IGLYO on... Mental Health - March / 2007

on...

no.1 March / 2007

Mental Health

Hello and Welcome!

Index:

IGLYO on... Mental Health

We at IGLYO are proud to present our first release of the new periodical magazine, a project that was born out of the need to develop an in-depth understanding of the current array of issues affecting LGBT youth.

We choose to tackle “mental health” as the first issue to further build upon IGLYO most recent Annual Conference 'Beyond coming out' which took place in Riga (Latvia) in december 2006.

You will find in this publication many looks to the issues of mental health affecting youth: a practitioner and an ecucational advisor will share their thoughts; then IGLYO will have a say in light of the main outcomes of our Conference. To then finally looking at two member organisations that are currently focusing a lot of their work around Mental Health, these organisations are in fact LGBT Youth in Scotland and GenderDoc-M in Moldova.

International Lesbian Gay Bisexual Transgender Queer Youth & Student Organisation p.o. BOX 3836 - 1001 AP Amsterdam The Netherlands info@iglyo.com - www.iglyo.com Bank Account: 678594953 ING Bank - Amsterdam-Centrum Herengracht 580, 1017 CJ, AMSTERDAM (The Netherlands) IBAN: NL59 INGB 0678 5949 53 BIC (Swift): INGBNL2A

TABLE OF CONTENTS Mental Health & well being in Europe

by David Farrington

We at IGLYO hope that this publication and the following ones would be beneficial and of interest to a wide range of audience, starting from our member organisations to those interested in LGBT Youth specific issues.

Young's people mental health: who can help?

We welcome your feedbacks and we wish you a happy reading...

by Darren R. Vella

the IGLYO Board Björn, Bruno, Darren, Fabio & Lucy

- LGBT Youth Scotland - GenderDoc-M / Moldova

by Dr. D Andrew Charters

Putting words into action Sharing Practices

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IGLYO on.... No.1, march 2007 Project Coordinator: Fabio Saccà Editors: Darren R. Vella, Colette Farrugia Bennet Contributors: Andrew Charters, Alon S. Chen, David Farrington, Nico Juetten, Lilia Raileanu Proofreading: Gary Rowland Design & Layout: Assaf Arbel, www.assafarbel.com Printer: NUOVAGRAFICA, www.tipolitonuovagrafica.it

extra resources and further readings to this edition on www.iglyo.com page 2

© 2007 IGLYO. Reproduction permitted, provided that appropriate reference is made to the source.

This newletter is published with the support of the European Youth Fundation and the European Commission. The information contained in this publicaa tion does not necessarily reflect the position of opinion of the European Commission or of the Council of Europe. They are not liable for any use that may be made of this information.

IGLYO on...Mental Health - no.1 / March 2007

LGBT Young People: Mental Health & Well Being in Europe

By David Farrington

So… What is Mental Health or LGBT Youth Mental Health? that has often created confusion or misunn derstanding especially from inter-cultural perspectives. Internationally, the most widely used definition is that of the World Health Organisation (WHO) which describes Mental Health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community”. It is a resource for living and more than just the absence of mental illness.

Good Mental health is a resource. There is no health without mental health.

Good Mental Health is important for individuals as well as for society. At individd ual level good, mental health enables people to realize their intellectual and emotional potential and to find and fulfil their roles in social, school and working life. At Society level good mental health is a resource for social cohesion, a better social and economic welfare it facilitates the transition of the EU into a knowledge society.

EU Commision 2006

David Farrington has been working in the LGBT sector for over 10 years, across many different cultural contexts and has been working extensively in the area of LGBT youth in the past few years.

The term ‘Mental Health’ can be one of the most vague, misunderstood and until recently, poorly defined words in the English language. It is this lack of clarity

From an LGBT young persons’ perspective, while these defii nitions are important frames of reference, it’s important to consider that we also construct our own definitions of what Mental Health means to us as a community and as a distinctive set of our own cultures. At IGLYO Conference, young people were invited to ‘paint’ what they felt ‘Mental Health’ meant to them. This proved an interesting experience as the Mental Health ‘universe’ was interpreted across many different dimensions - personal, organisational, cultural and social, reflecting the complexity of the area and the need to consider our own cultures’ perceptions in creating definitions. At the conference young people collectively defined ‘Mental Health’ for them as being an interaction between the social and individual, together with the opportunity to find one’s own identity and the ability to express such an identity, to be respected and the ability to value yourself. With the possibility of viewing such as being a fluid and changeable process that allows the individual to grow and have a meaningful life. To finally looking into the possibility of having resources in order to cope and the ability to access help both internally and externally. (IGLYO, 2006) externall IGLYO on...Mental Health - no.1 / March 2007

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Mental Health & well being in Europe

IGLYO’s 22nd Annual conference ‘Beyond Coming Out’ represented an extraordinary milestone in European LGBT cultural history and a political turning point for queer young people in regards to Mental Health. Mental Health is now being seen as an integral and important part of how it affects and has a direct relationship in creating an equitable, healthy and prosperous society. It has been said that we judge the basis of a civilisation on how well it supports its most vulnerable of citizens. In many ways the well being of young LGBT people acts as a barometer of democracy, citizenship and indicator of a just and fair European society. The mental health of LGBT young people therefore has important implications on the well-being of all Europeans.

& well being in Europe

Mental Health

Positive Mental health is “a state of wellbeing in which the individd ual realizes his or her own abilii ties, can cope with the normal stresses of life, can work producc tively and fruitfully, and is able to make a contribution to his or her community. It is a resource for living & more than just the absence of mental illness. The primary aim is to enhance well being by focusing on strengths / resources, reinforcing & enhancc ing external protective and reducing risk factors.”

This is especially important considering heterosexist norr mativity and the imposition of alternative cultural values onto our own. Living a life free from the impact of homophobia and heterosexism would be a common sense definition of positive mental health. As a culture we have made incredible advances in, for example, sexual health approaches in LGBT communities; we expect to see the same in the area of mental health for young people. LGBT culture and especially young LGBT people are sometimes particularly creative (FLAIRS, Farrington, 2007) for example. Being able to positively support and express that creativity may be an important aspect of an LGBT mental health definition and is an essential expression of good mental health. Highly creative people are also sometimes more at risk of mental illness being quite often gifted.

Therefore we should also consider the vulnerabilities and risks that may accompany such creativity in our young people as well as nurture their creative strengths (FLAIRS, 2007) World Health Organisation, 2004

Mental Illness vs One of the biggest issues to Mental Health emerge in the fiels, is the critical and in the field, is the critical difference between mental illness and mental health. For many countries and health systems, mental health means only one thing; mental problems and mental illness. Referred to as the medical or deficit model this approach to mental health (the most common for the first part of the 20th Century) views mental health in the negative.

A useful concept is that of the mental health continn uum proposed by Mezak & Haggerty (1994).

Mental illness is what results when an individual loses their mental health and can no longer cope with demands and pressures of everyday life and experii ence major problems in their work, social and emoo tional lives. Much of the thinking about mental health historically and professionally has focused on this area of the mental health continuum. What this means is that we think about mental health as something we repair when it breaks down and to do this we need specialist and professional help. The mental illness approach also tends to be more established and linked to class and narratives of power in society.

Traditionally, the medical profession has defined and controlled the ‘mental illness’ agenda and the ‘treatt ment’ of mental illness through drugs, therapies and surgery. While medical and psychological approaches to treating mental illness are still critical, the medical model is limited in its ability to explain or treat mental illness that has been created by social mechanisms such as poverty, social exclusion, discrimination and the dynamics of community psychology. page 4

IGLYO on...Mental Health - no.1 / March 2007

Mental Health for LGBT Youth includes: • The impact of interaction between individuals and Society • Having the opportunity to find your own identities expressing it and to be respected.

• Valuing yourself and being valued by others.

• Is fluid and changes.

• To grow and develop to have a meaningful life.

• Having the recourses in order to cope and the ability to access help both internally and externally. by participants from IGLYO 20th Conference "Beyond Coming Out", Riga, Decenber 2006

Positive mental health fits well with the social model of mental health for LGBT young people, which views homophobia, heterosexism, stigma and the resulting social exclusion as the major social determinants of the mental health inequalities young queer people experii ence. If we use this critical approach then we better understand the reason for existing problems and especially how to prevent the development of mental illness in a very different way. Mental health promotion (using the principles of the OTTAWA Charter) and commuu nity development approaches to identity-based positive mental health have been proven to be effective, sustainable and relatively cheaper as a strategy to prevention. A ‘risk and resill iency’ prevention approach looks at decreasing the many things that place young people the most at risk for becoming ill and increasing the things make young people emotionally stronger, more resilient and maintain their positive mental health.

Research convincingly indicates the major risk factors are most often family and parent rejecc tions, school bullying and isolation in many forms be it from other young queer people (especially rural young people), from LGBT understanding services and through the isolating effects of mental health stigma to even seek help. Risk also occurs at times of major change such as during coming out or from stress of having to manage being ‘closeted or out’ all the time. Young LGBT people appear most at risk for suicide when they know their sexual identity but have not actually ‘come out’ or if come out at very early ages when there very family dependent. Homelessness or unemployed due to homophobia are also major risk areas. Self harm has been shown to be a way of coping and surviving with homophobia.

Things that protect young queer people are being attached to a young LGBT culture and LGBT youth groups, having supportive parents and friends, sometimes faith in the case of ethnic young people, a positive and supported coming out, positive role models, IGLYO On...Mental Health - no.1 / March 2007

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& well being in Europe

Positive Mental A controversial aspect of the Conference was that of the notion of Health and Well positive mental health and what this means. If we examine the other Being of LGBT end of the mental health continuum we discover a whole different Young People universe of wellness, prevention and positive mental health. Positive mental health is being mentally, emotionally and psychologically well, the opposite of mental illness. From a health perspective there is now much interest in understanding what keeps people well rather than what makes them sick and designing services and projects that prevent mental illness from occurring. In the last decade there have been incredible advances in positive mental health and the prevention of mental illness. Indeed many advanced health care systems now fully fund illness and prevention-based approaches and in the era of health care cost blow outs, prevention of mental illness makes even more sense though this varies across Europe considerably. considerabl

Mental Health

The illness model also has a damaging history in LGBT human rights, actually reinforcing the disempowerment of sexual Mental Illness is the impairr minorities. For example, even today in First World countries ment of an individuals social, mental health professionals still continue to pathologise sexual emotional and occupational difference or at best interpret the causes of a LGBT young functioning which affects persons distress to them as individual vulnerability rather than their ability to lead their life to the broader powerful forces of homophobia and heterosexx as they previously did.

Medical Model ism in their lives. In many other countries, sexual orientation and gender identity remain a psychiatric diagnosis in their own right. Further, the medical model potentially creates stigma and the social exclusion of young people within LGBT communities themselves because of fear of mental illness, especially in disempowered minority cultures. Not surprisingly, a critical issue for many LGBT youth services in Europe when approaching the mental health universe is they have fallen into the illness model, for example providing only individually focused support services, counselling and therapies. These services are critically important to have but it means focusing on young people who are already developing or have major problems and not addressing broader social and cultural approaches at the community level for maintaining wellness in all young queer people.

& well being in Europe

Mental Health

Mental Health is an essential part of any citizens health and well being. As such it is an essential component of communities. Good Mental health is a basic human right factors that adversely affect mental health represent a major and growing threat to economic, social and public health in the world. Mental Health Europe 2006.

and being free from bullying and other forms of homophobia.

There are also differences positively and negatively according to whether a young person is lesbian, gay, bisexual or transs gender (the latter two young people are often most at risk).

LGBT Youth Practice, LGBT youth workers and young Participation and LGBT Activists are often the Peer Education in people closest and most trusted by young queer people. Consequently Communities as professionals or within an activists role they have a critical first line role in several aspects of their mental health. At an individual level and with the right support & training, they can help in identifying early signs of illness i.e. early intervention and in specialist referring, thy can promote mental health awareness and challenging mental health stigma in queer youth culture. They can also strengthen protective factors such as social support and create positive role models. The community principle of civic citizenship and especially participation - young people participatt ing themselves in all aspects of their own community development including finding solutions for their mental illness and positive mental health is itself a major protective factor and is mental health promoting. Peer education in particular is a powerful social approach that youth workers and young LGBT activists can develop in consultation with young people. Peer education informally places young people’s owns shared experiences at the heart of what best works for them in both preventing problems as well as what can be done if a young person is becoming unwell. It is also a way to spread strategic prevention messages about mental health, raise mental health awareness and support community development. It is an effective way to support young people sharing effective coping and resiliency skills especially in dealing with homophobia and social exclusion or teaching mental health ‘first aid’ to young LGBT people. Mental health promotion importantly means going beyond just the individual focus & tackling the broader causes of mental illness as well as promoting what naturally improves or maintains good mental health especially in at risk groups such as LGBT young people. This means working across multiple sectors where risk and promotion issues are such as in schools, in cyberspace, at work and with parents & families. It means addressing structural barriers in homophobic and heterosexist young peoples mental health services to improve access as well as strengthening communities to develop their own responses to specific issues such as suicide awareness & prevention. Designing services that are informal or not ‘mental illness’ identified is an important aspect to engage young LGBT people because of the effects of mental health stigma in reducing help seeking. At the end of the day, mental health & well being for LGBT young people requires a whole community approach for it to succeed.

“Beyond Coming Out” meant addressing broader social issues for young LGBT people and the impact upon mental health. Young LGBT like any young person today have often higher pressured, faster and more complex lives than a generation ago and less time to simply ‘be young’. The LGBT and mainstream media has a powerful influence on identity construction and pressures to conform to narrow, unrealistic stereotypes and images. Globalisation, overwork, changing employment and family patterns, technology, the commercialisation of young life and the Western ‘me only’ culture means social connection, a sense of community and things that preserve well being are becoming lost in many industrialised European counn coun tries for young people. These pressures only add and interact with homophobia and heteroo sexism and their impact and increase a possible need for a social and cultural approach to LGBT Youth mental health.

World Health Organisation (WHO) - "on mental health..." - www.who.int/mental_health/en/ Pictures in this article shows Educational Activities in the IGLYO 20th Conference “Beyond Coming Out”, Riga © IGLYO 2006 page 6

IGLYO on...Mental Health - no.1 / March 2007

By Dr Andrew Charters

Dr Andrew Charters is a Consultant Psychiatrist and works for Child & Adolescent Mental Health Services in Barnsley Primary Care Trust.

Young people’s mental health is rarely far from the front pages.

Whether it’s drug related gun crime, worries about size zero models and anorexia, or the threat of paedophiles, related subjects are often in the news, with young people portrayed as a problem. Newspapers seek somewhere to point the finger, and politicians are expected to respond. Lone parents, junk food advertising, permissive culture, TV and computer games all come in for criticism, as we question how to protect young minds. This article explores current debates in mental health, focusing on young people and the services we provide.

So what is mental health? It used to be defined by what it wasn’t, i.e. in contrast to mental illness. Most people know www.barnsleypct.nhs.uk someone who has suffered from a bout of depression or anxiety, although they may not realise how bad it can actually feel. As an alternative to the “medical model”, with its labels and diagnoses, terms such as mental health problems, difficulties or disturbance, are often preferred. However most of the language remains negative. Recently, there’s been a move towards defining mental health in terms of achieving one’s full potential in all aspects of life, e.g. education, relationships, and work. Identifying obstacles, in terms of unmet needs, is now thought more likely to lead to solutions and success. An emphasis on aims, resources, resilience and coping skills may help someone identify the strengths they can build on.

The flip side to such positivity is the danger of being glib, saying the glass is half full when it’s empty. A UNICEF survey of developed nations recently caused some soul searching. Young people in the UK, along with those in the USA, were found to be the most unhappy and insecure, with those in the Netherlands and Southern Europe at the opposite end of the spectrum. What do we have to learn from those nations, and from others, less developed in material terms, which may put greater emphasis on wellbeing? In competitive economies, it’s hard to avoid the trap of working longer and harder, to afford better holidays and more expensive gadgets. Young people are equally attracted to these rewards, whose pleasures can be brief, and which bring stress when unaffordable or unavailable. Are problems with young people’s mental health a price we pay for such competition and individual striving?

Whilst this may be a factor, the happier nations have similar economies. Perhaps we need to look more closely at young people’s experiences, at family life, education and peer relationships to answer this question.

Central to this debate is the idea that things were happier and easier in the past, and that young people have a lot more to cope with today. Undoubtedly they have more choice and reach some developmental stages earlier. In contrast they remain in education, and in a dependent role for longer, instead of starting work or training at an early stage. They are more, if not better fed, and have more variety. They have mobile phones, internet messaging services, and easier access to information.

These bring pressures, but also rewards. There are some obvious negative trends: rising crime and violence, increased drug and alcohol use, and obesity, but young people are also better informed about their health and more able to state their needs.

Perhaps adult commentators are just more aware of their experiences, and less likely to brush them aside as “something you go through”.

IGLYO on...Mental Health - no.1 / March 2007

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Young People’s Mental Health: who can help?

Young People’s Mental Health: who can help?

who can help?

Young People’s Mental Health:

I work as a child psychiatrist in Barnsley, a town in the north of England. It famously suffered the loss of its manufacturing industry, and with that a way of life, during the 1980’s. The town has had to adapt to major changes.

How have these changed circumstances affected young people? The certainty of a job offer following school has been lost. There’s more pressure to do well in school, because “you won’t get a job without qualifications”.

Government pressures on schools to achieve attendance and exam targets are passed down to pupils, who seem to be constantly preparing for assessments. Homework starts earlier, which can breed a disinclination towards education, though equally it can stimulate curiosity. This picture is not unique to Barnsley or the UK, but is spreading through contemporary Europe.

So how does this pressure cooker atmosphere manifest itself in young people? A degree of stress can be a useful challenge. Too much though, and it can provoke self harm, or lead to school absenteeism. It’s difficult for schools to foster both competition and cooperation.

Some children thrive, whilst others don’t and are found to have learning difficulties, such as dyslexia and dyspraxia, or concentration difficulties, as in attention deficit hyperactivity disorder (ADHD). Open classrooms and team work, while helping young people to develop important skills, can be difficult for a child whose social skills are poor, whether through bad experiences, or because of innate characteristics as in Asperger’s syndrome, a form of autism.

Work with young people goes beyond the person and their family, to include for example, liaison with schools. Sometimes we act as a bridge, or an advocate. We can be in the best position to help both sides understand each other or cooperate. We also work with social services, for example when there are child proo tection concerns, when a young person is a risk to themselves or others, or when they are looked after by the local authority. They may have been taken into care following abuse or neglect. Some children have a strong spirit of survival, but others carry a huge psychological burden from long term maltreatment. We also work with other health professionals, like health visitors, speech therapists and school nurses, and with the voluntary sector: charities like Barnardo’s or the National Society for the Prevention of Cruelty to Children, who run special projects, and provide counselling in schools. These are just some of the workers involved in enhancing young people’s wellbeing.

There is now a lot that can be done to help young people, and not just by professionals of course. Young people’s first points of call will usually be their family and friends, and then people close to them like teachers and neighbours. Other workers, like family doctors and paediatricians may be involved at an early stage. We provide training and support for these colleagues. Group approaches, following models developed in the USA and Australia, can be very effective, and provide an opportunity for different agencies to work together. In the UK, parents can be forced to attend such groups. Fortunately, once over the hurdle of coercion, they can benefit as much as those attending voluntarily. voluntaril As well as these special projects and novel approaches, there is still room for traditional 1:1 counselling. A young person may need to work through bereavement or other issues, without upsetting other people in their family. Despite atrocious experiences, young people can be surprisingly loyal to those around them, and want to leave their concerns with us, rather than face going over them with their parents. On other occasions it’s vital that we see page 8

IGLYO on...Mental Health - no.1 / March 2007

I hope this gives you a snapshot of the role of a child psychiatrist and their colleagues. A far cry from that painted in some newspapers, of someone who dishes out “kiddie cocaine” and antidepressants at the drop of a hat. Medication can be helpful for conditions like ADHD, OCD, and Tourette’s syndrome, but in combination, and often following, psychological approaches. The majority of young people, who come to us with fears, phobias, reckless behaviour, depression, or self harm, will talk through their problems, either on their own, or with their family. Despite seeing them at times of transition, and greatest vulnerability, I am often amazed by their strengths. Young people struggle with the pressures of competition, new technology, and the weight of the world’s problems, but this struggle contains their fight for a better future, in which they can lose and find themselves.

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who can help?

IGLYO on...Mental Health - no.1 / March 2007

Young People’s Mental Health:

family together, to help with boundaries and communii cation. Some families find it very difficult to express feelings, and their worries surface as physical problems, like collapsing or pains. Barnardo’s has imported Family Group Conferencing from New Zealand. They bring the extended family together, and support them in finding their own solutions. This practice started amongst the Maori, as a way of reducing outside involvement, and preventing children being taken into care. With severe conditions such as anorexia nervosa, we may need to provide a combinaa tion of these approaches; individual and family counsell ling, medical care and liaison with education. We’re learning all the time too. Because sexuality and gender identity are more widely discussed, young people are more likely to seek help in coming to terms with themm selves, or with others’ reactions and expectations.

Putting Words into Action – Putting Concepts into Seeking Solutions

IGLYO:

putting words into action

By Darren Vella

Mental health is a particular area of discourse, as one can see that it is very easy to look at the symptoms yet difficult to pin-point the origins. This embedded deficit within mental health is one that is well known. From the difficulties many experience in actually defining what mental health is in the first place (both articles prior to this one actually tried to define it), to actually seeking solutions. When writing an article about mental health for activists, the most appropriate language is one which looks at seeking solutions. It is easy to see that we are now moving beyond the arena of saying that LGBT mental health is something that needs to be addressed; the discussion now needs to shift to how to do it. This article will try to answer such questions by looking at what is going on in the field of mental health, looking at policy within EU structures, to approaches that young LGBT and non-LGBT activists can take when discussing mental health, not only at a grass-roots level but also with major stakeholders.

Darren Vella is a board member of IGLYO, his work in mental health stems from the recent IGLYO Mental Health conference organised in Latvia, to his area of academic specialisation and employment. He is currently working in one of the largest LGBT charities in London that specialises in LGBT mental health.

When looking for strategies in relation to mental health, key aspects to think about are what is being said/discussed in policy, and also local specificities in relation to research. These are an intrinsically important part in the process of trying to make an effective case for work to be initiated within the area of mental health. Looking at both strands it is easy to see that within a mental health framework both have their own strengths and weaknesses.

The arena of research can easily be seen as a strength within mental health, stemming from the fact that so much work has been done in this area. The wealth of information in regards to mental health and the specific experiences of LGBT youth is widespread. A common trend exists in research and that is in the essence of the constant patholagisation of mental health, so one would expect to see the same trend in relation to LGBT youth mental health. It is through this wealth of information that LGBT activists get an in-depth understanding of the core issues that are currently being discussed. This is an important thing to look for, either within your own work, or how you might address a symptom/problem. Currently in Europe there are a lot of LGBT organisations that are working on the active collation of research trying to place knowledge in one main portal. Such a resource would assist in the easy access, storage and dissemination of information. An example of an organisation doing such work is ANSO and the database project they are currently undertaking (www.anso.dk).

Research is important within the area of mental health as it legitimises the need for LGBT activists in the area of mental health in stating that there are specific needs which aren’t being met. As an example, IGLYO used research in its report on social exclusion of LGBT youth in which it states actual numbers to reinforce examples of the need to policy makers. It demonn strated that currently policies are not effective and change needs to occur.

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IGLYO on...Mental Health - no.1 / March 2007

The discourse of policy is an interesting factor when thinking about mental health and the intricacies and intercultural dimension of such understanding. A basic question that needs to be addressed, though, is what is meant by policy? Policy and its process ‘includes the identifii cation of different alternatives, such as programs or spending priorities, and choosing among them on the basis of the impact they will have’. Since IGLYO is a pan European organisation the best example that we can bring in this area is the EU (European Union) dimension.

Research and policy work are not the only means and methods to do work within mental health. Mental health provision in the form of peer support groups, counselling, and advocacy are just an array of methods used. Examples of verifying methods used in different countries can be found in the two member organisations featured in this publication.

IGLYO, following the conference that took place in Riga, December 2006 is interested in becoming more involved in the process of the forr malisation of the proposed European Commission Mental Health Policy, as it is in essence a lobbying tool that IGLYO members can use when diss IG cussing their specific needs within Mental Health frameworks. It is seen as a beginning to push for a process which members can be a part of, in the active inclusion of LGBT youth, within the complex discourse of mental health.

Pictures in this article show Educational Activities in the IGLYO 20th Conference “Beyond Coming Out”, Riga © IGLYO 2006 IGLYO On...Mental Health - no.1 / March 2007

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putting words into action

Mental health policy on an EU platform is still going through this process. The Green Paper produced by the European Commission is called "Promoting the Mental Health of the Population: Towards a Strategy on Mental Health for the European Union". This document was meant to safe-guard the EU’s strategic policy objectives including the areas of ‘prosperity, solidarity, social justice, and quality of life of citizens’. This approach unfortunately, barely mentioned the aspect of multiple discrimination in the area of its impact on mental health and well being, let alone specifically sexual orientation. Fortunately after the first revision and as part of the documents proposed, and issues to be included within the white paper, sexual orientation can now be found. LGBT youth issues were not and have not been specifically included. IGLYO sees the process after the introduction of the white paper as being when it can lobby and explore the possibility of including the LGBT youth dimension within such framework.

IGLYO:

It is surprising to find out that the EU is still working on a final stand point in regards to mental health. When writing a pan-European policy paper the process is not as straight forward as one might expect. There is an original draft called a Green Paper that after consultation turns into a White Paper and subsequently is voted on to finally become an official Policy Paper.

Sharing Practices - LGBT Youth Scotland

LGBT Youth Scotland

by Nico Juetten LGBT Youth Scotland provides both direct services to young people and work with other, non-LGBT-specific services to mainstream LGBT equality to improve LGBT young people’s experience of service use through research, policy and training work. We support and empower young people through the provision of advice and support, youth groups, outreach and opportunities for participation, such as volunteering. Mental health issues including low self esteem, suicidal thoughts and self harm are among the most frequent issues which young people present with.

What are the cultural precedents that allow or hinder your work in the area of Mental Health?

Scotland has a number of high profile campaigns to raise awareness of issues around mental health, including the anti-stigma campaign See Me (www.seemescotland.org) and the anti-suicide strategy and action plan Choose Life (www.chooselife.net). We also anticipate a campaign by regional representatives of the European Alliance Against Depression (www.eaad.net).

www.lgbtyouth.org.uk

Documents and research such as the NHS (National Health Service) Inclusion Project’s Towards a Healthier LGBT Scotland (www.lgbthealthscotland.org.uk) led policy-makers and funders to recognise that people who are socially excluded and discriminated against are more likely to experience poor mental health and barriers to accessing services.

While there are a number of positive developments, we feel that the mental health of LGBT young people is not a priority for policy-makers and the health sector. LGB young people’s mental health and transgender mental health in particular continues to be misunderstood and neglected.

What is the history for your organisation to work within Mental Health and what were the initial difficulties that you encountered?

Since our organisation was founded in 1989, much of our youth work provision has focused on reducing the isolation that many LGBT young people face and on addressing issues around low self-esteem and low confidence levels. Much of our work broadly relates to the mental wellbeing of LGBT young people. However, our first larger piece of work in mental health was Live to Tell, a study into the prevalence of suicide and suicidal ideation in gay and bisexual young men in Edinburgh and the Lothians, which we published in 2003. (www.lgbtyouth.org.uk/content/resources/download.asp?id=101) Last year we published a research report into homophobic bullying in schools that documented the severe negative impact that homophobic bullying can have on LGBT young people’s mental health. We will utilise the learning from this research to develop resources for teachers to tackle homophobic bullying in schools in the near future.

In terms of involvement in mental health policy, we are looking to extend our work in the future. Our partnership with SAMH and our current policy and parliamentary work are likely to form the basis for more targeted work in mental health policy. page 12

IGLYO on...Mental Health - no.1 / March 2007

What future do you see for the organisation in tackling an issue such as Mental Health?

Does your country have in place an inclusive Mental Health Policy, and if it does or doesn’t has your organisation had a role within such discourse?

There is recognition in some of the major mental health policy documents that LGBT young people are at a greater risk of suffering poor mental health but the issue still seems to be marginalised despite the clear evidence base.

A recent major piece of legislation now requires policy-makers and service providers to exercise their functions in line with the equal opportunities requirements of the Scotland Act 1998, which explicitly includes sexual orientation.

General equality legislation might help improve services for LGBT people.

How would the inclusion of LGBT Youth Mental Health Policy affect your work?

There are real obstacles to achieving legal changes and changes in policy, but speaking from a Scottish perspective a lot has changed in favour of LGBT equality, particularly over the last decade or so.

What advice would you give to those organisations who would like to work in the area of LGBT Youth Mental Health?

Most importantly, listening to LGBT young people is the first step. We respond to the articulated and evidenced needs of LGBT young people throughout our range of services and our policy work in mental health is based on this as well.

In our direct work with young people we are interested in the recovery model, which takes a person centred outlook on mental health and talks about finding hope, rediscovering meaning and purpose, feeling in control, participating in your community and taking creative risks.

Partnership work with specialist organisations is crucial both to our direct work with young people, and in our research, policy and training work. The capacity of the LGBT sector is limited and working in partnership with other organisations and sharing knowledge, learning and resources is therefore imperative.

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LGBT Youth Scotland

Mental health policy that gives due prominence to LGBT young people’s issues would enable us to build upon existing work to forge stronger straa tegic partnerships with mental health service providers and achieve better outcomes for LGBT young people who use their services. It would also potentially open up new funding opportunities for us to extend our services and provide more targeted mental health work directly to LGBT young people.

Sharing Practices -

LGBT Youth Scotland would like to see more resources including websites and literature aimed at LGBT young people, and more options for peer support such as befriending, emailing and web communities, especially for the most isolated young people.

GenderDoc-M / Moldova

Sharing Practices -

GenderDoc-M

by Lilia Raileanu

“GenderDoc-M”, views Mental Health as a systemic and multidimensional concept which does not just refer to the absence of a mental disease. To view mental health from the perspective of absence of a mental disease or from the perr spective of being solely concerned with mental illness was common for the Soviet Union countries. We look at Mental Health from the perspective of all factors that influence the psychological wellbeing of a person.

What are the cultural precedents that allow or hinder your work in the area of Mental Health?

Lilia Raileanu – psychologist, Participatory Drama practitioo ner.. Lilia has worked with various vulnerable groups as unemployed people, refugees, survivors of trafficking in human being, LGBT people etc. At GenderDoc-M, Lilia coordinates the Psycho-social program and the Network of Psychologists for Social Inclusion, Diversity and Non-Violent Communication.

The growing interest of mental health specialists to increase their professional knowledge, skills and the quality of the provided services make our work easier. Related to this, more and more LGBT people gain trust toward mental health services. Also, there is a greater focus on Mental Health afrom the Ministry of Health within the tendencies of the Republic of Moldova to integrate into the European Union. The factors that hinder our work are many, and this is related to the fact that homosexuality was considered a mental illness during the Soviet Union Regime. Even after it was excluded from the list of mental disorders, mental health care providers still have continued to consider it as an illness. According to the research “Evaluation of LGBT Mental Health Policy in Moldova” (2006), almost 50% of the mental health providers interr viewed still consider homosexuality to be an illness or a behavioral disturbance.

Existence of multiple stereotypes among members of society toward mental health providers (psychologists, social workers, psychotherapists, psychiatrists) also is a hindrance Also, Mental Health as a concept is perceived by many people as more related to Psychiatry than as a multidisciplinary and systemic concept.

What is the history for your organization’s work within the area Mental Health and what were the initial difficulties that you encountered?

Mental health was one of the priorities of “GenderDoc-M” beginning with 2002 when the project “Empowerment of the LGBT community in Moldova” started in partnership with COC Netherlands. The psycho-social assistance program was created, and one of the most important activities in this field was the systematically functioning service for individual coun seling of LGBT people. In 2003 the Network of Psychologists “For social inclusion, diversity and non-violent communication” was created by “GenderDoc-M”. The goal was to increase the quality of the services offered to social-vulnerable groups and to raise awareness about the LGBT community among mental health providers.. In 2002, the methods of Social Theatre and Participatory Drama were implemented in activii ties with the beneficiaries of the organization as well as activities to raise awareness of the general population about the LGBT 1 The research “Evaluation of the LGBT Mental Health Policy in Moldova” was implemented by “GenderDoc-M” in partnerr

ship with “Credo” and “CBS Axa”, with the financial support of the Open Society Institute, New-York. page 14

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community. In 2006 more focus was addressed to the mental health of transgender people by organizing the first support group and by establishing contacts with potential transgenderr friendly health care providers. In 2005-2006 the research “Evaluation of LGBT Mental Health Policy” was carried out.

What future do you see for the organization in tackling an issue such as Mental Health?

www.gay.md/eng/genderdoc.php All the above mentioned opportunities could be developed

by GenderDoc-M. I am writing “could”, because at the moment, further development of the Psycho-social program is under a question mark. While this article was in the writing process, the administration of “GenderDoc-M” decided to reduce the entire Psycho-social program and plans to only offer psychological counselling services. The reason for this decision, as it was presented by the adminiss tration to us, staff members, is based on a financial deficit.

Does your country currently have in place or adopted an inclusive Mental Health Policy, and if it does or doesn’t, does your organization have a role within such discourse?

Mental Health policy in Moldova was part of the National Health Policy of the Republic of Moldova. In 2004 the Mental Health Policy draft was developed in cooperation with Stability Pact for South Eastern Europe. At the moment the Mental Health Policy is approved. The conclusions of our research on the mental health policy in Moldova state that current policy does not reflect the needs of the LGBT community, but the ongoing health reform provides important and viable opportunities for the integration of LGBT group. Also, one of the conn clusions is that the shortcoming of the current policy can be explained by the low attention paid to the issue on the public agenda in the decision-making process, lack of public programs targeted to these society needs, and insufficient qualification and sensitivity on the part of the mental health specialists.

GenderDoc-M, as a result of the implemented research, has proposed an alternative mental health policy that does consider also the needs of the LGBT community. The alternative policy also proposes a combination of community-based and non-residential integrated care services combined with a specialized LGBT centre.

The proposed alternative was sent to the Ministry of Health. The first written feed-back of the Ministry was that they do not consider there is need to formulate separate objectives for LGBT community as this “will increase the segregation of the LGBT community in the society”. Instead, the positive answer was about the need to develop all the needed procee dures for transgender people.

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Sharing Practices - GenderDoc-M

There are several directions in which “GenderDoc-M” could continue to work. One direcc tion is to provide services for the LGBT community, which is getting even more ground with the new Community Centre opened by GenderDoc-M this year. Also, working on the improvement of mental health services outside of the organization is another direction, and in this sense the further development of the Network of Psychologists for Social Inclusion, Diversity and Non-Violent Communication would be an asset. Lobbying and advocacy is another priority and in this sense to develop and monitor the implementation of various reguu lations and programs at the National level is appropriate in the next period. These include an inclusive mental health policy for those who identify as LGBT, creation of a working group at the national level to ensure an appropriate assistance to transgender people in the period of gender-reassignment, and development of the university curricula that teaches in an adequate way the issues of LGBT people including youth.

GenderDoc-M

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