Education for Mental Health Toolkit - Inclusivity – LGBTQ+

Research shows that individuals who are LGBQ+ are more likely to experience poor mental health compared to heterosexual individuals (2-4). This is especially true for younger cohorts (5). Additionally, the literature shows that individuals from sexual minority groups experience poorer physical health than their heterosexual counterparts (6) and they are more likely to engage in risky behaviours (7). A UK-based systematic review and meta-analysis of 94,818 people showed that LGBQ+ individuals (particularly youth and older people) reported poorer wellbeing and mental health than non-LGB individuals (10) Many of these outcomes are the result of experiencing harassment and discrimination (8, 9). Reports from Queer Futures (11) and The Mental Health of Young LGB&T People (3) identified homophobia and biphobia, sexual norms, managing sexual orientation, being unable to talk to someone and experiencing life difficulties (such as bullying, abuse and shame) as predictors of enhanced levels of stress for this population.

Many people identifying as LGBQ+ experience discriminatory acts, and are victims of hate crimes (12, 13). Research found that harassment and discrimination undermine the wellbeing of LGBQ+ students (14). The National Union for Students (15) reported that 1 in 5 LGBQ+ students experienced bullying or harassment on their university campus because of their sexual orientation; these students are also 2 to 3 times more likely to consider dropping out from their course. However, many instances of discrimination and victimisation go underreported and can lead to social marginalisation and isolation (16).

An environment supports the integration of sexual minority students when peers are accepting, as it fosters a greater sense of belonging to such community (17). Universities are environments that rely on acceptance, mutual trust, and inclusivity to promote learning and to make students feel safe to explore academic resources and navigate social networks (18). However, universities are often not considered to be ‘safe spaces’ as homophobia on campus is a critical issue despite the implementation of the Equality Act (16, 19). In fact, a report from Stonewall (20) highlighted that homophobia is still a significant problem in educational environments and especially in universities, which are environments where students learn how to define their sexual identities, where they feel vulnerable, and where being treated negatively can lead to experiencing stress, loss of confidence, self-exclusion, and isolation (21).

Literature showed that hearing derogatory terminology is linked to worsening of academic outcomes and to lower grades (14). Furthermore, being the victim of discriminatory experiences has been found to interfere with academic development and educational outcomes, which can lead to academic drop-out (14, 22).

However, literature suggests that increasing students’ sense of belonging through academic and social integration can facilitate academic development and it is positively associated with persistence in the academic environment (14, 22). In fact, Garvey and colleagues (23) suggested that perception of a comfortable and warm campus climate is associated with higher academic success. When students experience positive interactions with faculty and academics, they are more likely to thrive within the academic environment, to perceive higher academic satisfaction and more social acceptance (24, 25). Conversely, poor academic performance and outcomes, absenteeism, disengagement, drop-out and poor academic engagement are linked with experiencing negative social interactions, poor social acceptance, and harassment (14, 25, 26).

Students’ sense of belonging and engagement through learning are paramount for academic success and for retention, and supporting these processes requires an inclusive approach to learning, teaching and assessment, which can be achieved with an inclusive student-centred learning approach (27). This approach needs to take into consideration curriculum design and content, delivery and pedagogy, assessment, and feedback, as well as an institutional commitment to inclusive learning and teaching (27, 29). See Inclusivity.

In terms of academic engagement, LGBQ+ students often do not see their experiences and history reflected in the curriculum (15, 16). However, a range of factors can help build and develop resilience, such as adopting an ‘out and proud’ identity to tackle stigma and shame, being accepted, having a partner and/or familial support, being a part of the LGBTQ+ community and having hope for the future (3, 30). When academics create safe learning environments in which discriminatory behaviour is challenged in relation to sexual orientation this can support LGBQ+ students to feel a greater sense of belonging, have psychological safety, learn more and perform better academically (16).

Key lessons

1. The National Union for Students reported that 1 in 5 LGBQ+ students experienced bullying or harassment in their university campus because of their sexual orientation; these students are also 2 to 3 times more likely to consider dropping out from their course.
2. Many people identifying as LGBQ+ undergo discriminatory acts, are victims of hate crimes and research found that heterosexist harassment and discrimination undermine the wellbeing of these students. 
3. Increasing students’ sense of belonging through academic and social integration can facilitate academic development and it is positively associated with persistence in the academic environment. In fact, the perception of a comfortable and warm campus climate is associated with higher academic success.
4. When students experience positive interactions with faculty and academics, they are more likely to thrive within the academic environment, to perceive higher academic satisfaction and more social acceptance.
5. There is a strong need to promote development, sense of belonging and respectability on college campus and teaching environments through educational practices in order to reach all students and support inclusivity for LBGQ+ students.

Top tips

1. Being able to talk to a caring instructor may have a substantial positive impact on the academic experiences of marginalised students (31); thus, academics could try to be open to start a dialogue with these students in order to create a climate where they can feel supported and accepted.
2. Include LGBQ+ examples within curriculum content.
3. Attitudinal changes on the side of the educators and awareness raising are of vital importance to address prejudice and contribute towards a more positive climate (16).
4. Avoid making assumptions about students and try to avoid using language which can unintentionally exclude e.g., assuming someone’s partner is of the opposite gender.

Resources

• Applying the Seven Learning Principles to Creating LGBT-Inclusive Classrooms: https://www.aacu.org/publications-research/periodicals/applying-seven-learning-principles-creating-lgbt-inclusive

References

1. Smithies D, Byrom NC. LGBTQ+ Student Mental Health: The challenges and needs of gender, sexual and romantic minorities in Higher Education. 2018.

2. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC psychiatry. 2008 Dec;8(1):1-7.

3. Weeks H. The mental health of young LGB&T people. 2017.

4. Roberts AL, Rosario M, Corliss HL, Koenen KC, Austin SB. Elevated risk of posttraumatic stress in sexual minority youths: mediation by childhood abuse and gender nonconformity. American journal of public health. 2012 Aug;102(8):1587-93.

5. Meyer IH, Frost DM. Minority stress and the health of sexual minorities. 2013.

6. Lick DJ, Durso LE, Johnson KL. Minority Stress and Physical Health Among Sexual Minorities. Perspect Psychol Sci. 2013;8(5):521–48.

7. Hagger-Johnson G, Taibjee R, Semlyen J, Fitchie I, Fish J, Meads C, et al. Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE). BMJ Open. 2013;3(8):e002810.

8. Woodford MR, Kulick A, Sinco BR, Hong JS. Contemporary heterosexism on campus and psychological distress among LGBQ students: The mediating role of self-acceptance. American Journal of Orthopsychiatry. 2014 Sep;84(5):519. Available from: doi: 10.1037/ort0000015

9. Woodford MR, Weber G, Nicolazzo Z, Hunt R, Kulick A, Coleman T, Coulombe S, Renn KA. Depression and attempted suicide among LGBTQ college students: Fostering resilience to the effects of heterosexism and cisgenderism on campus. Journal of College Student Development. 2018;59(4):421-38.

10. Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC psychiatry. 2016 Dec;16(1):1-9.

11. McDermott ES, Hughes E, Rawlings VE. Queer Future Final Report: Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour. 2016.

12. Bachmann CL, Gooch B. LGBT in Britain: Hate crime and discrimination. Stonewall; 2017.

13. Bachmann C, Gooch B. LGBT in Britain. University report. London: Stonewall. 2018.

14. Mathies N, Coleman T, McKie RM, Woodford MR, Courtice EL, Travers R, Renn KA. Hearing “that’s so gay” and “no homo” on academic outcomes for LGBQ+ college students. Journal of LGBT Youth. 2019 Jul 3;16(3):255-77.

15. National Union of Students. Education beyond the straight and narrow: LGBT students’ experience in higher education. 2014.

16. Ellis SJ. Diversity and inclusivity at university: A survey of the experiences of lesbian, gay, bisexual and trans (LGBT) students in the UK. Higher Education. 2009 Jun 1;57(6):723-39.

17. Woodford MR, Kulick A. Academic and social integration on campus among sexual minority students: The impacts of psychological and experiential campus climate. American journal of community psychology. 2015 Mar 1;55(1-2):13-24. Available from: doi: 10.1007/s10464-014-9683-x

18. Deakin Crick R, Barr S, Green H, Pedder D. Evaluating the wider outcomes of schools: Complex systems modelling. Educational Management Administration and Leadership. 2015;45(4). Available from: doi: 10.1177/1741143215597233

19. Legislation.gov.uk. Equality Act 2010. [Internet]. 2010. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents

20. Stonewall. Serves You Right: Lesbian and Gay People’s Experiences of Discrimination. [Internet]. London: Stonewall. 2008. Available from: www.stonewall.org.uk/documents/servesyouright.pdf

21. Valentine G, Wood N. The experiences of lesbian, gay and bisexual staff and students in higher education. 2010.

22. Rankin S, Blumenfeld WJ, Weber GN, Frazer S. State of higher education for LGBT people. Charlotte, NC: Campus Pride; 2010 Jul 3.

23. Garvey JC, Squire DD, Stachler B, Rankin S. The impact of campus climate on queer-spectrum student academic success. Journal of LGBT Youth. 2018 Apr 3;15(2):89-105. Available from: doi: 10.1080/19361653.2018.1429978

24. Kim YK, Sax LJ. Student–faculty interaction in research universities: Differences by student gender, race, social class, and first-generation status. Research in Higher Education. 2009 Aug;50(5):437-59. Available from: doi: 10.1007/s11162-009-9127-x

25. Silverschanz P, Cortina LM, Konik J, Magley VJ. Slurs, snubs, and queer jokes: Incidence and impact of heterosexist harassment in academia. Sex Roles. 2008 Feb 1;58(3-4):179-91. Available from: doi: 10.1007/s11199-007-9329-7

26. Woodford MR, Krentzman AR, Gattis MN. Alcohol and drug use among sexual minority college students and their heterosexual counterparts: The effects of experiencing and witnessing incivility and hostility on campus. Substance Abuse and Rehabilitation. 2012;3:11. Available from: doi: 10.2147/SAR.S26347

27. Thomas L. Developing inclusive learning to improve the engagement, belonging, retention, and success of students from diverse groups. In: Widening higher education participation; 2016 Jan 1 (pp. 135-159). Chandos Publishing.

28. Hockings C, Cooke S, Yamashita H, McGinty S, Bowl M. Switched off? A study of disengagement among computing students at two universities. Research Papers in Education. 2008 Jun 1;23(2):191-201.

29. Bowl M. Valuing diversity in the social science curriculum. Learning & Teaching in the Social Sciences. 2005 Jul 1;2(2).

30. Nodin N, Peel E, Tyler A, Rivers I. The RaRE Research Report: LGB&T mental health–risk and resilience explored. 2015.

31. Stewart DL, Howard-Hamilton MF. Engaging lesbian, gay, and bisexual students on college campuses. Student engagement in higher education: Theoretical perspectives and practical approaches for diverse populations. 2015:121-34.