Striving for inclusive practice

Article in Review: Wishart, M., Davis, C., Pavlis, A. & Hallam, K. (2020). Increased mental health and psychosocial risks in LGBQ youth accessing Australian youth AOD services, Journal of LGBT Youth, DOI: 10.1080/19361653.2019.1663335

Summary & relevance: A recent study has focused on young people engaged with Alcohol and Other Drug (AOD) services to test the hypothesis that LGBQ young people are more vulnerable across several risk indicators when compared to non-LGBQ young people.

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Current research suggests that LGBQ young people have significantly higher rates of substance abuse than their non-LGBQ counterparts. This has been traditionally understood through the Minority Stress model which suggests that the combined effect of stigma, prejudice and discrimination create a unique hostile and stressful social environment that contributes to negative physical and mental health problems among marginalised groups.

A 2020 study has assessed the suggestion that young people who identify as LGBQ would have higher rates of:

• Current issues
• Conflict with families
• Disconnect from families
• AOD usage
• Severity in AOD use
• Experiences of trauma and violence
• Poor psychological health
• Poor mental health
• Suicide attempts

Methodology

A matched pairs sample was drawn from groups of young people who had been accessing youth AOD services on specific dates in Victoria and Queensland. Youth workers engaged with the young participants accessed wide-ranging data related to the individuals, in categories such as demographics, program involvement, substance use, employment, training, literacy and numeracy, experiences of neglect and abuse, violence, mental health, suicide and self-harm and involvement in the justice system. In relation to sexual identities, youth workers were asked “has/ does your client identify as lesbian, gay, bisexual or queer?” with the possible answers of Yes, No or Don’t Know.

As a result of these four field selections, the term LGBQ is used in the study but it is noted that the use of this acronym could be seen as a limitation and “will be improved in future research”- the acronym LGBTI+ is now preferred.

Findings – familial relationships

When compared to non-LGBQ young people, a greater number of LGBQ young people:

• Perceived current issues with their families
• Reported significantly more conflict with their families in the past four weeks
• Reported significantly higher rates of being disconnected from their families

Findings – service involvement

LGBQ young people were engaged with AOD services for a longer average of time (33.75 weeks) when compared to non-LGBQ young people (22.67 weeks), however, this was determined to be not statistically significant.

Findings – substance use

Findings related to substance use were mixed. One significant difference between LGBQ and non-LGBQ young people in relation to substance use was increased use of non-opiate prescription drugs among the LGBQ group. Other assessment of the data found that young people identifying as LGBQ had used a significantly greater range of substances over the past four weeks, and that substance use was rated with greater severity in the LGBQ group. LGBQ young people also reported more admissions to hospital, ambulance attendance, physical injuries and harm related to substance use. They also had higher rates of driving a vehicle and unwanted sexual encounters while substance affected.

Findings – physical health and quality of life

There was not a significant difference in the physical health levels of the LGBQ and non-LGBQ groups; however, LGBQ participants rated more poorly in terms of quality of life rating.

Findings – mental illness and trauma

A significant difference was found in the psychological health rating between the LGBQ and non-LGBQ groups. 37.9% of young people identifying as LGBQ disclosed previous self-harm, compared to 22.8% of non-LGBQ youth. LGBQ young people had also made significantly more suicide attempts. LGBQ young people involved in the study had experienced significantly more emotional and sexual abuse, trauma events and violent crime than young people identifying as non-LGBQ.

Conclusion

As hypothesised, the LGBQ group fared worse overall than their non LGBQ counterparts. The complex needs of this cohort are likely to be both triggered and influenced by substance use behaviours. It is recommended that practitioners should empathetically and sensitively enquire about the diverse sexualities of young people accessing their AOD services; to be able to better understand unique risks and vulnerabilities. Given the higher rates of mental health and psycho-social concerns among LGBQ young people, practitioners should strive to create more inclusive practices and supports to improve the quality of life for our diverse young people.