Irreconcilable differences?: epistemic injustice and the integration of mental healthcare for LGBTQ+ young people.

BACKGROUND

Integrated youth mental healthcare is an approach that has evolved in response to the global escalation of young people's poor mental health, and the failure of current mental health systems and models to improve this situation. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) young people have disproportionately high rates of poor mental health compared with their cisgender, heterosexual peers, but there is a dearth of research examining how best to integrate mental healthcare for LGBTQ+ youth.

AIM: To identify differences in the discursive construction of LGBTQ+ identity, youth, and mental health between LGBTQ+-specific youth mental health services and mainstream services and how these differences may facilitate or limit the integration of mental healthcare.

METHODS

We conducted a qualitative secondary analysis using Foucauldian discourse analysis, a method that centralises power and knowledge, to examine the discourses used to construct LGBTQ+ identity, youth, and mental health across four different mental health services. Using epistemic injustice as a theoretical framework, we analysed interviews with LGBTQ+ young people and staff (n = 30).

RESULTS

Mainstream discourses of LGBTQ+ youth mental health concentrate on risks, trauma, and harm, and reinforce a passive, pathologised, and patronised subject position for LGBTQ+ youth. In contrast, we identified three counter-discourses in LGBTQ+-specific mental health services: Knowing and telling, Resisting pathology, and Capability. These counter-discourses allowed for wider, transformative possibilities for LGBTQ+ youth subjectivities and mental wellbeing.

DISCUSSION: Existing models of integrated youth mental healthcare privilege a clinical, developmental, and universal approach that does not consider justice or the oppressive power systems implicated in LGBTQ+ young people's mental healthcare. Without addressing in/justice, there will remain fundamental irreconcilable differences that will forfeit effective and inclusive systems of mental healthcare for LGBTQ+ young people.