Invitation to Tender

The Gay and Lesbian Equality Network (GLEN) and BeLonG To Youth Services wish to commission research funded by the HSE’s National Office for Suicide Prevention (NOSP) on LGBT mental health. Full details, including tender guidelines, are attached.

Should you have any queries

regarding any aspect of this tender, please contact Odhrán Allen, Director of Mental Health, at GLEN on 01-6728650 or [email protected] We would be obliged if 3 hard copies of applications could be returned to the address provided below and in electronic format to the above e-mail address. Please note that the closing date for receipt of completed tenders for this research is Monday 9th December 2013 at 12 noon and any short-listed applicant(s) will be interviewed on Monday 16th December in Dublin city centre. It is expected that the final research report will be submitted by the end of December 2014. If, for any reason, you are unable to tender for this reserach, we would be most grateful if you passed this documentation on to others whom you consider to have the required expertise.

Background to the Research Reach Out 1 identifies lesbian, gay, bisexual and transgender (LGBT) people as a group at risk of suicidal behaviour related to their experience of stigmatisation, harassment and marginalisation. The strategy outlines the need for LGBT research that would inform the development of services, supports and information/education resources to improve the mental health and well-being of LGBT people and reduce increased risk of suicidal behaviour. The NOSP-funded Supporting LGBT Lives study 2 was the first major research on the mental health and well-being of LGBT people in Ireland. This aim of this groundbreaking study was to examine suicidal behaviour among the LGBT population in Ireland and to determine how to best address the mental health needs of the LGBT population with a special emphasis on LGBT young people. The data from Supporting LGBT Lives mirrored that of international research 3. It found that stress experienced because a person is LGBT – minority stress – has real and negative

effects on their mental health and is strongly linked with increased risk of suicide. Stresses identified included fear of coming out, lack of support after coming out, bullying in school, harassment/violence in daily life and barriers in accessing support services. Of the 1,110 participants in the survey, 27% had self-harmed and 18% had attempted suicide. The Supporting LGBT Lives report made recommendations for LGBT suicide prevention and mental health promotion in Ireland and GLEN and BeLonG To have been funded by NOSP since 2009 to work on, among other things, the implementation of these recommendations. While minority stress exposed a significant percentage of LGBT people in the study to suicidality, it was also clear that given adequate support most developed resilience to the stress caused by stigmatisation, harassment and discrimination. 81% of participants reported being comfortable now with their LGBT identity and the majority reported good selfesteem and life satisfaction. Over 2/3 had come out to all their immediate family and their friends. Support of family (parents in particular) and friends as well as positive experiences in their communities, schools or workplaces were critical for LGBT people’s well-being and good mental health. Mental health resilience (i.e. the ability to cope with minority stress) was related to: acceptance and support from family and friends; a positive turnabout or life event such as the transition out of secondary school; support from LGBT community organisations and services; developing positive coping strategies and good self-esteem; and positive school or work experiences. The findings from Supporting LGBT Lives were instrumental in enabling GLEN and BeLonG To to ensure that LGBT issues were recognised across a wide range of sectors including health, education, youth and workplace, and significant engagement with professional bodies. This represented a major milestone as some of these sectors had previously been reluctant to engage with LGBT mental health issues in a meaningful way. Supporting LGBT Lives provided evidence of the need for suicide prevention and mental health services, and indeed wider health, social and education services, to target LGBT people and respond to their needs. The study highlighted the very significant role that social and structural determinants of mental health play in any increased mental health risk among LGBT people. Over the last five years, there has been significant progress in policy and in legislation for LGBT people in Ireland leading to a positive change in the status of LGBT people. More people are able to be open about their LGBT identity in their families, schools, workplaces and with service providers.

Despite this, LGBT people continue to experience very significant levels of homophobia and transphobia in Ireland which seriously impacts on their lives and their mental health. There is a real need for more current research to guide the development of programmes and services to address these and other determinants of mental health and suicidality of the Irish LGBT population in this new context.

LGBT Mental Health The term minority stress describes the mental health consequences of stigmatisation and harassment that members of minority groups such as LGBT people may face and the increased risk of psychological distress associated with these experiences 4. A significant body of research has demonstrated that minority stress results in increased risk of suicidal behaviour and self-harm among LGBT people as well as increased risk of depression and substance misuse 5. The minority stress model is a very useful conceptual lens for the examination of LGBT mental health and suicidality, particularly because it is centred on an understanding that alienation from social structures, norms and institutions can create psychological distress and increase the risk of suicide 4,6. Although social attitudes towards LGBT people have changed markedly in recent years, nevertheless LGBT people can still experience discrimination, harassment and exclusion, and

young

people

in

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may

be

affected

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stressors

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homophobic/transphobic bullying, resulting in psychological distress and feelings of isolation. This is particularly true for people becoming aware of their LGBT identity as a young person, which is increasingly common 6,7,8. Depending on their families and where they live, LGBT people may have to struggle against prejudice and misinformation about their sexual orientation or gender identity and often fear being rejected by family and friends if they come out 9. This can be compounded by rural isolation for those living outside of urban areas 2,7.

The Supporting LGBT Lives Study Supporting LGBT Lives examined LGBT mental health risk and resilience for the first time in an Irish context. Data was analysed from 1,110 survey participants and 40 qualitative interviews. A key finding of this study was that LGBT people, and young people in particular, can be at risk of suicidal behaviour related to difficulties before and after coming out to their family and stressors in school and everyday life. Below are the key mental health findings of the study.

‘Coming Out’ as an LGBT Person:  12 years of age was the most common age to realise one’s LGBT identity  17 years of age was the most common age to first disclose one’s LGBT identity to anyone  5 years was the most common number of years that young LGBT people concealed their identity from others. This 5 year period coincided with puberty, school and a critical period of social, emotion and vocational development.  The period prior to coming out was particularly stressful because of fear of rejection (from parents in particular) and because of experiencing distress in isolation  The majority came out to a friend or another trusted individual before coming out to their family. Friends and family, but parents in particular, had a crucial role to play in supporting LGBT people as they came out and this support acted as a protective buffer against specific stresses LGBT young people encountered such as homophobic/transphobic bullying in school LGBT Mental Health and Suicidality:  27% had self-harmed and 85% of these did so more than once  16 years was the average age of first self-harming  40% of females and 20% of males had self-harmed  18% had attempted suicide and 85% saw their first attempt as related to stresses associated with their LGBT identity (e.g. fear of rejection by family or friends)  17.5 years was the average age of first suicide attempt  24% of females and 15% of males attempted suicide at least once  Over a third of those aged 25 years and under had thought seriously about ending their lives within the past year and over 50% had done so at some time  The 3 most common LGBT-specific stresses identified were: - fear of rejection when considering coming out; - negative school experiences; and - experiences of harassment and victimisation LGBT School Experiences:  58% reported homophobic bullying in their schools  Over 50% had been called abusive names related to their LGBT identity by fellow students  40% verbally threatened and 25% physically threatened by school peers  34% reported homophobic comments by teachers  20% missed or skipped school because they felt threatened or were afraid of getting hurt at school because they were LGBT  8% were called homophobic names by teachers  5% left school early because of homophobic bullying Experiences of Harassment & Victimisation:  80% had been verbally abused because of their LGBT identity and 40% had been threatened with physical violence  25% had been punched, kicked or beaten at least once because of being LGBT  25% of those who had ever worked had been called abusive names at work because they were LGBT. 15% had been verbally and 17% physically threatened at work

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10% missed work because they were afraid of being hurt or felt threatened because of their LGBT identity

The Research Project GLEN and BeLonG To Youth Service are carrying out this research project to address a number of key issues: 

The data from the Supporting LGBT Lives study was collected in 2008 and is now 5 years old. This data has been very beneficial for LGBT organisations in making progress in areas including mental health, education, community development and workplaces. However, there is a need for more up-to-date research and data to ensure that any new strategic approaches or new programmes and policies are addressing up-to-date needs or prioritised needs.

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The original study focussed on surveying LGBT participants. This will be repeated in module 1 of this study (see below). Repeating similar elements of the 2008 research in a 5-year follow-up study will allow for comparison of research findings. It will also allow for evaluation of progress since the original study and identify which actions arising from the original study should continue or cease.

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Module 2 (see below) of this study will include research with the general population. This will give a greater understanding of homophobic and transphobic behaviours and attitudes in an Irish context and the factors underlying them.

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The findings from module 1 and 2 will make a vital contribution to directions for future LGBT suicide prevention and mental health promotion programmes in Ireland and will inform how LGBT mental health and suicidality can be approached and sustainably mainstreamed in future national policies and strategies.

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There has been significant change in Ireland in the period since Supporting LGBT Lives and this new study would allow for the impact on LGBT mental health, if any, of these changes to be assessed. This new study will also build on Supporting LGBT Lives and update the body of knowledge in Ireland with regard to effective LGBT mental health promotion and suicide prevention strategies and actions going forward.

Aims of the Research The proposed aims of this research project are to: 1. Compare research findings from Supporting LGBT Lives and the new study to evaluate changes and identify trends in:

a. Mental health and suicidal behaviour among LGBT people in Ireland with a special emphasis on young LGBT people b. Impact of minority stress on LGBT mental health including experiences of coming out, school, violence/harassment, etc. 2. Measure homophobic and transphobic attitudes and behaviours among the Irish general population and explore factors underlying them. 3. Identify priorities and make recommendations for suicide prevention and mental health promotion targeting LGBT people at risk of suicidal behaviour based on this new data (see section on research advisory group below).

Research Methodology The research project is being modularised for the purpose of this tendering process and applicants are invited to tender for one or both modules. Module one pertains to aim 1 above and module two pertains to aim 2. The commissioners and the research advisory group will consult with the researchers in meeting aim 3. The commissioners will give fair consideration to all tenders whether for one or both modules. Module 1: This involves studying LGBT people with regard to mental health and suicidal behaviour with a special emphasis on young people and comparing new findings to Supporting LGBT Lives findings. It will involve quantitative methods and may also involve qualitative methods. Module 2: This involves studying a nationally representative sample of the general Irish population to measure homophobic and transphobic attitudes and behaviours. It will also include a qualitative exploration of the factors underlying homophobic and transphobic attitudes and behaviours. Contractors are invited to propose methodologies that they feel are best suited to fulfilling the aims of the project. Contractors must indicate which materials and resources they intend to use, their intended use and their respective strengths and weaknesses with regard to achieving the central aims of the proposal. The contractor must provide a detailed overview of the proposed approach and methodology including where appropriate, information on data sources, sampling; qualitative methods and /or surveying; weighting and analytical approaches and reasons for selection.

Considerations for ethical approval procedures must be indicated. Contractors should address issues of intellectual property rights pertaining to the research findings and the final research report in their submission. Contractors should also address the inclusion of LGBT respondents aged under 18 if tendering for module 1.

Research Advisory Group The commissioners will establish a research advisory group comprised of relevant service providers, policy makers and organisations. GLEN, BeLonG To and the research advisory group may be able to assist with access to research participants and distribution of promotional materials but contractors must identify appropriate strategies and resources for same. The role of the Advisory Group will be to: 1. Provide advice and support in sourcing information in areas relevant to the research brief 2. Provide advice and support in framing the research report and in framing feasible recommendations for next steps and strategies to pursue the recommendations The research findings from both modules will require translation of findings into priorities and recommendations for action to prevent LGBT suicide and promote LGBT mental health and wellbeing. The commissioners with the research advisory group will lead on this in consultation with the researchers.

Research Timeframe and Deliverables The projected timeframe required for this research project is fifteen months. Below is a breakdown of the project timeframe: Project Deliverable

Timeframe

Commissioning researchers & forming research advisory group

3 months

Data gathering and analysis

9 months

Final report, publication & launch

3 months

Total

15 months

It is essential that all outputs are rigorous, evidence-based and accessible to both a policy and, where appropriate, a lay audience. follows:

The project has a number of deliverables, as

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A project initiation document which will incorporate the detailed scope of the study, roles and responsibilities, assumptions, risks, deliverables, reporting and timing. The contractor shall provide the draft project initiation document in advance of meeting with the research advisory group for approval prior to the commencement of the project.

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An interim progress report including a summary of activities undertaken, outstanding methodology, key findings and an annotated draft final report structure.

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A draft final report.

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A final report shall be submitted to the commissioners within 4 weeks of the advisory group providing feedback on the draft final report. It is expected that the final research report will be completed by no later than the end of December 2014.

Contract, Fees and Payment Contractors are invited to outline appropriate costs with breakdowns for the completion of this project.

Without being prescriptive, an amount in the region of €50,000 – 60,000

(inclusive of all fees, additional charges and VAT) is available for this project. The commissioners will publish the final research in a format of their choosing and this will be separate to these costs. Contractors are encouraged to submit detailed modularised costing – comprising those elements core to achieving the project aims and any additional elements that the contractor feels would further enhance the project.

Where the contractor has specified additional

elements, a detailed costing should be provided, where relevant. Three payments will be made, namely at project initiation (50%), on acceptance of the interim report (20%) and at final report (30%). While the researcher(s) will be the author(s) of the final research report, the requirement of the commissioners and the funder is that the final published report will be a co-branded one and that the commissioners will have ownership of the research data and findings. The commissioners may extract key findings for publication and will use the information gathered from this research throughout their work. The commissioners with the input of the research advisory group will have oversight of any recommendations that emerge from the research. The contract will be between GLEN and the researcher(s).

Submission of Response to Tender All tender documentation must be received by 12 noon on Monday 9th December 2013. Contractors should submit three hard copy tender proposals in a plain envelope clearly marked “Research Tender” to: Odhrán Allen, Director of Mental Health, GLEN, 2 Exchange Street Upper, Dublin 8. Contractors should additionally submit an electronic version of their proposal to [email protected]. Please note that interviews for any short listed applications will take place Monday 16th December in Dublin city centre.

References 1. Health Service Executive (2005). Reach out: national strategy for action on suicide prevention. Dublin: Health Service Executive. 2. Mayock P, Bryan A, Carr N & Kitching K (2008). Supporting LGBT lives: a study of mental health and well-being of lesbian, gay, bisexual and transgender people. Dublin: GLEN & BeLonG To. 3. The Lancet (2011). Health of lesbian, gay, bisexual, and transgender populations. Lancet, 377 (9773): 1211. 4. Meyer I (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence. Psychol Bull, 129 (5): 674-697. 5. Health Service Executive (2009). LGBT health: towards meeting the healthcare needs of LGBT people. Dublin: Health Service Executive. 6. Meyer I (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36 (1): 38 – 56. 7. Higgins A, Sharek D, McCann E, Sheerin F, Glacken M, Breen M & McCarron M (2011). Visible lives: identifying the experiences and needs of older LGBT people in Ireland. Dublin: GLEN. 8. Minton SJ, Dahl T, O’Moore AM & Tuck D (2008). An exploratory survey of the experiences of homophobic bullying among lesbian, gay, bisexual and transgendered young people in Ireland. Irish Educational Studies, 27 (2): 177-191. 9. Ryan C, Huebner D, Diaz R & Sanchez J (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay and bisexual young people. Pediatrics, 129: 346-352.