Improving the mental health of young LGB&T people: Using Public Health leadership to tackle homophobic, biphobic and transphobic bullying in schools. While bullying is a problem for all children and young people, LGB&T groups face an increased risk Recent decades have seen considerable progress in social attitudes to non-heteronormative sexual identities, and in social, political and legislative change – BUT there is still considerable work to be done Same-sex contact is seen as a criminal offence in 74 countries – punishable by death in 13 (research published by International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA)) At the same time, discourses around sexual and gender identity are continually evolving Photo credit: Ludovic Bertron from New York City, USA - https://www.flickr.com/photos/23912576@N05/2942525739 Lina Martino - Specialty Registrar in Public Health, Warwickshire County Council Andy Beckingham - Independent Consultant in Public Health Christina Gray - Consultant in Public Health, Somerset County Council

Plan for this session Individual exercise (5 min) Background and evidence (10 min) Group discussion (30 min) Feed back summary to wider group (10 min) Reflection on individual exercise (5 min)

Aims of session Understand what works and what is currently being done in local areas to tackle homophobic, biphobic and transphobic bullying Discuss facilitators and barriers to implementing interventions effectively Identify actions for local Public Health teams

Before we start… Think about a time you felt uncomfortable or threatened in a social or work situation. Take a few moments to feel back into that – and write down (for yourself) how that felt. Choose one word in particular and write on a post-it. Do same for a time you felt confident and supported in a social or work situation.

Definitions Bullying in schools is defined by the UK Government as ‘physical assault, teasing, making threats, name calling’ or ‘cyber bullying – bullying via a mobile phone or online’ It is often aimed at specific groups, including LGB&T Can range from passive resentment to victimisation and physical violence

Bullying and the stress response Adaptive response - mobilising energy to fight or run away Repeated or chronic stress can lead to high blood pressure, heart disease, reduced immunity, depression and anxiety – directly through physiological changes, and indirectly through health behaviour Longer-term impact on educational attainment, employment and relationships

The scale of the problem Online survey by Stonewall1 of 1,614 LGB people aged 11-19 found that: 55% experienced bullying in schools 96-99% heard homophobic remarks A study using Next Steps data2 found that a greater proportion of 19 year olds identifying as LGB were bullied during compulsory education (age 13-14) and at age 19-20: ‘Ever been bullied’: 60.5% of LGB vs 45.4% of heterosexual ‘Frequent bullying’: 19% of LGB vs 6.1% of heterosexual Lack of robust data on transgender individuals to date BUT one study found that 64% of people transitioning from FTM and 44% of MTF experienced bullying3 A US survey reported high rates of harassment (78%), physical assault (35%) and sexual violence (12%) between the ages of 7-19 among people who expressed transgender identity or gender non-conformity in school4 1. Guasp, A. (2012) The School Report: The experiences of gay young people in Britain’s schools in 2012. Stonewall. Henderson, M. (2015) Understanding Bullying Experiences among Sexual Minority Youths in England, London: Centre for Longitudinal Studies. Nationally representative longitudinal survey - 7,220 pupils answered the relevant questions. 3. Mitchell, M. and Howarth, C. (2009) Trans research review, Manchester: Equality and Human Rights Commission (EHRC): http://www.natcen.ac.uk/our-research/research/trans-researchreview/ 4. Grant, J.M., Mottet, L.A., Tanis, J. with Harrison, J., Heman, J.L., and Keisling, M. (2011) Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, National Centre for Transgender Equality and National Lesbian and Gay Task Force: http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

Teacher perspectives Stonewall’s teacher survey in 2014 found that since the previous survey in 2009, and following provision of support, resources and training: Half the number of secondary school teachers said pupils were often or very often the victim of homophobic bullying: 13% vs. 25% in 2009 Significantly more said that their school had a policy that explicitly addressed homophobic bullying: Primary schools: 31% vs. 19% in 2009 Secondary schools: 55% vs. 30% in 2009 There was no real improvement in the proportion of teachers who believed that their head teacher or school governors (in England and Wales) demonstrated clear leadership in tackling homophobic bullying 45% of primary school teachers said that pupils at their school had experienced homophobic bullying or name-calling 86% had not received any specific training on how to deal with it

Impact on mental health and wellbeing The impact of stigma and discrimination (direct and indirect) can continue long after leaving school Gay employees report more than twice the level of workplace bullying than heterosexuals MSM have a relatively high risk of sexual and domestic abuse – though only a fifth of incidents are reported to authorities5 National Institute for Mental Health in England (NIMHE, 2007):6 LGB people are 1½ times more likely to develop depression and anxiety compared to the rest of the population Gay and bisexual men are 4 times more likely to commit suicide Scottish Trans Mental Health Study (2012):7 88% of trans people reported a mental health problem Over 37% had experienced physical threats or intimidation 19% had experienced physical violence for being trans. Links to health behaviours and interrelationship between mental and physical health 5. PHE (2014). Promoting the health and wellbeing of gay, bisexual and other men who have sex with men. https://www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-gay-bisexual-and-other-men-who-have-sex-with-men 6. National Institute of Mental Health England Mental disorders, suicide, and deliberate self-harm in lesbian, gay and bisexual people: a systematic review; 2007. 7. McNeil et al. (2012). Trans Mental Health and Emotional Wellbeing Study 2012. http://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdf

What works (1) Good experiences in childhood build resilience for mental wellbeing across the life course – regardless of sexual identity (PHE, 2014) E.g. universal parenting programmes in early childhood; Rise Above programme for adolescents Targeted LGBT-specific programmes include staff training, learning resources for teachers, and classroom-based programmes to prevent bullying and improve social emotional learning

What works (2) Evaluation of an anti-HB&T bullying programme commissioned by Government Equalities Office (2016)8 found that: Training for governors and senior leadership teams helped demonstrate the importance of a HB&T bullying policy Improving staff awareness and understanding in relation to HB&T bullying increased their confidence to challenge bullying and use of HB&T language This was supported by building teacher knowledge and skills, and better provision of teaching resources One-to-one and group pupil support increased feelings of self-esteem and resilience to HB&T bullying Attempts to improve pupil awareness were less effective - higher awareness at baseline, and limited time between activity and follow-up Whole-school approaches were most effective when: Senior school staff were not yet convinced of necessity Staff and pupils felt that they had not received enough training to deal with issues confidently Adequate support was not yet available in-house for pupils experiencing HB&T bullying NatCen Social Research (2016). Evaluation of an anti-homophobic, biphobic and transphobic bullying programme. http://natcen.ac.uk/media/1216039/natcens-independent-evaluation-of-an-anti-hbt-bullying-programme_research-report.pdf

In your groups: What is the role of Public Health? You may wish to consider the following in your discussion: What is currently being done in your area to prevent and address HBT bullying? What works well in terms of influencing schools? What are the barriers to influence and effective intervention? How can local authority public health teams and other partners provide leadership and support? Who else might we engage to facilitate this relationship? Using the post-it notes, write down three key messages to feed back to the group.

Thank you for taking part! Reflection Thinking back to the individual exercise at the start of the session: What one thing are you going to do to create an environment that promotes the positive experiences? Thank you for taking part!