Investigators
- Associate Professor Yael Perry, The Kids Research Institute Australia, University of Western Australia
- Professor Adam Bourne, La Trobe University
- Dr Shane Worrell, La Trobe University
- Dr Jack Farrugia, The Kids Research Institute Australia, University of Western Australia
- Professor Graham Brown, La Trobe University
- Professor Gerardo Melendez-Torres, University of Exeter
- Ms Nicola Bath, LGBTIQ+ Health Australia
- Associate Professor Ruth McNair, University of Melbourne
- Professor Ashleigh Lin, University of Western Australia
- Associate Professor Mathew Coleman, WA Country Health Service
- Dr Julie Mooney-Somers, University of Sydney
- Dr Penelope Strauss, The Kids Research Institute Australia, University of Western Australia
- Dr Joel Anderson, La Trobe University
- Dr Natalie Amos, La Trobe University
What is Optimise+?
Optimise+ is a research project designed to build on the best parts of LGBTQ+ community-controlled mental health and AOD services across Australia, with the aim of further enhancing service options.
LGBTQ+ community-controlled organisations are crucial supports for community members, who can face significant barriers to accessing a range of health and wellbeing services. Optimise+ brings together leading lesbian, gay, bisexual, trans, queer and other gender and sexuality minority (LGBTQ+) service providers and LGBTQ+ health and wellbeing researchers to help inform a patient-centred and sustainable model of care for LGBTQ+ people within existing health systems.
Funded for four years by the Medical Research Future Fund (2024- 28), Optimise+ will explore how LGBTQ+ community-controlled mental health and alcohol and other drug (AOD) models work, how they can be further enhanced and how they might inform broader health systems seeking to be more LGBTQ+ inclusive.
Background
Safe and affirming services and programs are urgently needed to address alarmingly high rates of mental ill-health, suicidality and alcohol or other drug (AOD) use among LGBTQ+ people in Australia (1).
A survey of more than 6,800 LGBTIQ people in Australia (1) found that:
Mental health
- More than 57% reported experiencing high or very high levels of psychological distress in the previous four weeks, four times higher than the general population
- About 76% of trans men, 66% of trans women and 75% of non-binary participants reported high or very high levels of psychological distress in the previous four weeks
- More than 5% reported having attempted suicide in the previous 12 months. This figure was much higher for trans men (13.7%) and trans women (10.9%)
- Nearly 75% reported having ever considered attempting suicide
- About 91% of trans men, 86% of trans women and 90% of non-binary participants reported having ever considered attempting suicide
- About 60% reported ever having been diagnosed with depression
- More than 47% reported ever having been diagnosed with anxiety
AOD use
- Almost 17% reported struggling to manage their use of alcohol or negative impacts associated with alcohol use at some point in the previous 12 months. Less than one in five of these participants had sought professional help for their alcohol use during the same time period
- Some 44% reported having used one or more drugs for non-medical purposes in the previous six months
- Fourteen percent reported struggling to manage their use of drugs or negative impacts associated with drug use in the previous six months. About one in five of these reported having sought professional help for their drug use in that time
Service access
- Of participants reporting high or very high levels of psychological distress, less than 60% had accessed mental health services
- Of those who had accessed mental health services for very high levels of psychological distress, 44% had accessed a mainstream service, 22% an LGBTIQ+-inclusive mainstream service and almost 5% an LGBTIQ-specific service
- More than 75% reported that they would be more likely to attend a health service that had been accredited as LGBTIQ-inclusive
- Only about 38% of participants who had accessed mainstream medical clinics in the previous 12 months felt that their sexual orientation or gender identity was “extremely” respected
Despite this acute and concerning situation, many mainstream services do not consistently provide culturally safe mental health or AOD services or programs to this population, with discriminatory acts commonly reported alongside insufficient awareness of unique needs and circumstances. These present considerable barriers to engagement and support.
Many LGBTQ+ people turn to community-controlled organisations, which provide mental health and AOD services and programs controlled by and for LGBTQ+ communities nationwide. Community-controlled organisations have addressed significant service gaps that broader health services have been unable (or unwilling) to close. The work of LGBTQ+ community-controlled organisations constitutes a unique model of care that can be optimised and harnessed to address an area of unmet need to better advance health outcomes for LGBTQ+ people.
The questions we're asking
- What LGBTQ+ community-controlled mental health and AOD services and programs are happening and where?
- How are they happening? In what format and with what distinguishing features?
- How are they perceived and experienced by consumers and providers, relative to other forms of health engagement?
- How do mental health and AOD interventions delivered by community-controlled organisations operate and achieve their outcomes for individuals and communities they serve?
- How are LGBTQ+ community-controlled services connected to the rest of the health system and how might their role be strengthened?
A partnership between leading researchers and frontline services
Led by the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University, Optimise+ also includes researchers from The Kids Research Institute, University of Western Australia, University of Melbourne, University of Sydney and University of Exeter (UK).
Optimise+ also brings together 13 of Australia’s leading LGBTQ+ community- controlled health and wellbeing organisations to share experiences and challenges and to help shape better models of care both within in the community-controlled sector and more broadly.
Organisations involved include ACON, A Gender Agenda, LGBTIQ+ Health Australia (LHA), Living Proud, Meridian, Minus 18, Queensland Council for LGBTI Health, Switchboard Victoria, Thorne Harbour Health, Trans Folk of WA, Trans Gender Victoria, Twenty 10 and Working it Out.
The Optimise+ approach
Key questions about how LGBTQ+ people access mental health and AOD services at community-controlled organisations underpin this project.
We aim to answer these questions through four workstreams, which will engage with LGBTQ+ community-controlled services across Australia in the following ways:
- Workstream One: An audit of LGBTQ+ community-controlled mental health and AOD services
- Workstream Two: An exploration of LGBTQ+ community-controlled settings
- Workstream Three: An evaluation of effectiveness of LGBTQ+ community-controlled services
- Workstream Four: A systems-level analysis of LGBTQ+ community-controlled organisations’ strengths and potential to inform change
Priorities of the Optimise+ project
- Ensuring those in need of intervention receive support from culturally (LGBTQ+) safe and acceptable services
- Strengthening referral pathways
- Enabling evidence-based targeting of health resources to meet pressing needs
- Enabling a better understanding of what mental health and AOD interventions work for whom and in what context, taking into consideration intersectionality
Outcomes and impact
A comprehensive and accessible report will articulate an optimised model of care for LGBTQ+ people through LGBTQ+ community-controlled organisations.
The Optimise+ report will outline community member and service provider perspectives on how the model operates in practice and the ways in which it can effectively influence and strengthen the broader health system.
Further outputs and activities will be tailored to specific audiences, including:
- Mental health and AOD service or program policymakers, commissioners or funders
- LGBTQ+ community-controlled organisations
- Mainstream organisations delivering mental health and AOD services and programs
- LGBTQ+ community members
- Academic researchers
For more information
Learn more about Optimise+ at latrobe.edu.au/arcshs/work/optimise-plus.
For more details or to ask questions, contact Dr Shane Worrell, project manager: s.worrell@latrobe.edu.au
References
- Hill et al. Private Lives 3: The health and wellbeing of LGBTIQ people in Australia. Melbourne: La Trobe University; 2020
Funding statement
Optimise+ is funded by the Medical Research Future Fund: MRF2032097