated risks of mental health needs, including self-harm and suicidality. Experiencing self-harm or suicidal feelings, and being LGBTQ+, are both associated with stigma and rejection, including within mental health services; this can have implications for help-seeking and being open about their identities.

Aims: This study aimed to explore the experience and impact of LGBTQ+ identity disclosure in NHS mental health services, for young people (aged 14-25) who experienced difficulties with self-harm or suicidality. The study aimed to provide space for young people’s voices, and to promote changes within systems for improving care for this group of young people.

Method: Qualitative semi-structured interviews were used to gather information from five young people, recruited through social media. Transcripts were analysed using Reflexive Thematic Analysis.

Findings: Three primary themes were developed from the analysis: ‘power and powerlessness’, ‘making sense of identity’, and ‘the importance of relationships’. The experience and impact of these concepts were explored, recognising the context of pervasive heteronormativity in NHS services, from a critical realist epistemological stance.

Conclusions: There is a need for change in individual clinical relationships, and at service and wider policy levels in the NHS, to prevent harmful experiences and longer-term consequences for LGBTQ+ young people. Changes are needed to reduce heteronormative bias and provide affirmative, transparent, supportive care to young people experiencing self-harm or suicidality, in their LGBTQ+ identity disclosures and subsequent interactions with clinicians.