Derbyshire’s school nursing service has invested in extra training for its team to help them better support LGBT+ pupils. The project has equipped school nurses with the skills and confidence to address the issues these pupils face, helping improve their mental health in the process. This case study showcases the important role of school nurses in the education system.
The challenge LGBT+ young people face
Mental health problems, such as depression, self-harm, alcohol and drug abuse and suicidal thoughts can affect anyone, but they are more common among people who are LGBT+.
Being LGBT+ doesn’t cause these problems, but some things LGBT+ people go through can affect their mental health, such as discrimination, homophobia or transphobia, social isolation, rejection and difficult experiences of coming out.
A study by Stonewall in 2021 found that over the previous year:
- half of LGBT+ people had experienced depression and three in five had experienced anxiety
- one in eight young people had attempted to end their life
- nearly half of trans people had thought about taking their life
Derbyshire School Nurse Hen Sloman has been instrumental in the work done in the county. Mx Sloman, who is trans, uses both their lived experience and professional knowledge to support the school nursing service run by Derbyshire Community Health Services NHS Foundation Trust.
They said: “It was very clear our LGBT+ pupils needed better support. As school nurses we could see that loud and clear. We have been seeing increasing numbers coming to us with mental health difficulties – young people who are self-harming and even trying to take their own lives. I don’t think it is necessarily related to the pandemic, but the last two years have certainly given people more time to think and reflect.
“And we know from the research that has been done that there are long waits for specialist gender services for young people. School nurses though are in a perfect position to support young people. We take a holistic approach. We are trusted and we know the pupils, the schools and the families. We wanted to do more to help,” they added.
“Key is gender-affirming care”
The service has worked with Gendered Intelligence, a charity that is focussed on increasing understanding of gender diversity, to run a one-day training course for staff.
Mx Sloman said: “The training was about making our staff aware of how to approach the issue and best support pupils. The key is providing gender-affirming care – not just to trans pupils but to all.
“We start off by asking pronouns and what name they use. That makes a big difference – it basically unlocks that issue from the start and gives the pupil confidence they can talk about gender and sexuality if they want to. I guess it is an extension of the ‘My name is…’ campaign.
“When you do that, it often doesn’t take long for it to surface. The teenage years are crucial, people are exploring their identity. What we have found by just affirming their identity, having someone to talk to who understands and gives them acceptance can really help. We get on to discussing lots of different issues from sleeping problems to family relationships.
“Everyone is different though. We sometimes find that for some pupils they have a handful of sessions with us and that’s it. While, for others, they want help from the school nurses to come out to their family or at school. We can support them because of our unique role.”
‘LGBT+ champions for the whole trust’
As well as providing one-on-one support, the school nurses have also started going into schools to give talks about LGBT+. “We’ve had schools where pupils have come out as trans and there has been some bullying. We’ve gone in and explained why that is unacceptable and talked about some of the issues around this.
“It has had a real impact on those year groups. We’ve also found that pupils have started messaging us via Chat Health off the back of those talks. The more we discuss gender identity, sexuality, and public health the more people we reach. Some pupils are referred to us because it is clear to school staff they are struggling, while for others it is opportunistic – a drop-in session or perhaps when we are discussing another issue. Every contact is a therapeutic opportunity.”
The support has been greatly received by the pupils the service has worked with. “My school nurse helped me so much,” one young person said. “I wouldn’t be where I am now if I hadn’t had support. By someone understanding my struggles without me having to explain everything made everything so much better.”
And a pastoral leader in one school added: “Our school has been working together with the school nurses to implement positive sexual health relationships including LGBT+ relationships. In addition to educating students about relationships, the school nurses have also worked with us to provide information about gender identity and expression. It has been a huge success and it got the students talking and asking questions. Encouraging our students to broaden their knowledge, educating them, and supporting them.”
To help ensure the momentum is maintained, the service has set up a working group of school nurses to monitor emerging practice and the latest research. And this push goes further than just the school nursing team as all 0-19 Healthy Child Programme staff took part in the training with Gendered Intelligence.
Mx Sloman said: “Health visitors were also involved so they can support gender diverse families. The 0-19 workforce are becoming LGBT+ champions for the whole trust, helping influence policy and the way we work. Our priority is supporting all young people at the right time, in the right way whomever they are.”