1. Improving the mental health of young LGB&T people: Using Public Health leadership to tackle homophobic, biphobic and transphobic bullying in schools.
While bullying is a problem for all children and young people, LGB&T groups face an increased risk
Recent decades have seen considerable progress in social attitudes to non-heteronormative sexual identities, and in social, political and legislative change – BUT there is still considerable work to be done
Same-sex contact is seen as a criminal offence in 74 countries – punishable by death in 13 (research published by International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA))
At the same time, discourses around sexual and gender identity are continually evolving
Photo credit: Ludovic Bertron from New York City,
Lina Martino - Specialty Registrar in Public Health, Warwickshire County Council
Andy Beckingham - Independent Consultant in Public Health
Christina Gray - Consultant in Public Health, Somerset County Council

2. Plan for this session Individual exercise (5 min)
Background and evidence (10 min)
Group discussion (30 min)
Feed back summary to wider group (10 min)
Reflection on individual exercise (5 min)

3. Aims of session
Understand what works and what is currently being done in local areas to tackle homophobic, biphobic and transphobic bullying
Discuss facilitators and barriers to implementing interventions effectively
Identify actions for local Public Health teams

4. Before we start…
Think about a time you felt uncomfortable or threatened in a social or work situation. Take a few moments to feel back into that – and write down (for yourself) how that felt. Choose one word in particular and write on a post-it. Do same for a time you felt confident and supported in a social or work situation.

5. Definitions
Bullying in schools is defined by the UK Government as ‘physical assault, teasing, making threats, name calling’ or ‘cyber bullying – bullying via a mobile phone or online’
It is often aimed at specific groups, including LGB&T
Can range from passive resentment to victimisation and physical violence

6. Bullying and the stress response
Adaptive response - mobilising energy to fight or run away
Repeated or chronic stress can lead to high blood pressure, heart disease, reduced immunity, depression and anxiety – directly through physiological changes, and indirectly through health behaviour
Longer-term impact on educational attainment, employment and relationships

7. The scale of the problem
Online survey by Stonewall1 of 1,614 LGB people aged found that:
55% experienced bullying in schools
96-99% heard homophobic remarks
A study using Next Steps data2 found that a greater proportion of 19 year olds identifying as LGB were bullied during compulsory education (age 13-14) and at age 19-20:
‘Ever been bullied’: 60.5% of LGB vs 45.4% of heterosexual
‘Frequent bullying’: 19% of LGB vs 6.1% of heterosexual
Lack of robust data on transgender individuals to date BUT one study found that 64% of people transitioning from FTM and 44% of MTF experienced bullying3
A US survey reported high rates of harassment (78%), physical assault (35%) and sexual violence (12%) between the ages of 7-19 among people who expressed transgender identity or gender non-conformity in school4
1. Guasp, A. (2012) The School Report: The experiences of gay young people in Britain’s schools in Stonewall.
Henderson, M. (2015) Understanding Bullying Experiences among Sexual Minority Youths in England, London: Centre
for Longitudinal Studies.
Nationally representative longitudinal survey - 7,220 pupils answered the relevant questions.
3. Mitchell, M. and Howarth, C. (2009) Trans research review, Manchester: Equality and Human
Rights Commission (EHRC):
4. Grant, J.M., Mottet, L.A., Tanis, J. with Harrison, J., Heman, J.L., and Keisling, M. (2011) Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, National Centre for Transgender Equality and National Lesbian and Gay Task Force:

8. Teacher perspectives
Stonewall’s teacher survey in 2014 found that since the previous survey in 2009, and following provision of support, resources and training:
Half the number of secondary school teachers said pupils were often or very often the victim of homophobic bullying: 13% vs. 25% in 2009
Significantly more said that their school had a policy that explicitly addressed homophobic bullying:
Primary schools: 31% vs. 19% in 2009
Secondary schools: 55% vs. 30% in 2009
There was no real improvement in the proportion of teachers who believed that their head teacher or school governors (in England and Wales) demonstrated clear leadership in tackling homophobic bullying
45% of primary school teachers said that pupils at their school had experienced homophobic bullying or name-calling
86% had not received any specific training on how to deal with it

9. Impact on mental health and wellbeing
The impact of stigma and discrimination (direct and indirect) can continue long after leaving school
Gay employees report more than twice the level of workplace bullying than heterosexuals
MSM have a relatively high risk of sexual and domestic abuse – though only a fifth of incidents are reported to authorities5
National Institute for Mental Health in England (NIMHE, 2007):6
LGB people are 1½ times more likely to develop depression and anxiety compared to the rest of the population
Gay and bisexual men are 4 times more likely to commit suicide
Scottish Trans Mental Health Study (2012):7
88% of trans people reported a mental health problem
Over 37% had experienced physical threats or intimidation
19% had experienced physical violence for being trans.
Links to health behaviours and interrelationship between mental and physical health
5. PHE (2014). Promoting the health and wellbeing of gay, bisexual and other men who have sex with men.
6. National Institute of Mental Health England Mental disorders, suicide, and deliberate self-harm in lesbian, gay and bisexual people: a systematic review; 2007.
7. McNeil et al. (2012). Trans Mental Health and Emotional Wellbeing Study

10. What works (1)
Good experiences in childhood build resilience for mental wellbeing across the life course – regardless of sexual identity (PHE, 2014)
E.g. universal parenting programmes in early childhood; Rise Above programme for adolescents
Targeted LGBT-specific programmes include staff training, learning resources for teachers, and classroom-based programmes to prevent bullying and improve social emotional learning

11. What works (2)
Evaluation of an anti-HB&T bullying programme commissioned by Government Equalities Office (2016)8 found that:
Training for governors and senior leadership teams helped demonstrate the importance of a HB&T bullying policy
Improving staff awareness and understanding in relation to HB&T bullying increased their confidence to challenge bullying and use of HB&T language
This was supported by building teacher knowledge and skills, and better provision of teaching resources
One-to-one and group pupil support increased feelings of self-esteem and resilience to HB&T bullying
Attempts to improve pupil awareness were less effective - higher awareness at baseline, and limited time between activity and follow-up
Whole-school approaches were most effective when:
Senior school staff were not yet convinced of necessity
Staff and pupils felt that they had not received enough training to deal with issues confidently
Adequate support was not yet available in-house for pupils experiencing HB&T bullying
NatCen Social Research (2016). Evaluation of an anti-homophobic, biphobic and transphobic bullying programme.

12. In your groups: What is the role of Public Health?
You may wish to consider the following in your discussion:
What is currently being done in your area to prevent and address HBT bullying?
What works well in terms of influencing schools?
What are the barriers to influence and effective intervention?
How can local authority public health teams and other partners provide leadership and support?
Who else might we engage to facilitate this relationship?
Using the post-it notes, write down three key messages to feed back to the group.

13. Thank you for taking part!
Reflection
Thinking back to the individual exercise at the start of the session:
What one thing are you going to do to create an environment that promotes the positive experiences?
Thank you for taking part!