An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory.

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.

"These are people just like us who can work": Overcoming clinical resistance and shifting views in the implementation of Individual Placement and Support (IPS).

PURPOSE: Individual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland. METHODS: The study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis. RESULTS: Three key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES' competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs' views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of 'service user' and their diagnosis. CONCLUSIONS: It is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

LGBT + young people's perceptions of barriers to accessing mental health services in Ireland.

AIM: To explore the barriers to accessing mental health services in the Republic of Ireland from the perspectives of young LGBT + people aged 14-25. BACKGROUND: Significant mental health disparities exist between LGBT + young people and their cisgender and heterosexual peers, yet they do not have equitable access to mental health services. Limited research has explored barriers, which exist for LGBTI + young people in accessing services, particularly from their perspectives. METHOD: An anonymous online survey design, consisting of closed and open questions, was used. The study was advertised through local and national organisations and media. 1,064 LGBT + participants aged 14-25 opted to complete the survey. RESULTS: Most participants reported several barriers to them accessing mental health services that were interlinked across three levels: individual; sociocultural; and mental health system. CONCLUSION: Cultural competency training for practitioners, which address issues and concerns pertinent to LGBT + young people, is key to addressing many of the barriers identified. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use the findings to advocate for practice and organisational change within their services to ensure that care and support is responsive and sensitive to the particular needs of LGBT + young people.

Education Needs of Families of Transgender Young People: A Narrative Review of International Literature.

Education plays a crucial role in the lives of families of transgender young people and mental healthcare practitioners are well-placed to support families in this regard. This paper reports findings from a narrative review of 31 papers that explored the education needs of families of transgender young people. The emergent themes were synthesised to develop a five-stage model that depicts the role of education in the lives of these families. Key themes included: (i) learning that a family member is trans; (ii) family responses; (iii) accessing education and information; (iv) impact on the individual; and (iv) moving beyond the individual. The key implications for mental health practitioners, families, and future research are discussed.

Building resilience in the face of adversity: navigation processes used by older lesbian, gay, bisexual and transgender adults living in Ireland.

AIMS AND OBJECTIVES: To explore resilience processes among older lesbian, gay, bisexual and transgender adults. BACKGROUND: Older lesbian, gay, bisexual and transgender identities have frequently been viewed from a deficit, vulnerability and pathological perspective; consequently, the natural resilience processes that underpin the lives of many older lesbian, gay, bisexual and transgender people goes unrecognised, with few studies focusing on the processes they use in building resilience. DESIGN: The design of the study is qualitative and exploratory. METHODS: Data were collected through in-depth, face-to-face interviews. Thirty-six lesbian, gay, bisexual and transgender people participated in the interviews. The mean age of the interview participants was 60·3 years. Thematic analysis was used to analyse the data. RESULTS: Nine processes were identified that enhanced participants resilience, namely: 'Making a decision to accept oneself and not be defined by lesbian, gay, bisexual and transgender identity'; 'Acquiring an empowering perspective'; 'Learning to let go and moving on'; 'Leaving oppressive social environments'; 'Experiencing affirming relationships with family and others'; 'Accessing formal supports'; 'Maintaining connections with lesbian, gay, bisexual, and transgender people'; 'Remaining positive and being thankful for life' and 'Remaining active and keeping busy'. These processes fostered the development of characteristics, such as: courage and strength; a positive sense of self and an optimistic outlook on life. CONCLUSION: This study provides evidence of the considerable strength among this group of people, highlighting how adversity has engendered in participants a set of resilience skills, adding to the emerging body of research into resilience and older lesbian, gay, bisexual and transgender people. RELEVANCE TO CLINICAL PRACTICE: Nurses not only need to be aware of the life histories of older lesbian, gay, bisexual and transgender people but they also need to assess their strengths and offer sensitive services that promote and support resilience among this population.

Mental Health Needs of People Who Identify as Transgender: A Review of the Literature.

Transgender people face many challenges in society including accessing and using healthcare systems. However, little is known about the specific mental health service needs and concerns of transgender people in this regard. The aim of the study was to establish the mental health service needs of transgender people through a review of relevant studies that address the experiences and views of this group. A comprehensive search of CINHAL, Cochrane, Google Scholar, PubMed, PsychInfo, PsychLit, Sociological Abstracts, Scopus, and Web of Science databases from inception to January 2014 was conducted. Studies were identified that met specific criteria that included: using qualitative methods, involving transgender people, and addressing issues related to mental health services. The search yielded 217 papers in total. Following the application of rigorous inclusion and exclusion criteria 33 papers were included for retrieval. Finally, 10 papers were considered suitable for the review. The data were analyzed and key themes identified. The review highlighted distinct challenges that exist in terms of mental health service provision. These included accessing appropriate services and treatments, responsiveness of practitioner's, the provision of family supports and potential mental health service developments. The review findings are discussed and key recommendations are made in terms of mental health nursing practice developments, education and research.

Impact of perinatal mental health education on student midwives' knowledge, skills and attitudes: A pre/post evaluation of a module of study.

BACKGROUND: Whilst midwives are well-placed to identify and address the mental health need of women in their care, many report lacking the ability to do so. Therefore, they ignore or brush aside women's mental health needs. To improve midwives' competency in this area, the first authors developed and delivered a module on perinatal mental health issues within their university. The module aimed to improve knowledge, skills, and attitudes in relation to working with women about mental health issues. In 2012, a post-survey evaluation of the module demonstrated positive findings; following a number of revisions to the module, this more robust pre/post evaluation was conducted. OBJECTIVES: The objective of this study was to examine the impact of the perinatal mental health module on student midwives' knowledge, skills, and attitudes in addressing mental health issues with women. Design Pre-module and Post-module Surveys were Used. PARTICIPANTS: Participants were students undertaking a 4-year undergraduate direct entry midwifery degree programme in Ireland. The pre-survey had 28 participants, the post-survey had 26 participants, and there were 25 matched pairs. METHODS: The data were analysed using SPSS Version 21.0. Descriptive, frequencies and paired sample t-tests were calculated. Qualitative data were analysed thematically. RESULTS: Comparison of the pre and post measures, based on paired samples t-tests, showed that the programme statistically increased participants' knowledge and skills. Whilst students' self-reported attitudes towards women and mental health issues were already quite positive, they reported even more positive attitudes following the course. Written feedback provided by students also supported these positive findings. CONCLUSION: This evaluation provides evidence that a module on perinatal mental health is effective at improving the self-reported knowledge, skills, and attitudes of student midwives towards women with mental health issues. It is recommended that educators consider the opportunity of including a similar module in their curriculum.

The impact of four family support programmes for people with a disability in Ireland.

BACKGROUND: This article reports on an evaluation of four family support programmes in Ireland for families of people with a physical or an intellectual disability or autism. The focus of the evaluation, which took place within a year of the programmes' completion, was on establishing whether the programmes had an impact on families' capacity to effectively support their family member. METHOD: A mixed-method design was used, which included a survey (n = 38) and interviews (n = 19) with participating family members. Ethical approval for the study was given by the relevant university ethics committee. RESULTS: Findings suggest that participation in the programmes enhanced knowledge, attitudes, and competencies of families and also impacted their ability to advocate for their family member and to connect with the community. DISCUSSION AND CONCLUSIONS: Whilst outcomes were overwhelmingly positive, further follow-up would be required to ascertain if sustained capacity building took place.

Older LGBT people's experiences and concerns with healthcare professionals and services in Ireland.

BACKGROUND: The specific healthcare needs and concerns for older lesbian, gay, bisexual and transgender (LGBT) persons have not been explored to any degree within Ireland. AIMS AND OBJECTIVES: The aim of this paper, which is part of a larger study, is to detail older LGBT persons' usage, experiences and concerns with accessing healthcare services, disclosing their LGBT identity to professionals, preferences for care and their suggestions for improvement in services, including nursing services. DESIGN: A mixed methods research design combining quantitative survey and qualitative interview approaches of equal significance was used. METHODS: 144 respondents completed an 84-item questionnaire concerning their use of healthcare services, experiences and needs. The qualitative phase involved in-depth interviews where 36 participants' experiences and concerns around health services were explored more in-depth. Quantitative data were analysed using descriptive statistics. Qualitative analysis employed the constant comparative process to generate the leading themes. RESULTS: Only one in three participants believed that healthcare professionals have sufficient knowledge of LGBT issues, and less than half (43%) felt respected as an LGBT person by healthcare professionals. Although 26% had chosen not to reveal their LGBT status for fear of a negative response, many positive encounters of coming out to healthcare professionals were relayed in the interviews. LGBT persons have specific concerns around residential care, particularly in relation to the perception that the Irish healthcare services emanate a heteronormative culture. CONCLUSIONS: Irish healthcare services need to reflect on how they currently engage with older LGBT persons at both an organisational and practitioner level. Consideration needs to be given to the specific concerns of ageing LGBT persons, particularly in relation to long-term residential care. IMPLICATIONS FOR PRACTICE: Healthcare practitioners need to be knowledgeable of, and sensitive to, LGBT issues.

Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: a narrative account.

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights-based, socially-inclusive, and recovery-oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in-depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research.

Survey of lesbian, gay, bisexual, and transgender people's experiences of mental health services in Ireland.

Very little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in relation to mental health services. Therefore, the overall aim of the current research was to explore LGBT people's experiences of mental health service provision in Ireland. The objectives were to identify barriers and opportunities, to highlight service gaps, and to identify good practice in addressing the mental health and well-being of LGBT people. A mixed methods research design using quantitative and qualitative approaches was deployed. A multipronged sampling strategy was used and 125 respondents responded to the questionnaire. A subset of phase 1 (n = 20) were interviewed in the qualitative phase. Quantitative data was analyzed using descriptive statistics. Qualitative data were analyzed thematically. The sample consisted of LGBT people (n = 125) over 18 years of age living in Ireland. Over three-quarters (77%) had received a psychiatric diagnosis. Findings include that whilst 63% of respondents were able to be 'out' to practitioners, 64% felt that mental health professionals lacked knowledge about LGBT issues and 43% felt practitioners were unresponsive to their needs. Finally, respondent recommendations about how mental health services may be more responsive to LGBT people's needs are presented.

Lesbian, gay, bisexual and transgender older people in Ireland: mental health issues.

International policy initiatives have highlighted the need to include older lesbian, gay, bisexual and transgender (LGBT) issues in the provision of appropriate health and social care. However, empirical studies in the area remain sparse. The aim of this study was to investigate the experiences and needs of LGBT people over the age of 55 years living in Ireland and this article reports on specific mental health issues. Mixed methods were used involving 144 surveys and 36 semi-structured in-depth interviews. The findings revealed that a significant number of the survey respondents had experienced a mental health problem at some point in their lives with interview participants providing further details of their concerns. It is recommended that policy makers address the mental health needs of older LGBT people in future strategic directives and develop standards of care that support the principles of equality, inclusion and respect for diversity.

Barriers and facilitators for oncology nurses discussing sexual issues with men diagnosed with testicular cancer.

PURPOSE: Testicular cancer occurs at a time in a man's life when major social life changes are occurring and when body image, fertility, sexual desire and performance can be central issues. Oncology nurses, as members of the multidisciplinary team, are in an ideal position to address men's concerns. The aim of this study was to investigate oncology nurses' self-perceived knowledge and comfort in relation to discussing sexuality concerns with men diagnosed with testicular cancer and to identify the barriers and facilitators to such discussions. METHODS: This study employed a self-completion, anonymous survey design with a sample of registered nurses working in five, randomly chosen, oncology centres in Ireland. RESULTS: In total, 89 questionnaires (45% response rate) were included for analysis. Findings suggest that although nurses were open to addressing concerns, few informed patients they were available to discuss sexual concerns. Nurses reported lacking knowledge of, and discomfort in, discussing the more intimate aspects of sexuality, including: ejaculatory difficulties, erectile dysfunction, impotence, prosthesis options and testicular self examination. CONCLUSIONS: Findings reinforce the need for more comprehensive education on sexuality issues and testicular cancer. Nurses need to take a more proactive approach to sexuality care, as opposed to the 'passive waiting stance' that permeates the current culture of care. Education programmes need to include specific information on sexual issues associated with testicular cancer, and oncology nurses must subsume sexuality as an essential aspect of their role through changes in policies and nursing care planning.

Mixed methods evaluation of an interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability.

AIM: . To report a study evaluating the effectiveness of a 1-day interdisciplinary sexuality education programme for staff working with people with acquired physical disability. BACKGROUND: Changes associated with an acquired physical disability can diminish a person's self-esteem, sense of attractiveness, relationships, and sexual functioning. Research suggests that people are dissatisfied with the quality of information and support around sexuality during their rehabilitation. DESIGN: A mixed methods design was used, involving pretest and posttest questionnaires and interviews. METHODS: Questionnaire data were analysed using descriptive statistics and paired samples t-tests to evaluate the effects of the programme on knowledge, skills, and comfort. Interview data were analyzed thematically, with particular emphasis on participants' opinions about the application of the course within practice. Participants were working in the area of acquired disability and rehabilitation, and were drawn from a number of disciplines. Data were collected between 2008-2009. RESULTS: Comparison of the pre- and postmeasures, based on paired samples t-tests, showed that the programme statistically significantly increased participants' knowledge, skills, and comfort. Participants felt positive and enthusiastic about the programme and reported numerous incidents where they were more willing to raise issues for discussion and create a supportive listening space for patients to talk about their concerns around sexuality. CONCLUSION: Providing healthcare practitioners with a 1-day programme leads to positive changes in knowledge, skills, and comfort towards sexuality. Sexuality education may be an ideal topic for bringing practitioners together within an interdisciplinary education context.