Background:Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Objectives:To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support. Method:This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Results:Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. Conclusions:In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. Study registration:This study is registered as PROSPERO CRD42019135722. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

IntroductionPeople with intellectual disabilities experience health inequalities at a greater level than their non-disabled peers. Notably, while general health status is starting to receive some attention, the reproductive health and rights of people with intellectual disabilities continue to be understudied from a policy and research perspective. The objective of this review is to elucidate the complex interplay between individual, social and structural factors that influence reproductive health outcomes for this population. The findings will be used to develop a theoretical framework to explain how and why reproductive health inequalities persist for people with intellectual disabilities and to identify gaps in the knowledge base to inform future research on this topic.Methods and analysisA six-stage meta-narrative review will be undertaken to synthesise the available evidence that seeks to explain the reproductive health inequalities experienced by people with intellectual disabilities and the factors contributing to these inequalities. The protocol for this review was developed in accordance with the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guideline is completed to ensure transparency.Ethics and disseminationThis meta-narrative review protocol does not require formal ethics review because it will be based on published studies. The findings from this review will be submitted to a peer-reviewed journal and presented at national and international conferences. We will also produce our findings in a range of accessible and easy-to-read formats.PROSPERO registration numberCRD42024495199.

Despite overwhelming international evidence of elevated rates of poor mental health in LGBTQ+ youth compared to their cis-heterosexual peers, we know relatively little about effective mental health services for this population group. This study aims to produce the first early intervention model of "what works" to support LGBTQ+ youth with emerging mental health problems. Utilizing a mixed method case study, we collected data across 12 UK mental health service case study sites that involved: (a) interviews with young people, parents, and mental health practitioners (n = 93); (b) documentary analysis; (c) nonparticipant observation. The data analysis strategy was theoretical using the "explanation-building" analytical technique. Our analysis suggests an intersectional youth rights approach with 13 principles that must be enacted to provide good mental health services as advocated by the United Nations Convention on the Rights of the Child and World Health Organization. This approach should address the multiple forms of marginalization and stigmatization that LGBTQ+ youth may experience, enable informed independent decision-making, and uphold the right to freedom of safe self-expression. A rights-based approach to mental health services for LGBTQ+ young people is not prominent. This needs to change if we are to tackle this mental health inequality and improve the mental well-being of LGBTQ+ youth worldwide.

Autistic people experience a higher prevalence of self-harming behaviours than do the general population. Self-harm remains a stigmatised topic, and until recently, self-harming behaviours in autism were considered to be limited to self-injurious behaviours experienced by intellectually impaired autistic children and not to be experienced by cognitively able autistic adults. Because of the belief held by many professionals that many mental health-related problems are inherently part of autism and immune to treatment or help, many autistic people are left unable to access the help and support that they desperately need. This study adopts an online qualitative methodology to explore this under-researched phenomenon, thematically analysing online forum posts from autistic adults to determine what forms of self-harm are described, what precipitates the self-harm and how forum users support each other. The findings reveal that self-harming behaviours are nuanced and complex, highlighting the connections between sensory overload, meltdowns, stimming and impulsive repetitive blunt trauma seen as autistic self-injurious behaviours. When seeking help, barriers include navigating misdiagnoses of other mental illnesses and being misunderstood or disbelieved by professionals. Online forum users offer help in the form of emotional empathy, as well as practical solutions, providing an example of valuable peer support.

This meta-narrative review on mental health early intervention support for LGBTQ+ ​youth aimed to develop a theoretical framework to explain effective mental health support. Using the RAMESES standards for meta-narrative reviews, we identified studies from database searches and citation-tracking. Data extraction and synthesis was conducted through conceptual coding in Atlas.ti. in two stages: 1) conceptual mapping of the meta-narratives; 2) comparing the key concepts across the meta-narratives to produce a theoretical framework. In total, 2951 titles and abstracts were screened and 200 full papers reviewed. 88 studies were included in the final review. Stage 1 synthesis identified three meta-narratives - psychological, psycho-social, and social/youth work. Stage 2 synthesis resulted in a non-pathological theoretical framework for mental health support that acknowledged the intersectional aspects of LGBTQ+ ​youth lives, and placed youth at the centre of their own mental health care. The study of LGBTQ+ ​youth mental health has largely occurred independently across a range of disciplines such as psychology, sociology, public health, social work and youth studies. The interdisciplinary theoretical framework produced indicates that effective early intervention mental health support for LGBTQ+ ​youth must prioritise addressing normative environments that marginalises youth, LGBTQ+ ​identities and mental health problems.

The British Student Doctor Journal is a high quality, open access, biannual, peer-reviewed, general medical journal, which publishes articles written primarily by medical students. In addition to publishing original research and systematic reviews, we also provide a platform to medical students to express original thought and reflections on clinical practice, student life and medical education.All of our content is fully open access, available without subscription and with no authorship charges. All articles published in The British Student Doctor Journal go through a rigorous peer-review process, led by our student editorial team. The governance of the journal is overseen by our faculty advisory board, and we are published by Cardiff University Press and funded by Cardiff University School of Medicine.For more information, please visit our homepage at www.bsdj.org.uk.

BACKGROUND:Emergency Hormonal Contraception (EHC) has been underused in Britain and internationally since its introduction. 'Stigmatisation' has been identified as one of the barriers to EHC. However, few, if any publications have focussed on the significance of this factor in the British context, the social meanings for women of seeking EHC and the implications for future contraceptive provision and innovation.METHOD:In-depth qualitative material from 27 women across two British studies was analysed. The first, in which 11 young women were interviewed in-depth regarding EHC specifically, was supplemented by material from a multi-stage narrative study of 15 women concerning their life history experiences of using contraception more broadly.RESULTS:Stigmatisation of EHC use is a key barrier and derives from associations with irresponsible behaviour. This irresponsibility exists on a continuum with some behaviours and some women more ir/responsible than others. In addition, despite not being an abortifacient, EHC may be closely aligned with abortion meaning users can be perceived as 'bad women' in a similar way to abortion seekers. This stigma can deter participants seeking EHC when they may need it.CONCLUSION:Stigma is a powerful barrier to EHC use due to the social significance of responsibility and expectations pertaining to the behaviour of 'good women.' Understandings about stigmatisation in the case of EHC should be translated to other aspects of contraceptive service delivery and future innovations, to ensure effective provision of methods and safeguard their uptake.

In this article, we critically reflect upon the experience of public health research involving children and contribute to existing conversations about the methodological and ethical facets of research in this field. Drawing on two phases of a study that sought to explore the lived experiences of families with young children who have had a recent common childhood illness (gastrointestinal infection), we address the research process, from inception of the studies, to fieldwork and the resultant material obtained. We argue that when researching with families about a child-centered experience, it is important to look beyond the individual adult as “participant” and to conceptualize dependents either as, or “like” participants—what we suggest as a “family-centered approach.” Theoretically, this strategy best addresses the lived reality of relationality and responsibility of parent/carers for dependent children; while improving the ease and safety of data collection for the researcher and participants alike.

In this commentary, we reflect critically on the experience of delivering community-based sexual pleasure workshops for self-defining women in order to share lessons from our practice with others working in sex and sexualities education in higher education or in practice settings. Our discussion about facilitating these workshops in informal learning spaces contributes to the literature on pleasure inclusive sex and sexualities education. Specifically, it highlights the demand for spaces which women can think critically about sexuality and pleasure, and shares women's perspectives on these workshops. We begin by addressing the context in which we delivered the sexual pleasure workshops and describe what we did and why. Next, we share reflections on what we have learned from delivering these workshops, before concluding with suggestions about what this may mean for pleasure inclusive sex and sexualities education more broadly.

This article will explore how LGBTQ+ young people sustain, and in some cases survive, family relationships. We develop the concept of ‘paradoxical family practices’ and use this to demonstrate the ways in which LGBTQ+ young people manage family life through everyday emotion work. This highlights: (1) how families ordinarily navigate heteronormativity and ‘issues’ of gender/sexuality; (2) the efficacy of ‘paradoxical family practices’ as a conceptual tool; (3) the value of emotion-centred multiple qualitative methods to explore the lives of LGBTQ+ young people and mental health. Findings derive from a small-scale UK study funded by the Wellcome Trust (UNS39780) and were generated through a two-stage methodology comprising digital/paper emotion maps and qualitative interviews with LGBTQ+ young people aged 16–25 (n = 12) followed by diary methods and follow-up interviews (n = 9). Interviews were also completed with ‘family members’ (n = 7).

Gastrointestinal (GI) infections exert a significant public health burden in the United Kingdom and the numbers of episodes are increasing. Younger children are considered particularly vulnerable to infection, and can experience 2-3 GI infections episodes per year, with consequences being more severe for more disadvantaged children, who are much more likely to be admitted to hospital. Few qualitative studies have explored the lived experience of GI infection in the community in the UK. The aim of the study reported here was to contribute to addressing this evidence gap, by examining the consequences of GI infection for 'normal' family life. Eighteen mothers with young children who had recently experienced a gastrointestinal infection were recruited from two socioeconomically contrasting neighbourhoods in North West of England. The findings demonstrated that GI infections were particularly disruptive: experienced as disgusting, laborious and stressful and significantly impacted normal family routines. Women felt burdened by the heavy physical and emotional demands of caring for a GI infection, resulting in feelings of isolation and insufficient support in their caring role from male partners. Tensions also arose from interactions with external community organisations, particularly in complying with their regulations on infection which often undermined caregivers knowledge and expertise of what was best for their children. This study challenges assumptions that managing GI infections in the home is unproblematic and experienced by caregivers as a 'minor ailment.' Infection control measures need to incorporate insights gleaned from the day-to-day realities of caring for sick children in the community.

Background LGBTQ +young people experience disproportionately poor mental health outcomes compared to their heterosexual counterparts. Poor mental health is linked to family conflict about sexual orientation whereas supportive family relationships are correlated with mental wellness in LGBTQ +youth. However, little research focuses on family environments for LGBTQ +youth and to date there is no UK evidence on the topic. In addition, both ‘family’ and ‘youth’ remain under-theorised and mental health research typically uses a psycho-biomedical framework where emotion is pathologized. This limits our understanding of the complexity, relationality and meanings of youth mental health. Aim/Objectives This methodological paper will explain the interdisciplinary critical mental health taken to researching LGBTQ+youth and family relationships in a small-scale study in England. Specifically, I will critically reflect on the epistemological and practical aspects of centralising emotion within this research project. Methods Two phases of qualitative research with13 LGBTQ +young people and 7 ‘family members’ was conducted. Phase one involved family mapping and semi-structured interviews; and phase two used diary methods. Emotion mapping techniques were used throughout and an emotion-centred analysis conducted including through the development of ‘I-feel poems’; and drawing on Hochschild’s (1979) concept of ‘emotion work.’ Results Our approach to researching LGBTQ+young people and their families yielded material that was saturated with emotion and highlighted myriad ways that LGBTQ+youth mental health is influenced by doing emotion work in their families for the purposes of becoming, belonging and survival. Conclusions Our method/ology successfully captured emotion and facilitated an emotion-centred analysis of LGBTQ +youth/family relationships. Although it’s likely much emotion remains hidden from view and its exposure presents ethical risks for researcher and participant, this methodological approach offers a valuable alternative perspective on mental health that attends to the meanings and relationality of LGBTQ +youth experience.

Conflict with the family about sexual orientation and gender diversity is a key risk factor associated with poor mental health in youth populations. Findings presented here derive from a UK study that employed an interdisciplinary critical mental health approach that de-pathologised emotional distress and conceptualised families as social and affective units that are created through everyday practices. Our aim was to explore how family relationships foster, maintain or harm the mental health and well-being of LGBTQ+ youth. Data were generated through exploratory visual, creative and digital qualitative methods in two phases. Phase 1 involved digital/paper emotion maps and interviews with LGBTQ+ youth aged 16 to 25 (n = 12) and family member/mentor interviews (n = 7). Phase 2 employed diary methods and follow-up interviews (n = 9). The data analytic strategy involved three stages: individual case analysis, cross-sectional thematic analysis and meta-interpretation. We found that family relationships impacted queer youth mental health in complex ways that were related to the establishment of their autonomous queer selves, the desire to remain belonging to their family and the need to maintain a secure environment. The emotion work involved in navigating identity, belonging and security was made difficult because of family heteronormativity, youth autonomy and family expectations, and had a stark impact on queer youth mental health and well-being. Improving the mental health of LGBTQ+ youth requires a much deeper understanding of the emotionality of family relationships and the difficulties negotiating these as a young person.

This letter seeks to synthesise methodological challenges encountered in a cohort of Wellcome Trust-funded research projects focusing on sexualities and health. The ten Wellcome Trust projects span a diversity of gender and sexual orientations and identities, settings; institutional and non-institutional contexts, lifecourse stages, and explore a range of health-related interventions. As researchers, we originate from a breadth of disciplinary traditions, use a variety of research methods and data sources. Despite this breadth, four common themes are found across the projects: (i) inclusivity, representations and representativeness, (ii) lumping together of diverse groups, (iii) institutions and closed settings (iv) ethical and governance barriers.

Background There is limited evidence on the impact of multi-component interventions to support the delivery of palliative care in care homes. In 2015, one hospice established an innovative 'Hospice in Your Care Home' team using a number of interventions: role modelling and working alongside staff, responses to urgent referrals, advance care planning and training courses. This project has been externally evaluated. Aims • To evaluate the process and outcomes of the 'Hospice in Your Care Home' initiative, with specific reference to hospital admissions and end of life care practices. • To ascertain the costs of delivering the project. • To identify facilitators and barriers to the implementation of the initiative. Methods The responsive evaluation comprised: • an analysis of secondary service provision data • focus group interviews with care home managers (n=7), care home staff (n=11) and the project team (n=6) • preliminary analysis of cost (time and finance). Secondary data was analysed using descriptive and inferential statistics. Framework analysis structured the qualitative data analysis. Results Nine care homes participated with one facility leaving and one joining part way through. Hospital admissions were significantly reduced by 25% (p=0.01), between 2015 and 2016. Resident status meetings were conducted in each facility, with 4479 residents discussed at 217 meetings. Staff described increased confidence in their ability to care for residents with palliative care needs. To establish this project three stages of implementation were identified: initiation, assimilation, and 'everyday' running. The project was facilitated by the hospice team's flexibility and supportive approach. Reported barriers reflected the ongoing challenges regarding staffing levels and release of staff to attend training. Conclusions This hospice model has demonstrated significant reductions in hospital admissions and increased confidence of care home staff in end of life practices. It has the potential to be expanded in other localities.

Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced.