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Strauss P, Marion L, Hill NT, Gilbey D, Waters Z, Moore JK, Costanza M, Lamblin M, Robinson J, Lin A, Perry Y. Development of best practice guidelines for clinical and community service providers to prevent suicide in LGBTQA+ young people: A Delphi expert consensus study. Aust N Z J Psychiatry 2024; 58:425-434. [PMID: 38217434 DOI: 10.1177/00048674231223697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia. METHODS We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14-25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines. RESULTS A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people. CONCLUSION These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people.
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Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | | | - Nicole Tm Hill
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Julia K Moore
- The Gender Diversity Service, Child and Adolescent Health Service - Mental Health, Perth Children's Hospital, Perth, WA, Australia
| | - Marco Costanza
- Telethon Kids Institute, Nedlands, WA, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, WA, Australia
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Gilbey D, Brealey G, Mateo-Arriero I, Waters Z, Ansell M, Janse van Rensburg E, De Gouveia Belinelo P, Milroy H, Pace G, Runions K, Salmin I, Woolard A. The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service. Clin Psychol Psychother 2023; 30:1303-1312. [PMID: 37078825 DOI: 10.1002/cpp.2854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. METHOD Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6 months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. RESULTS Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. CONCLUSIONS The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.
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Affiliation(s)
- Dylan Gilbey
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Georgia Brealey
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Irene Mateo-Arriero
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Megan Ansell
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Giulia Pace
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Kevin Runions
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Ivan Salmin
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
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Francis J, Sachan P, Waters Z, Trapp G, Pearce N, Burns S, Lin A, Cross D. Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia. Int J Environ Res Public Health 2022; 19:10089. [PMID: 36011720 PMCID: PMC9407760 DOI: 10.3390/ijerph191610089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.
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Affiliation(s)
- Jacinta Francis
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Pratishtha Sachan
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Zoe Waters
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Psychological Science, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Gina Trapp
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Natasha Pearce
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Sharyn Burns
- School of Population Health, Curtin University, Kent St., Bentley, WA 6102, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
| | - Donna Cross
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia
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Strauss P, Lin A, Winter S, Waters Z, Watson V, Wright Toussaint D, Cook A. Options and realities for trans and gender diverse young people receiving care in Australia's mental health system: findings from Trans Pathways. Aust N Z J Psychiatry 2021; 55:391-399. [PMID: 33198483 DOI: 10.1177/0004867420972766] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. METHODS We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. RESULTS A total of 859 trans and gender diverse young people aged 14-25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. CONCLUSION These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people.
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Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Sam Winter
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Zoe Waters
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Vanessa Watson
- North Metropolitan Health Service, Western Australian Department of Health, Perth, WA, Australia
| | - Dani Wright Toussaint
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Strauss P, Winter S, Waters Z, Wright Toussaint D, Watson V, Lin A. Perspectives of trans and gender diverse young people accessing primary care and gender-affirming medical services: Findings from Trans Pathways. Int J Transgend Health 2021; 23:295-307. [PMID: 35799951 PMCID: PMC9255217 DOI: 10.1080/26895269.2021.1884925] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Background: Increasing numbers of trans young people are seeking medical services worldwide, but there have been few qualitative investigations of the experiences of trans young people attempting to engage with these services to explore in-depth experiences of clinical interactions. Aims: We aimed to explore the experiences of trans young people accessing primary care and gender-affirming medical services in Australia for reasons related to their gender. Methods: Using data from a large mixed methods cross-sectional study, we explored the personal experiences of trans young people aged 14-25 (N = 859) receiving care within primary care services and gender-affirming medical services. Qualitative data on these service experiences were thematically analyzed. Results: Trans young people in Australia reported experiencing difficulties when accessing medical services, especially in relation to gender-affirming medical intervention, referrals to specialist services, and obtaining clinical support in an affordable and timely manner. We found that trans young people were frequently confronted with negative experiences due to clinicians lacking expertise in providing gender-affirming care. Trans young people also reported many positive experiences, including feeling their gender identity was valued and respected by certain services. Although many practitioners attempted to assist their trans patients, they often did not provide satisfactory care and young people were often left to navigate the health care system unsupported. These interactions were often constrained by long waiting times and service cost. Discussion: In general, clinicians require further training to be able to respectfully interact with trans patients and to adequately assist trans young people to obtain necessary medical care. The danger of providing such non-affirmative care to a trans young person is not only invalidating the young person's identity, but also an elevated risk of ill-health due to later avoidance of health care.
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Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Sam Winter
- School of Public Health, Curtin University, Perth, Australia
| | - Zoe Waters
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Vanessa Watson
- Western Australian Department of Health, North Metropolitan Area Health Service, Perth, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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Finlay-Jones A, Strauss P, Perry Y, Waters Z, Gilbey D, Windred MA, Murdoch A, Pugh C, Ohan JL, Lin A. Group mindful self-compassion training to improve mental health outcomes for LGBTQIA+ young adults: Rationale and protocol for a randomised controlled trial. Contemp Clin Trials 2021; 102:106268. [PMID: 33421648 DOI: 10.1016/j.cct.2021.106268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Young adults who are lesbian, gay, bisexual, trans, queer or questioning, intersex, asexual and other diverse genders and sexualities (LGBTQIA+) are more likely to experience mental health difficulties and are at significantly elevated risk of substance abuse, self-harm and suicide, relative to their heterosexual, endosex and cisgender peers. There is a need for effective mental health interventions for LGBTQIA+ young adults. Mindful Self-Compassion training is a promising approach; among LGBTQIA+ individuals, self-compassion accounts for more variation in mental health outcomes than bullying, victimization, and adverse childhood experiences combined. Furthermore, LGBTQIA+ individuals with high self-compassion report more positive identity and happiness, less self-stigma, and lower suicidality than those with low self-compassion. METHOD This paper outlines the rationale and protocol for a single-blind CONSORT-compliant randomised controlled trial, comparing group Mindful Self-Compassion to a delayed-treatment waitlist control group, for improving mental health, decreasing self-criticism and increasing self-compassion in LGBTQIA+ young adults (age 18-25 years). Mindful Self-Compassion training is an 8-week group program that focuses on cultivating self-compassion and mindfulness. While typically delivered as a face-to-face program, the proposed trial will investigate efficacy of the program when provided via videoconferencing. DISCUSSION Videoconference Mindful Self-Compassion training has the potential to improve the mental health of Australian LGBTQIA+ young adults and provide a possible cost-effective, scalable intervention for this population. The proposed trial will be the first to determine its efficacy for LGBTQIA+ young adults and will provide the first data on the delivery of the program via videoconferencing.
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Affiliation(s)
- Amy Finlay-Jones
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Penelope Strauss
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Yael Perry
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia.
| | - Zoe Waters
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Dylan Gilbey
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Meg-An Windred
- Minus18, 81 Rupert St, Collingwood, VIC 3066, Australia.
| | - Adrian Murdoch
- Minus18, 81 Rupert St, Collingwood, VIC 3066, Australia.
| | - Charlotte Pugh
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia.
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
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