Audio transcript (edited)

MS FARRUGIA: Welcome everyone to today's webinar on the social and emotional wellbeing of LGBTIQA+ young people. I'd firstly like to acknowledge the traditional custodians of the land, the Wurundjeri and the Bunurong people of the Kulin nation and pay my respects to their elders past, present and emerging, and acknowledge all first nation's people that are attending this Webinar. I'm speaking to you today from Naarm Melbourne. My name is Claire Farrugia. My pronouns are she/her. And I'm a senior research officer at the Australian Institute of Family Studies. So many LGBTIQA people live happy, healthy, resilient lives, however, a disproportionate number of young people experience worse social, emotional and health outcomes than their peers. Within a few decades in Australia we have seen the introduction of marriage equality and in many areas it is legally and socially unacceptable to discriminate based on sexuality, gender and sex characteristics. Yet many LGBTIQA people continue to have experiences that negatively impact on their social and emotional wellbeing. To differing extents we see that mainstream service providers are working to understand these needs of the diverse groups and respond accordingly. But there continues to be gaps in understanding what the experiences of this group of people are and how best to respond to their needs using evidence and evidence based practice. So today we are really going to touch on the research, the practice and lived experience trying to fill these gaps. We will focus on the now what? How today can we improvement engagement with LGBTIQA young people and optimise their social and emotional wellbeing. So a quick note before we begin. Lesbian, gay, bisexual, transgender, intersex, queer, asexual people are made up of highly diverse groups of people with very distinct experiences. We can't necessarily do justice to their experiences here in this hour, nor can the panel represent the diversity of these experiences. But really the aim today is to start a conversation, to draw attention to some of the overlapping struggles that are faced for young people that are not necessarily heterosexual or in a relationship with a man and a woman, when their gender doesn't align with the sex they're assigned, male or female usually, when they were born, or if they were born with a variation in sex characteristics, so identify as part of a broader intersex community. So if you want to know a bit more about the actual acronym itself please refer to the included resources in the hand out section to this webinar which might be helpful during or after the webinar. And also before we do go into introducing the presenters I'd like to acknowledge that some of the content we're discussing today could be triggering and does include some discussions about suicide. So we encourage you all to take it easy and access your support network and services to debrief after the webinar. So now I'm going to turn to introduce our presenters.

Firstly, we have Adam Bourne, who is a bit of a powerhouse and has a long list of titles that include associate professor of health and deputy director of the Australian Research Centre in Sex, Health and Society at La Trobe. He's also a senior visiting fellow at the Kirby Institute at the University of New South Wales. Adam has taken a leading role in the development of research that examines health and wellbeing of LGBTI people at both domestic and international levels, so welcome Adam.

MR BOURNE: Thank you very much, Claire. It's a pleasure to join you today and thank you to AIFS for organising this webinar. I'd also like to acknowledge that I'm joining you today from the lands of the Wurundjeri people of the Kulin nation and I pay my respects to their elders past, present and emerging.

MS FARRUGIA: Thank you, Adam. I'll introduce Vikki now, who is our next panellist, Vikki Ryall, who is the Executive Director of Clinical Practice at Headspace, the National Youth Mental Health Foundation, in a career that has spanned over 25 years. Vikki has extensive clinical experience with young people, young people that are also marginalised from mainstream services or difficult to engage and present complex needs. Vikki is a passionate advocate for youth mental health and youth participation, so welcome Vikki.

MS RYALL: Thanks, Claire, thanks Adam, nice to be here.

MS FARRUGIA: Now I'll introduce Nicole Scott. Nicole is an advocate for positive youth mental health education in schools, specifically early education around emotions and how people can be helped with anxiety and depression. In her position as a Headspace Youth National Reference Group member Nicole wants to inspire and empower young people to seek help and ultimately to see their own power. Nicole identifies as part of the LGBTIQA+ community and is a strong advocate for self-care, who did some painting this morning, I do know that. Welcome Nicole, it's such a pleasure to help you.

MS SCOTT: Thank you so much, Claire, I'm really glad to be here.

MS FARRUGIA: Great. I think this is a perfect time to turn over to you now, Adam, because we have a lot to get through today, and Adam will be starting by sharing some insights about some of Australia's most recent data on this topic. Thanks, Adam.

MR BOURNE: Thank you very much, Claire. So I'd like to use my 10 minutes with you today to talk through the findings of a study that we've recently published called Writing Themselves In 4, a national survey of health and wellbeing among LGBTIQA+ young people in Australia. As the name suggests this is the fourth time that we've run such a survey, and the first time being conducted way back in 1998, and we've been able to kind of catalogue and understand the experiences of LGBTIQA+ young people over this long period of time. This time around the survey was conducted in late 2019, so this was all collected pre COVID, and that's really important I think to bear in mind. It recruited young people via a mixture of Instagram and Facebook advertising using a series of different characteristics and advertisements such as those shown on the screen before you right now. The survey included a whole range of questions about physical health and wellbeing, mental health as well as questions around connection to community, support from family and friends and experiences that they were having in education. The recruitment for the survey was pretty successful we think and it resulted in 6418 LGBTIQA+ young people participating. This makes it the largest ever sample of the population in Australia and actually one of the largest in the world. So we can speak with real confidence with these data. But more important than it being large though it's also really diverse.

We heard from large samples of young people in rural areas, people from culturally diverse backgrounds, those living with disability and a really diverse range of voices across the spectrum of gender identity and sexuality, all of those characteristics and those intersections they all matter. We're a strong community with a rich and shared history but we're also as diverse as any other population and we can't lose sight of that diversity when we're designing programs or planning services. Obviously, the focus here today is on mental health and on the experiences young people told us relating to suicidality, and I guess I want to be really up front about this. The figures that I'm about to discuss are pretty confronting. They tell a story of young people in some exceptional challenging circumstances and, to be honest, no matter how many times I or the rest of my team look at or talk about these data they're still really affecting and so, as Claire said at the start, do take a moment afterwards to reflect upon them and to reach out to support to debrief if you need to.

As a starting point, we use the K10 scale, a really, really commonly used mental health screen tool to establish psychological distress among participants. 81 per cent of participants displayed signs of high or very high psychological distress. This was even higher among young people living with a disability, those who are trans or gender diverse or those in living in rural areas. Now, that figure of 81 per cent is at least four times higher than what we observe in assessments made of young people in the general population. Of serious and particular concern was our finding that one in four of the young people, LGBT young people we surveyed, had attempted suicide at some point in their lives, so it's one in four, 25.6 per cent had attempted suicide at some point. One in 10 LGBTIQA+ young people had attempted suicide in the last 12 months, and this is a rate at least three times higher than what we observe in studies of young people in the general population. And as high as these figures are to begin with they're even higher still among certain groups.

The experience of attempting suicide was even more common among those aged 14 to 17 compared to those aged 20 to 21, which perhaps indicates the particular exposure to harm among school aged young people and those who are more likely to still be living at home perhaps with families who aren't understanding or supportive of their sexuality or gender identity, and much more common also among those who were trans or gender diverse where we saw one in six, 16.4 per cent, had attempted suicide in the last 12 months. One in seven young people living in rural or remote areas had attempted suicide in the last 12 months, nearly twice as high as the proportion who were living in capital cities who had that experience, and it was similar patterns that were also observed for people with disability as well. As you reflect on those mental health statistics and how striking as they are it's absolutely essential that you hold in your mind the kind of environment that many LGBTIQA+ young people still in habit. More than 40 per cent of them told us that they'd experienced verbal harassment specifically relating to their sexuality or gender identity in the last 12 months.

More than 22 per cent said that they'd experienced sexual harassment or assault and 9.7 per cent experienced physical harassment or assault in the last 12 months and all of these figures were much higher for participants who were trans or gender diverse. In recent analyses we've been performing all of these experiences have really highly associated with poor mental health outcomes. Those who'd experienced verbal, physical or sexual harassment or assault were at least twice as likely and sometimes three times as likely to have recently attempted suicide compared to those who haven't had one of these experiences. And this challenge around harassment and abuse and the notion of safety really is particularly evident in educational settings, at schools, at TAFEs or at universities, and these have been sites of lots of work over the last decade but also the sites of much debate. The data from Writing Themselves In 4 tell us that there's still a great deal of work ahead of us. More than 60 per cent of those at secondary school told us they felt unsafe or uncomfortable in the past 12 months because of their sexuality or gender identity and how they were treated by others. And although the proportion was lower it was still the case one in three young people at TAFE and 29 per cent of those at university reported a similar experience of feeling unsafe.

Nearly two thirds reporting hearing, frequently hearing negative remarks regarding sexuality at their school in the last 12 months, and these kinds of experiences were all much more common among those living in rural and remote locations. None of these experiences relating to safety or harassment if they're happening at home, in school or in any other context, none of them are historic. They're all things that happened in the last 12 months. They aren't experiences that have been banished to the dim and distant past where perhaps we thought there was greater visibility of homophobia and transphobia. These experiences of stigma and violence have been real and they've been very recent. They tell us just how far we have to go in tackling the upstream drivers of mental health and what we have to do to tackle homophobia, biphobia, transphobia and any other hostility directed towards LGBTIQA+ young people. But I don't want to leave you with the impression that everything in the lives of these young people is cast by a shadow. And alongside those stories of significant mental health challenges we also heard about the creativity and passion of LGBTIQA+ young people and the things that are helping to make them feel safe.

We didn't ask many open ended questions in the survey but towards the end we did ask participants what makes you feel good about yourself? And these are some of the most remarkable data in the whole report. The findings speak to how they find meaningful connection to others, how being affirmed by others in their gender or sexuality can be the most rewarding experience of all and how they find ways to express their individuality that make them feel confident and empowered. They talked about the creative outlets that they found, the relationships that mattered to them and the positive changes they tried to bring about for their community. If we want to try and improve health and wellbeing for LGBTIQA+ young people then these are the kinds of strengths and values that we can draw upon. And finally I guess we've been talking about mental health among this population for years and I wanted to underscore the fact that these findings I've shown you are not necessarily new, they replicate those found in several other studies conducted previously, but they tell the story with a larger and more diverse sample than we've ever had before, and studies like this help us to amplify the voices of LGBTIQA+ young people and encourage us to stand up and take action.

In the national report we make 21 different recommendations for actions including targeted mental health interventions and scale up of funding for LGBTI communities, national networks and forums for sharing of emerging good practice and clearer expectations placed on mental health services to ensure that they're safe and affirming of LGBTIQA+ young people so that they can get the help that they need if and when they reach out. And I encourage everyone to have a read of those recommendations in the report.

Finally, I just want to take a quick moment to thank everyone who makes this kind of project possible. It was funded by the Victorian Department of Premier and Cabinet, the New South Wales Department of Health, the Australian Capital Territory Office for LGBTIQA+ Affairs, and SHINE SA with support from Office of the Chief Psychiatrist in South Australia. And it won't surprise you to know that a very large team of people is required to make a project like this happen. My thanks to the colleagues within the centre as well as a really passionate and expert community stakeholder group and the Youth Advisory Group, who really did make sure this was attended to the needs of LGBTIQA+ young people. So thank you for your attention. Thanks to AIFS for convening this panel on what is such an important topic. At this point I'm going to hand over to Vikki Ryall from Headspace. Thank you very much.

MS RYALL: Thanks so much, Adam. I've, yeah, read Writing Themselves In again, each iteration, and each time it is a sobering reminder of how far we have to go and you kind of keep hoping that each time it comes out again that things will be better, and I guess in some ways they are and in many others for our community that's not necessarily the case. I want to start by acknowledging the lands that I'm on. I'm on the lands of Wurundjeri and Bunurong people of the Kulin nation, pay my respects to cultures, identity, connection to waters, kin and community. In particular Headspace is really committed to making a positive contribution in the lives of young Aboriginal and Torres Strait Islander people in providing services that are safe, welcoming and inclusive. I particularly today call out elders in the LGBTIQA+ community and likewise acknowledge that myself and hundreds of other people across Headspace have sought to try really hard to make sure our services are safe and welcoming, and we will always have a lot of improvements to make in that going forward. I'm going to start fairly big and end up with sort of day to day practice. I hope that's useful.

I'm going to talk about the Headspace brand, which is not brand for brand's sake. But Headspace started in 2006. We've had a National Youth Reference Group like the one that Nicole's in. Nicole's I think in the eighth or ninth iteration of that. And everything that we have done over time including the brand has been built with young people. The young man on this image I know very well because he has helped shape everything that we do. So everything you're about to see from a brand perspective, and this is the sort of description of our brand. And the reason I think this is really important in a space like making services inclusive is young people have continually told us that we need to make sure that Headspace for us and other services for other people represents itself for young people by young people delivering evidence based care and working alongside young people. And that I think is particularly important for our LGBTIQA+ young people.

As you will see when I'm coming down to sort of service based recommendations it starts to become very clear that the way that we create services and brands also has to speak to young people to give them the message that you are welcome here, I can see myself represented. So we are obviously all about making sure young people are mentally healthy and engaged in their community. Mental health is not a fixed state. It's something that we all, you know, need to kind of learn to manage. Like your physical health it will wax and wane. It feels important to say that particularly on the back of what Adam was talking about. The reason that LGBTIQA+ young people are over represented in mental health statistics is because of their experiences and because they have unsafe experiences and in many instances are not welcomed. So again you'll see through the organisation and practice recommendations what we're seeking to do is change that, is give all young people a positive experience of help seeking. And I'm going to go through some high level service statistics.

Currently there are 137 Headspace centres across the country. Some of them are sort of smaller centres, they're called satellites. And this is a mean, so it's an average, but what you can see here is that on average we see 62 per cent people that identify as female and 36 per cent identify as male and 2 per cent in the gender diverse group or haven't been comfortable to answer that question. Nationally the mean is 24 per cent of those nearly 100,000 young people last year identified as LGBTIQA+. Now, if you look at a modal distribution some centres are seeing as high as 50 per cent of their young people. So remember 137 centres, this is a national average. So it means that some centres are seeing a lot more LGBTIQA+ young people and certainly a lot more than any research will tell us proportionately that young people identify as. It usually comes out - Adam's going to be better at this than I am - but around 10, and I've seen things up to sort of 25 - 20 per cent rather. But we're seeing much higher numbers than population averages. The same in culturally and linguistically diverse, the same with Aboriginal and Torres Strait Islander young people. Which also makes sense because each of those groups are over represented in poorer mental health. So it's sort of what you want to see, if you see what I'm saying, that we want people who are struggling to be able to access our services, and it looks like that's what's happening. We also have a national online telephone service, it's called eheadspace, it's accessed through the Headspace website, and there's a bigger gender skew you can see there.

These gender patterns by the way are not uncommon in a lot of help seeking services. It's something we need to continue to work to redress, making young men feel more comfortable to access help. But you can see that in eheadspace the LGBTIQA+ numbers go up to 30 per cent and, again, that's an annual average across 32,000 young people in a single year. So the long and the short of that is we're seeking a lot of young people nationally and we are seeing a lot of people, young people who identify as part of our LGBTIQA+ community. I'm not trying to say here at all that we have it right. I have the responsibility of clinical governance across the network and we are definitely - we still get some complaints.

People, young are being misgendered or feeling like they didn't have a great experience, and I guess these are all things that we keep trying to improve our services from. Every March Headspace do a campaign, it's called Life Is Not Always Rainbow and Glitter. I think I've got that right. And each year the contributors to that campaign are young people from our National Reference Group, so there's three young people I imagine are known well to Nicole. It's a digital campaign so it's going out through all our social medium, and we also attend pride marches, Mardi Gras and Pride all around the country, and all the assets, so the digital assets and videos, et cetera, that we produce are used to support that campaign. And I'm going to go now to showing you a video.

Pronouns are the words we use in place of somebody’s name pronouns are a way of referring to oneself. He She. Sometimes people might not feel comfortable with either of those pronouns so they might want to use the gender neutral they or them but it can go a long way in terms of feeling comfortable and accepted by you. I think language is really important to members of the LGBTIQA+ community because it really gives us a sense of belonging. We've got this really beautiful and fluid community where things keep changing and identities kind of keep growing as people discover that you don't have to fit into the boxes you've necessarily been provided all your life. The way we speak about members of the LGBTIQA+ community and the language we use is really important in terms of I guess first and foremost conveying respect. It's who they are all the time. It's when your getting a coffee it's when your going down the street it's when your booking a hotel. It's whatever and it's really important to ask about them what are your pronouns? It's ok to do that it's better than assuming. Have a google sus it out educate yourself.

MS RYALL: Thank you. Look, that was an example of a video that we worked with some young people on creating. It was actually in response to we'd had a couple of complaints come to us across the network around young people are being misgendered, and we talked to some young people about what might be a really accessible way to teach people about how to make services more inclusive and identify pronouns. And so we got these badges, which you can't probably see, which all of the staff at Headspace National wear and we encourage all the centre staff to wear to identify their pronoun and help people have open conversations about use of pronouns. I'll move on. And I've talked a lot about really the key thing for Headspace in being LGBTI inclusive is being led by the voices of young people. This is our incredible group of young people. You can try and pick Nicole in this group if you want to. She looks a bit different now. But we employ as casual staff a group of about 20 young people. They are usually with us for 18 months to two years. This current group have been with us a bit longer because last year was extraordinary. They're from all over Australia, all sorts of different experiences, and they help us make sure that everything we're doing is safe. In terms of guidance, practical guidance for organisations - I'm hoping this is all fairly evident from what I've been saying - but offering a space that is accepting, and that's using rainbow or trans rainbow flags, inclusive imagery, developing partners with LGBTI services in the community where they exist, and obviously we know that that's not in some regional areas. That can be a problem. Providing training for staff to make sure that they feel confident and competent in supporting or adapting their care for LGBTIQA+ young people. Most of the products that Headspace National provide will use inclusive language, so forms, data collection. I mean, it really is thinking about every single contact a young person has with your service and making sure that there's nothing in that that's going to alienate them or not allow them to express their identity the way that they would choose to. I mean, it is in the evidence for LGBTIQA+ organisation inclusion to employ people that identify. I personally never needed to kind of come out in a one on one session with a young person, which is not to say that I wouldn't. So it's more about I think having people that understand the experience and will build the inclusivity of the service rather than a one on one talking about it, if that makes any sense. And I guess it is inclusive language around any conversations around gender and sexuality and engagement. We have also - Headspace works with people between the ages of 12 and 25. A lot of the organisation services need to be mindful that some young people may want to come and talk to a Headspace clinician about their gender or sexuality but they may or may not have actually spoken with their family member or support person about that as yet. So there's a whole lot of factors that we need to be mindful of and inclusive of but being sensitive to their experiences after that. I guess what this is really trying to say is open conversations, ask about identity, ask about sexuality, ask how that is for young people. And through my career, which is long now, those answers have really changed in some respects. Lots of people in the LGB, you know, identifying with those labels, feel like that's not necessarily a difficulty or why they're there but, as Adam said, very ably talked about, it may be much more about other experiences they've had that relate to that. But their experience of help seeking needs to affirm their identity and they need to feel like - so sex education for example in schools or as part of good mental health care needs to talk about, you know, safe sex practices for all sexualities, all identities. So I guess the last slide here is just building social supports. As Adam said, many - I mean, we did a survey of the Headspace Network not that long ago and over 50 per cent of them, without us saying that this has to happen or anything, but just driven by the young people, have created a social group, a rainbow social group or LGBTI. They're called all sorts of different things across the country. And as Adam's research suggested we know that young people get a lot from talking to other young people who identify as part of this group and do get that support and acceptance. And as I said, we know that we haven't got it all right and we're certainly happy to hear suggestions and continue improvements by young people. And that's it for me and I'm going to introduce Nicole.

MS SCOTT: Thanks Vikki. So my name is Nicole obviously. My pronouns are she and her. First off I just really want to thank everyone for coming along to this and giving me space to share my story and share really tangible tips that practitioners can do to create a more inclusive space. So first off I'm just going to do a little bit of a lived experience about my personal journey, and I really want to emphasise that my personal journey does not reflect everyone's experience. We're such a diverse group and we definitely can explore everyone's experience just in this one hour. So I have lived experience of depression and anxiety. I started experiencing those around the age of 14.

When I was a lot younger I started to think about who I was attracted to and my identity, my sexuality. But for me personally me needing to seek help for my mental health it wasn't actually linked to my identity or my sexuality, which I think is a really important thing to just point out. For some people it is. Some people have really bad experiences and that can affect their mental wellbeing. But for me personally it actually didn't have anything to do with that. And I was really lucky I had really amazing experiences mostly with practitioners and I never felt like I had to come out or talk about my sexuality. But there was a few things that some practitioners did that just helped me to feel really safe and if I wanted to have that conversation I felt like I could and that I was in a safe space and that, you know, if I wanted to share it it would be okay. So I think the one thing that was really important for me and still is, and I think it is for anyone in the LGBTIQA+ community, is a sense of belonging, a sense of community.

A lot of us we don't have super supportive family and we really need that sense of connection like all people do, but for us because we might not always have super supportive people around us that is even more important. And so there's some really simple ways that practitioners can do this, and some Vikki mentioned. So one of the things that I really love seeing is when practitioners have their badge but then they'll also have their pronouns on there. And it's not necessarily that I need my pronouns to show people, but when practitioners have that I'm like, oh, they're okay with this conversation, this must be a safe space, this is okay, I can come out and show my pronouns if I want to. And so it just creates that sense of safety and you're okay, you're seen, you're heard. And also having that on forms, so saying preferred pronouns on the form. And it's just having that opportunity and seeing that people are ready to have that conversation. It's almost like, oh okay, I'm okay here, this is going to be okay. And having posters, I've seen posters around that say you are welcome here or you are loved. I really love those ones. And when - sometimes people feel like it can be overwhelming if they don't know much about sexual identity and gender identity and it can feel a bit overwhelming. It's like, oh, what do I do, how do I start these conversations? But what it comes down to is, at least for me, it was the practitioner seeing me as a person, the practitioner actually wanting to understand me, wanting to know about me. The services that I went to and I felt like a person, I felt like I was being seen, I felt like all of me was being seen, and that was mainly through building trust and rapport. It just helped me feel so much more safe and that sense of belonging and sense of community. So it can be really, really simple small steps that practitioners can do. And I can understand that it can feel a little bit confronting or maybe a little bit uncomfortable to start to have the conversation around pronouns. That might be your first time hearing about pronouns today. But the thing is we need to have these conversations. You might feel a little bit uncomfortable about, oh, how do I ask this person about their pronouns, how are they going to react? But I can guarantee you we are more afraid. And what I mean by that is we're not afraid to talk about our pronouns but we are afraid of what if I get rejected, what if this person says something that's really from a hateful place? Or until we know that we are welcome, at least for me, going into a new environment like, okay, I need to hide myself a little bit, I need to pull back. And I think that's really sad, especially for young people. Like, I'm 26. Can you imagine what maybe a 14 year old feels, or just being able to start to have those conversations. I really encourage you to practice. So start saying when you meet people and in your workplace, my name's Nicole, my pronouns are she and her, what's yours? And it's just as simple as that. It can be really, really simple. And just practice. We need to practice at home with, like, a trusted person first. If that feels a little bit uncomfortable, it's okay. It's okay for these conversations to feel uncomfortable at first. We're not used to them. So it's really getting that practice in so that we can start to normalise pronouns and normalise talking about sexuality and identity because there is a little bit of stigma around it still unfortunately.

And so the last thing I really want to jump into is the importance of participation. So I'm part of the Headspace Youth National Group, and that helped me so much on a personal level knowing that I am in a safe space, my opinions and my experiences are being heard, and that is what Headspace is taking on and they're improving their services from that. If you are from a service and you don't have the voice of young people improving your practice it's something you need to do. Honestly, it's so, so important for us to feel heard and seen, and you'll get a lot better outcomes with the young people as well. And I think there was something mentioned, I think it was from Vikki, for young people by young people. And it's really, really important that we hear that. And then also you're getting education straight from people who are living it. So it's not just improving your own practice but it's also improving your own education, your own understanding. But I also really recommend getting training for your practitioners, professional training, going to little things like this. It's absolutely amazing, it really shows how committed you are to learning and wanting to create that safe space for us. So yeah, I think that's the main tips I wanted to go through. But we are going to go through some questions that you've sent through and we'll also have a recording of other questions. So I'm really looking forward to that and hopefully we can cover everything that you want us to go through.

MS FARRUGIA: Great. Thank you very, very much all of you. That was an incredibly insightful overview of what we've been, what I guess we've been talking about. I think on the one hand devastating, and I think particularly when we look at, you know, the kind of rates around assault and harassment and really shows how the high the stakes are when we then turn to look at that suicide data, and also in some ways what we have gone through today and what you touched on, Nicole, was also insightful but also simple in a lot of ways, the ways that being person centred, being strength based, you know, approaches we would have with all the clients, how powerful they are for creating welcoming, safe, comfortable environments, including not making assumptions I guess that this person automatically has a boyfriend or girlfriend or is automatically about gender because of the way they're presenting. So these are incredibly important insights. And we have a lot of questions and only a short amount of time. So if it's good with everyone I'll dive straight in. We've already touched on this through the conversation but one of those questions is around particularly what can be done about promoting healthy conversations, about LGBTI young people to feel welcome and safe in school. Nicole, would you like to start on that?

MS SCOTT: Yeah. So I'm not sure specifically around conversations but around something that kind of leads to that is creating the school into a safe space. And so really I think it would be really amazing if teachers were able to have their pronouns on them, really starting with that normalising conversation of pronouns, making sure that the school is getting appropriate training and also just having, like, posters and other sorts of flyers around, just really showing that you are as a school wanting to create that safe space and you are wanting to open up those conversations.

MS FARRUGIA: Adam or Vikki, feel free to jump in at any point.

MR BOURNE: Those are all great points, Nicole and Claire. Perhaps the thing I'd add is just the importance of having in the first place clear and responsive anti-bullying and inclusion policies around LGBTIQ but also making sure that all of the students know they exist and understand the principles of them. So in our recent analysis we've seen people who were aware of and familiar with an LGBTIQA bullying policy within their school were 35 per cent less likely to have high levels of psychological distress than those who didn't have that knowledge and awareness. And that just says something I think about I recognise this is a school that has thought about me, that understands me and has laid out what they will do in the circumstances where am I not treated with dignity and respect and where I'm not made to feel safe in my school environment. So I think it's not just the existence but people need to know it's there and they need to know how to use that policy to kind of help craft that safe environment.

MS FARRUGIA: Great. Vikki, are you happy if I move to the next question? Yeah, great. Well, we have a number of questions that I guess touch on the real difference in experience for different communities. So one of those questions is how does the panel think we can best support LGBTI young people from multicultural or multi faith backgrounds, particularly given there could be added cultural complexities. And I'm interested to see if any of the data also, Adam, brought that out.

MR BOURNE: Yeah, sure. So in the national report for Writing Themselves In, which perhaps we can put in the chat box, people can link to it easily as well. There's a series of chapters at the end that break down those responses around suicide, psychological distress, a range of other issues, by ethnicity, by the way you're living in different parts of the country, by whether or not you have a disability. And in relation to the ethnicity data you see really quite stark differences between those who identify as Anglo Celtic versus those, particularly those from Chinese, South East Asian or Indian backgrounds. I think a particular, a really particular thing to bear in mind is the much lower proportion of people from Chinese and South East Asian backgrounds for example who feel supported by their family and by their friends in relation to their gender identity or sexuality. And I think while we're thinking about and planning and furthering interventions in schools and in other kinds of services, you know, we need to remember the really key and important role that families play within this as well and think creatively in partnership with organisations that work on behalf of culturally and linguistically diverse groups, it has to be in partnership with them. It's important that we think creatively about what those kinds of family related interventions might look like and how we can support families in culturally diverse backgrounds to perhaps often just better understand the nature and complexity of sexuality and gender identity so that they're more empowered in understanding, you know, at said time when they're, you know, when one of their children identify as part of the LGBT community.

MS FARRUGIA: Yeah. I guess and also, you know, Nicole, you spoke to the importance of community, but of course we have multiple communities in our life and multiple belongings, and so particularly from people of migrant, refugee backgrounds, those belongings are very important. So thank you for that, Adam. I wonder, Vikki, I know we've had this throughout but what would be your key takeaways? We've got a question on what are some of the things a service has to do to ensure LGBTI young people feel welcome and safe? And so I wondered if you could just, like, pinpoint a couple of your key things.

MS RYALL: I mean, I think Nicole reiterated it really well, that front and centre is involving young people. It's almost like, I mean, what we, you know, what you want to do is - I mean, I think things like rainbow tick accreditation are really useful as a gap and answers of what services are missing. They do pick up really practical things but safe inclusive imagery, safe inclusive at every level, the forms, the receptionist. Receptionists are key in any support service and, you know, I think asking young people to critique your service will always, you know, highlight more things than I possibly can.

MS FARRUGIA: Yeah. And by inclusive imagery we also mean imagery of the rainbow or trans flag or, like, is there any other, like, Nicole, from your experience going in somewhere, was there anything else that you think is key for services to kind of use to flag to LGBTIQ communities?

MS SCOTT: Yeah, I think definitely badges with pronouns on them is really key, yeah.

MS FARRUGIA: On that note, there also has been a - yeah, go, Adam.

MR BOURNE: Sorry, just a quick one. I was just going to say and also thinking - I mean, I'm a researcher, I always get carried by data, but thinking about the kinds of questions you ask in intake forms. There can be nothing more confronting at times where the young person comes into your servicer and you present them with an option saying are you male or female or worse even when you say male, female or other, which immediately makes you feel somewhat very, very different. There are some really good guidance that's been recently published by the ABS on how you can effectively and ethically ask questions around gender identity and sexuality. Think about how you can adopt those within your intake forms within all of your services.

MS FARRUGIA: Yeah, fantastic. Especially those ABS guidelines are particularly useful. On that note also of pronoun badges we do have a question, Vikki, if it's possible to view the Headspace badge itself online. I wonder if there's people looking for some sort of template.

MS RYALL: Sure, yeah. I think I can show it to you this old fashioned way.

MS FARRUGIA: Old fashioned is good.

MS RYALL: I've actually got a whole collection but yeah, I'll send Claire a photograph of each of them.

MS FARRUGIA: Those items are excellent.

MR RYALL: And Minus 18 have some as well that we used to have before we had our own made, and I think you can get them for free.

MS FARRUGIA: Great. I think, like, before - we've only got a couple of minutes left and there also is a particular interest in the last period of COVID and the COVID restrictions. Has there been particular social and emotional concerns during this time and has there been any research done so far? I'll open that to all of you but I know, Nicole, you also have been doing some work around that as well at the moment.

MS SCOTT: Yeah, definitely. So just from my own personal experience, yeah, it does affect young people a lot, especially in the community, because a lot of us don't have safe spaces at home. So when we're restricted there's no safe space for us so that can really negatively impact our mental health and our wellbeing. And, yeah, I've been hearing that from my friends as well. It can be really damaging.

MR BOURNE: That was a really great point from Nicole. An awful lot of people find themselves having to go often back to families of origin, to birth families where, during lockdown, where they may not necessarily have been supported in relation to their sexuality or gender identity and that being problematic, and we've certainly heard about that in some recent research we've been doing here in Melbourne that was actually collecting data during lockdown. I mean, I guess just overall, you know, the community went into the pandemic where our mental health was, to be blunt, far worse than the vast majority of other people, like, we were in a more vulnerable position when we entered into this. It's hard to find anyone, gay, straight, cisgender or trans or gender diverse whose mental health wasn't impacted in some way by COVID-19. And I guess I'm just saying think about that when you're already starting from a pretty challenging or vulnerable position I guess.

MS RYALL: Yeah. So Headspace did a piece of research which we can give to AIFS to distribute, but it essentially shows it looked at the mental health experience in the first lockdown last, like, sort of March, April last year, that was published in about May, and it really showed that people did feel like their mental health got worse. And it cuts it up into sort of what was impacted, work, relationships, et cetera, and the report sort of concludes that the people with existing mental health problems their problems got worse, and those without also were affected. So, you know, it affected everybody, which is not really news. But the report doesn't specifically analyse in terms of LGBTIQA+ but they do note that the respondents were over representative in LGBTI. So I guess you can feel like it accurately speaks to the experiences of that community. And I think the other thing we can - there are some - it's really important in things like pandemics and natural disasters to remember there are some positive outcomes. So young people talked about new habits, improving some habits in the home, that kind of thing, some more downtime. That's covered in the report as well. That's a common occurrence with natural disasters. It's sort of a silver lining. But the other thing, it is reasonable to anticipate that the mental health impact of COVID and like other natural disasters is fairly long lasting. They're talking about three to five years. I don't know, Adam, if you know that research space, but it's suggesting that because we had floods, fires, et cetera, there's also a cumulative effect and that in the natural disaster literature there's sort of where we're in multiple phases at once, sort of response, recovery, et cetera. So there will be likely an even longer tail of mental health impact on young people.

MS FARRUGIA: Thanks for that, Vikki. I guess we also know - well, we don't have clear kind of stats at the moment, but we know that family violence during this period of time has also arisen. And I wonder, we've had a few questions about family violence for LGBTI young people and if they are more likely or at higher risk for facing family violence when they're coming out about their sexuality. I wonder if I can pose that question.

MR BOURNE: I mean, the answer is yes unfortunately. We certainly know that a lot of young - I mean, there's data in Writing Themselves In that talks about experiences of violence that occurred within the home, so verbal, physical and sexual harassment or assault as within the home and it documents who the perpetrator of that was. And it is the case unfortunately that there are still - I mean, any number is unacceptable. There's still, you know, a sizable proportion of young people who are, you know, who are in receipt of abuse in the home from family members who are not accepting or tolerant of their gender identity and sexuality. And I think it's insightful when you look at the data around experience of homelessness, and about one in five people had experienced homelessness at some point in their lives, about 10 per cent had that experience in the last 12 months. And when we asked them kind of what were some of the factors that influenced or led to your experience of homelessness, really, really high on that list was rejection from family at the point of which they disclosed. So yes, unfortunately, Claire, that's still a really common experience.

MS FARRUGIA: And how best do you include families that have, you know, potentially have resistance, or how do you include them at all for LGBTI young people? Nicole, is that something that I think we've talked a tiny bit about?

MS SCOTT: Yeah. I think the really important key is to let the young person choose that, choose when, if ever and in what ways that they would like that. It's really important to hear the young person's voice in that to avoid further damage.

MR RYALL: I mean, I'm a massive advocate for family inclusion in the care of young people from a mental health perspective, and I think the default should always be that the families should be included, but how that's done in particular in relation to LGBTIQA+ young people who may not be out to their families is critical. And similarly with young people who are from refugee migrant backgrounds or culturally and linguistically diverse. We have an interesting sort of generational, or we're at a point where young people at the moment are more mentally, from a more literate, from a mental health perspective than they perhaps have ever been, more inclusive from a gender and sexuality perspective than they perhaps have ever been. But that is not necessarily the case for their parents. And those that literacy is exacerbated even more with culturally and linguistically diverse or refugee and migrant populations. So there are, you know, there are sensitive ways to just have really frank conversations with young people about - it is often young people have better outcomes when their families are included but we need to be really careful about doing that in a way that feels okay for you. What can we talk about together with the family, what can't we talk about? And certainly I have many instances of where families have wanted us to, you know, almost do conversion therapy, seeing both people separate, ending up coming together with a, you know, not necessarily a celebration outcome but I guess an acceptance and having had some extent of the conversation that is as far as that's going to go. It's very - it takes a lot of time and relationship building with both ends in my experience. And quite a lot of confidence as a clinician that you - because, like, if I'm working with Nicole she needs to know and trust that I can and will respect everything she's going to say to me and that I can do that something similar with Nicole's family but not necessarily move information between that's not going to be helpful. But I think it can be done. I mean, I know it can be done, I've done it myself. I think the difficulty is, you know, a lot of certainly young clinicians don't have heaps of confidence in family work generally speaking and so I think that is a challenge. But I think, you know, do some training, get some supervision and have a go and, you know, be guided by the young person.

MS FARRUGIA: Yeah. And is there a particular, I guess additional barriers that we see for young people in rural and remote Australia? Adam touched on this. But I did wonder, Nicole, if there's any particular, yeah, differences that you saw being in regional Victoria from access, like when it comes to access to community or other aspects that people need to be aware of?

MS SCOTT: Yeah, absolutely. Obviously with COVID and restrictions it was a lot harder. But just in general as well I think people sometimes assume if you're in a regional area that you have access to internet and that kind of thing. And I actually didn't so that was something we had to try and work around when COVID hit and I was at uni. But also, yeah, for people who don't have that access to internet what can you do and how can you support them too? And obviously when there aren't restrictions the importance of having both in person and online services and having that option for young people is really important.

MS FARRUGIA: Yeah, absolutely. Is there any particular online - we have also had a question about resources that people think are useful, online resources that people can access. I guess we can include a number of these in the event description, but I'm wondering if there's any other resources that people want to throw off from the top of their head as well that practitioners can look up when they listen to this?

MS RYALL: Static resources you mean, Claire, like fact sheets?

MS FARRUGIA: Yeah, or online community. I don't know if there's communities that practice.

MS RYALL: Yeah. I think, I mean, Mental Health Professionals' Network I think has an LGBTI interest group. There's quite a few. It depends. There's also online, like, there's a Qheadpsace, so there's some online communities for young people talking about, you know, a whole range of things. So it kind of depends on - I can send you through a few different things for each audience.

MS FARRUGIA: And there's Minus 18 and other youth groups as well.

MS RYALL: Yeah.

MS FARRUGIA: There can also be different state based specialist services as well.

MS RYALL: We usually use the stuff from Adam's work first and foremost.

MR BOURNE: I'm glad someone's reading it, Vikki.

MS RYALL: Yeah, we read it. I mean, it's also people like, you know, I know it's - Jamie, one of Adam's colleagues, does sort of a supportive conversation for lots of the Headspace staff for example. I mean, that sort of mentoring if you like, I don't see that's - people need an ongoing conversation and somewhere safe to take it. I don't know if there is anything like that for others but, I mean, I just know that lots of the centres really value - the Victorian centres, because a lot of the other states and territories don't have as good LGBTI kind of services. It's probably something we should start a community of practice on, really.

MS FARRUGIA: Or hopefully inspire people to sort of start after today. So I think we do have to finish. I do want to ask Adam also, we've had questions about whether there's particular data on Aboriginal and Torres Strait Islander communities that have come out, and I am aware that we don't have representation today here in the panel and it is a real topic that we need to explore further. So I did want to end with, do you have any kind of insights that we could bring to the audience?

MR BOURNE: Yeah. So for the time being, well, I'll start by saying we were really fortunate to engage quite a relatively large number of LGBTIQ people who are Aboriginal and Torres Strait Islander in the survey, so in total there were 256, that's about 4 per cent of the sample, which to our knowledge is the largest ever survey of LGBTIQA+ Aboriginal and Torres Strait Islanders, young or adult. It's, like, still the largest sample. And I think it's really incumbent upon us to work with those data sensitively and ethically and in partnership with Aboriginal organisations. So what we're doing at the moment is working through a process of affixed approvals with different Aboriginal controls and ethics boards and forming a partnership of Aboriginal organisations in each state and territory to come together to help us look at the data, interpret them and understand them, to situate them within Aboriginal bodies of knowledge, and hopefully then the output of that perhaps a little bit later in the year will be a dedicated report that just talks about the experiences of Aboriginal and Torres Strait Islander LGBTIQA+ people. We're going to couple that - we did an adult survey recently as well, or private lives of LGBTIQ adults. So we're going to merge together these two different samples and then hopefully write a report that talks across them and in doing so provides really, really large rich data sets about Aboriginal experiences of the form we've not really had before. I can tell you from having just glanced, just eyeballed the data and had a look at it thus far that it is really troubling, that there's a lot in there. There's going to be a lot for us to reckon with and there's going to have to be a lot of soul searching about how we can best move forward with this in the near future.

MS FARRUGIA: Great. I think this is a great place to end today's conversation. Again thank you very much and we will be staying tuned for that future research, Adam, and so hopefully more future partnerships and talks on this conversation. So thank you all so much for joining us today, it's been great.

WEBINAR CONCLUDED

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Slide outline

1. Writing Themselves In 4: Mental health and wellbeing of LGBTQA+ young people

Dr Adam Bourne 
Associate Professor 
Australian Research Centre in Sex, Health and Society

2. Writing Themselves In 4

3. State/territory: Writing Themselves In 4

• ACT - 300
• NSW - 1619
• NT - 43
• Qld - 1008
• SA - 640
• Tas - 226
• Vic - 1859
• WA - 723
• Total = 6,418 aged 14-21 

4. Mental health and suicidality

5. Psychological distress

• 81.0% of participants displayed signs of high or very high psychological distress (K10)
• More common among those:
  • living in rural areas
  • trans or gender diverse

6. Suicidality and Self-harm

• 25.6% of participants had attempted suicide at some point in their lives
• 10.1% had attempted suicide within the previous 12 months
• More common among those:
  • aged 14-17
  • trans or gender diverse
  • living with disability
  • living in a rural area

7. Harassment and assault

• 40.8% experienced verbal harassment in the past 12 months
• 22.8% experienced sexual harassment or assault in the past 12 months
• 9.7% experienced physical harassment or assault in the past 12 months

8. Education based experiences

• 60.2% of those at secondary school felt unsafe or uncomfortable in the past 12 months
• 63.7% of those at school frequently heard negative remarks regarding sexuality in the past 12 months
• 38.4% missed days of school because they felt unsafe

9. What makes you feel good about yourself?

Romantic connection

‘Having loving friends and a partner and being comfortable with the thought that whatever happens in life I’ll still have them.’ 

Social connectivity to friends and family

‘Having friends who get me out of my depressive episodes and into real life, they support me.’ 

Creating and achieving

‘Making music, singing, writing, walking, gym, wearing clothes I like, talking about my sexuality openly, acting, performing, creating fiction.’ 

Affirmation from others

‘Dressing the way I want to having friends and family refer to me by the right name and pronouns, seeing the changes in my body as I progress in HRT.’

Affirmation from within

‘Thinking of me as a girl’

10. End of ARCSHS Presentation

11. Acknowledgements

12. Writing Themselves In 4 was made possible by support from...

• Victoria State Government | Premier and Cabinet
• ACT Government
• Office for LGBTIQ+ Affairs
• NSW Government | Health
• SHINE SA
• With support from Office of the Chief Psychiatrist, South Australia

13. Research teams

ARCSHS and Rainbow Health Victoria research team

• Adam Hill
• Anthony Lyons
• Jami Jones
• Ivy McGowan
• Marina Carman
• Matt Parsons
• Jen Power

Community Advisory board

• Tracey Hutt
• Starlady
• Josh Mueller
• Bonnie Hart
• Terence Humphries
• Micah Scott
• Sarah Lambert
• Tim Bavinton
• Peter Waples-Crowe
• Adrian Murdoch

Youth Advisory Group

• Rory Blundell
• Rose Simonsen
• Max Taylor
• Jamil Nabole
• Lachlan Houen
• Freya Corlis-Richards
• Claire Bostock
• Sunny Baek

14. headspace: National Youth Mental Health Foundation

Vikki Ryall 
Executive Director, Clinical Practice

15. Acknowledgement of Country

headspace would like to acknowledge Aboriginal and Torres Strait Islander peoples as Australia’s First People and Traditional Custodians. We value their cultures, identities and continuing connection to country, waters, kin and community. We pay our respects to Elders past and present and are committed to making a positive contribution to the wellbeing of Aboriginal and Torres Strait Islander young people, by providing services that are welcoming, safe, culturally appropriate and inclusive.

16. headspace brand

17. We believe in the power of youth (and talking like we mean it)

A clear consistent and compelling tone of voice is one of the best ways a brand can form real connections with people. And when you think about how important forming genuine connections is to us, it's easy to see why we've put plenty of thought into the way we speak and write.

Youth centric - Young people help influence our services and advocate for better care.

Thought leader - more than ten years experience providing progressive, evidence-based youth mental health services.

In partnership - Working together with those who support young people.

18. headspace vision and mission

headspace vision - All young Australians are supported to be ​mentally healthy and engaged in their communities.​

headspace mission - headspace collaborates to design and ​deliver innovative ways of working with young people to strengthen their mental health and wellbeing.​

19. headspace services

20. headspace Centres

Centres - In FY19/20 headspace centres provided 405,139 services to 97, 257

Priority groups - Aboriginal and Torres Strait Islander 9%; Culturally and Linguistically Diverse 11%; LGBTIQA+ 24%

Gender - 62% Female; 36% Male; 2% Gender diverse or undisclosed

21. eheadspace

eheadspace - In FY19/20 headspace, our online and phone counselling service provided 78,187 services to 31, 292 young people

Priority groups - Aboriginal and Torres Strait Islander 4%; Culturally and Linguistically Diverse 7%; LGBTIQA+ 30%

Gender - 78% Female; 18% Male; 4% Gender diverse or undisclosed.

22. headspace campaigns

23. LGBTIQA+

It’s not all glitter and rainbows - If life becomes overwhelming, headspace is a safe space for LGBTQIA+ young people to come and talk about everything they’re going through. We're helping thousands of young people from the LGBTIQA+ community get the support they need.

24. Video: LGBTIQ+ pronouns (opens in Youtube)

25: 2021 campaign performance

• Content was developed to increase mental health literacy amongst young people and their family, friends, colleagues and employers
• The campaign received over 704,000 impressions
• Ads reached over 311,000 people
• Campaign landing page received +23% more page views than 2020
• headspace was the leader in the sector across the month.
• headspace marched in the 2021 Mardi Gras parade, as we have done since 2013, to reinforce that headspace is a safe space for LGBTIQA+ young people

26. Youth led

27. practice guidance for organisations

• Offer a space that is safe, private and accepting (e.g., use of flags, imagery and resources)
• Develop partnerships to LGBTI community partners
• Provide training for LGBTI-competent mental health training

28. practice guidance for organizations part 2

• Seek to employ appropriately qualified and skilled staff who identify as LGBTIQA+
• Be flexible when engaging LGBTI individuals
• Be open to discussing gender and sexuality

29. practice guidance for workers

• Facilitate conversations about sexual identity
• Support identity formation and ‘coming out’
• Address internalised heterosexist and homophobia/biphobia/transphobia

30. practice guidance for workers part 2

• Encourage support and acceptance
• Strengthen social supports
• Regularly explore ways to enhance service delivery for young people who identify as LGBTIQA+

31. thank you