Beyond ‘Voice’ to ‘Learning with’: A Multiple Streams Policy Analysis and Qualitative Exploration Problematizing Representations of Young LGBT+ Identities

Abstract

Hearing young voices is of paramount importance, particularly as some voices are seldom-heard, including those of lesbian, gay, bisexual and transgender (LGBT+) youth. Recent research highlighting mental health disparities for these populations led to the formation of the Irish LGBTI+ National Youth Strategy, which prioritized youth participation through a Youth Advisory Group (YAG). A policy analysis of the initiation of the Strategy outlines the convergence of problems, policies and politics using a Multiple Streams Approach (MSA), with quantitative literature suggesting substantial vulnerabilities. This is enhanced through qualitative exploration of the views of six youth co-authors, with experiential expertise, and as YAG members. A university ethics committee granted approval for online recorded consultations via group, pair and individual interviews. The theme of ‘seen and heard’ highlighted unprompted discussions on discursive assumptions representing young LGBT+ identities almost solely in relation to mental health risk. These rich narratives problematize the (in)visibility and silence in representations of the diversity of LGBT+ youth identities, which may inadvertently reinforce stigma. This underscores the need for comprehensive and inclusive school curricula. While MSA may explain prioritization for policy initiation, participation potentially disrupts unintended negative consequences. This article concludes by emphasizing how ‘learning with’ LGBT+ young people can ensure research, policy and practice speaks directly to youth interests and concerns.

1. Introduction

1.1. Orientations and Identities

Adolescence has long been regarded as a period of storm and stress when the salience of identity formation was regarded as the key developmental task [1]. Such approaches represent adolescence as a universal stage of human development, facilitating socially adjusted entry into adulthood [1,2,3]. Identity achievement is regarded as providing an integrated coherent, stable self-concept, consistent across time and contexts [1,2,3]. These approaches contrast with socio-cultural theories problematizing essentialist concepts of identity formation [4,5]. Such debates situate and contextualize the experiences of sexual and gender minority youth.

The LGBTI+ acronym is used in Ireland and has evolved iteratively through policy-making processes [6,7] It comprises three dimensions: sexual orientation, gender identity and diverse sex development. The qualitative consultations referred to in this article focused on sexual and gender minority youth, rather than those with diverse sex development. As such, the LGBT+ acronym is used throughout, except when referring specifically to the Strategy. Sexual orientation refers to identification, behaviour and attraction, with suggestions of a higher life-time prevalence of same-gender behaviour and attraction than identification [8]. Gender identity refers to someone’s internal sense of their gender, extends beyond a binary definition of male/female, and may not accord with the sex assigned at birth [9]. Transgender and non-binary youth also have a sexual orientation and may be heterosexual, lesbian/gay, bisexual with the plus (+) encompassing a broad range of identities [8]. Intersex refers to the spectrum of variations of sex development that occur within humanity [10]. Those who are intersex also have a gender identity and sexual orientation. Much of the focus in the literature has been on young people who self-identify as lesbian and gay with a congruent primary same-gender attraction, behaviour and identification [11,12,13]. This contrasts with constructionist perspectives, facilitating exploration of identity meanings, with the potential for multiple, dynamic and fluid orientations and identities [14,15,16,17,18]. While the complexity within youth identities and subjectivities is acknowledged [19], concerns regarding mental health disparities for LGBT+ young people are well-established [20,21,22,23,24]. As a result, these young people tend to be represented as facing difficulties, particularly at the time of ‘coming out’ [25], reinforcing the idea of ‘storm and stress’ [1]. Such concerns extend to the Irish context [26,27,28], and are typically contextualized within a Minority Stress Model, which highlights the consequence of social injustice through stigma, prejudice and discrimination [29]. Stigmatization includes personally enacted stigma, alongside structural stigma, with a resultant impact on wellbeing [30].

As such, social justice is regarded as a pre-requisite for health, including mental health [31]. Fraser expanded the concept of social justice to include “recognitive justice,” highlighting that “cultural injustice is rooted in social patterns of representation, interpretation and communication” [32] (p. 12 & 14). Honneth concurred, conceptualizing recognitive justice through Recognition Theory, a tripartite framework with three interlinking spheres of recognition [33]. This both encompasses and surpasses interpersonal recognition to include legal recognition of universal human rights and recognition of the unique contribution of community members, as illustrated in Figure 1 [34].

As seen in Figure 1., Recognition Theory regards identity-formation as inextricably dependent on the development of self-confidence, self-respect, and self-esteem, through such forms of mutual recognition [33] (p. xi). Honneth applied this theory to emancipation struggles, with social justice predicated on the recognition and revaluing of disrespected identities, and providing an impetus for social change [34]. Activism by LGBT+ communities, regarded by Honneth as “identity politics” offers potential to achieve the “transformation of collective self-understanding… [and] lead to the claim for recognition of one’s own culture” [35] (p. 162).

Recognitive justice has particular resonance given that the Minister for Children and Youth Affairs initiated the development of the Irish LGBTI+ National Youth Strategy [36], in response to research suggesting heightened vulnerability to mental health distress for these populations [26].

1.2. The LGBTI+ National Youth Strategy

The initiation of the LGBTI+ National Youth Strategy acknowledged that health and social policies are integral to promoting youth wellbeing. An Independent Chair and Oversight Committee were appointed, comprising representatives from the statutory and voluntary sectors, alongside LGBT+ organizations. Youth Advisory Group (YAG) representation was core to the membership of the Oversight Committee and subgroups [6]. Collaborative, participatory approaches, such as advisory groups are regarded as essential in the research with youth [37,38]. Hearing the voice of LGBT+ youth, and peer allies, was regarded as paramount in this policy-making process, particularly as these voices may be seldom-heard [6,39,40,41,42,43,44]. This is of concern given Ireland’s strong commitment to ensuring that children and young people have the right to be consulted, their voices heard and their opinions sought, underpinned by The Lundy Model of Participation [45]. This rights-based approach conceptualized participation beyond voice; rather Article 12 of the United Nations Convention on the Rights of the Child included four interrelated, sequential domains: space, voice, audience and influence [45] (p. 927). The strategic development process sought to embed the participation of LGBT+ youth and peer allies, acknowledging that youth involvement and engagement can provide an on-going incentive for young people to engage fully in in matters that affect them [6]. Through a national network across Ireland, 13 young people were recruited onto the YAG [6,46]. The participation of young people throughout the policy-making process is illustrated in Figure 2.

While youth participation comprised one component of the policy-making process, as Figure 2 illustrates, there were multiple aspects informing participatory strategic development. YAG participation was complemented by a nationwide youth consultation and a nationwide survey of young people [6,46].

This commitment to participation acknowledged the cultural and social capital within youth networks, and recognized youth agency in relation to their own lives [39,41,44,47]. Such forms of capital were evident in the nationwide youth consultations which emphasized the importance of Relationships and Sexuality Education (RSE) [6]. Young people highlighted the lack of inclusive, comprehensive RSE in Irish schools, and called for its introduction, alongside gender theory and LGBTI+ history, within the curriculum [6]. This attests to the idea of ‘learning with’ youth, and suggests that young people are engaged and fully aware of factors that would be beneficial and promotive of their wellbeing [48]. During the development of the Strategy, the Department of Education and Skills announced a review of RSE content and delivery, specifically mentioning ‘LGBTQ+ matters’ [49]. As part of the review, an online student survey was conducted and identified the inclusion of LGBT+ identities and orientations as one of the most important topics for inclusion in the curriculum [50]. The review informed the plan to introduce a new curriculum as part of Social, Personal and Health Education (SPHE) in a staged process in primary and secondary schools [50,51]. The draft junior cycle, for those aged 12–15 years, includes: ‘understanding myself and others’; ‘making healthy choices’; ‘emotional wellbeing’; and ‘relationships and sexuality’ [51]. Consultation on the draft curriculum has resulted in often problem-informed, media coverage [52,53], reflected in comments that “children are not ready to hear information about sexual orientation” [52] (p. 1.). This simultaneously conflates sexual orientation as non-heterosexual, and stigmatizes such identities. Honneth identifies a continuum of disrespect, emphasizing the seriousness of stigmatization [34], which accords with distinctions between personally enacted and structural forms of stigma [30]. Implementing change against this backdrop may explain the longstanding nature of calls for comprehensive and inclusive RSE [54,55].

1.3. Rationale

The initiation of LGBTI+ National Youth Strategy, as part of a cross-governmental commitment, provides an opportunity to critically examine this policy agenda-setting using Kingdon’s Multiple Streams Approach (MSA) [56]. This conceptualizes how three streams: problems, politics and policies, converge through a window of opportunity to frame issues in terms of problems requiring policy formation [56]. MSA has particular relevance in examining the formation of the Strategy and the potential for policy development to respond to identified vulnerabilities [26,27].

This policy analysis is enhanced by a qualitative, participatory project aligned to the goals and objectives of the Strategy. Prioritization of research within the Strategy is noted in objective 15(g) which calls for research into positive mental health for LGBT+ youth [6].

This project prioritized the participation of young people with expertise by experience as LGBT+ youth, alongside their experience of participation of policy-making for the Strategy. Drawing from Baker and Beagan’s emphasis on ‘learning with’ LGBT+ communities [57,58], it seeks to amplify youth voices, in recognition that the conventional policy, practice and research focus may fail to hear the voices of LGBT+ youth. This may create barriers to participation, with unforeseen consequences in which these young people remain seldom-heard [39].

To the best of our knowledge, no study has sought to hear young LGBT+ people’s voices regarding the representation of their identities. In this context, qualitative methodologies have the potential to make a rich contribution to hearing the perspectives and priorities of LGBT+ youth.

2. Materials and Methods

This policy analysis and participatory, exploratory project seeks to illuminate an under-researched topic: that of the representation of young LGBT+ identities. Qualitative methods are considered appropriate in exploratory studies, underpinned by a constructivist ontological and interpretivist epistemological philosophies, with constructions of reality regarded as culturally and socially situated [59]. The first author was a member of the Oversight Committee and subgroup lead, while the youth co-authors were Youth Advisory Group (YAG) members [6,46]. As such, an ethnographic approach informed the research design. Ethnography provides a more nuanced picture of the meanings, understandings, and experiences of a social group through an insider lens [60,61]. Such insider approaches are considered beneficial in research with LGBT+ communities, and generate emic insights of cultural insiders’ self-understandings alongside etic research perspectives [62,63,64].

The Standards for Reporting Qualitative Research were followed in writing this paper [65] (see File S1). This is complemented by attending to Tracy and Hinrich’s eight criteria for qualitative quality: (1) worthy topic; (2) rich rigor; (3) sincerity; (4) credibility; (5) resonance; (6) significant contribution; (7) ethics; and (8) meaningful coherence [66] (p. 2). They argued that research must investigate a “worthy topic,” consistent with Rubin and Rubin who emphasized that qualitative research necessarily extends beyond a topic to “learning about what is important to those being studied” [67] (p. 15). Thus, the role of the YuPP☺ Project, both as an advisory group and in co-producing participatory research, was strengthened [37,38]. This qualitative approach was designed to ensure “rich rigor” through the appropriate use of complex theoretical constructs and data, sufficient time in the field, and providing a more nuanced and detailed picture of the phenomenon and its context [66].

2.1. Reflexivity

Reflexivity in ethnography refers to researcher awareness and open discussion of their role, providing a useful way to critically appraise their influence [60]. This accords with Tracy and Hinrich’s concept of “sincerity” [66]. A reflexive approach was adopted throughout the research process to make transparent the first author’s beliefs and assumptions, using a memo-writing process [68]. This recognized that subjectivity is part and parcel of the research process and research relationships [58,60,61,68]. This problematized the binary nature of emic and etic divisions, rather it privileged LGBT+ youth knowledge and knowing, underpinned by a fundamental belief in the young people’s experiential expertize [37,38], complemented by researcher expertize [58]. The research design used a Consulting-Conducting-Collaborating-Checking cycle [58]. This sought to ensure that participants could inform any aspect of the project, fundamental to ethnographic principles [60,61]. This approach underpinned the framing of research questions through to describing, analyzing and interpreting the rich data.

2.2. Aims and Objectives

The overarching aim of this study was to generate an in-depth understanding of the representation, interpretation and communication of LGBT+ identities–the social construction of these identities–and the nature and significance of such representations. Figure 3. outlines the aim, aligned to concepts of recognitive justice [32], with objectives seeking an ethnographic exploration of complex meanings, which are socially and culturally situated [60,61]. Informed by an iterative design, the LGBT+ YuPP☺ Project aimed to convene Young People’s Panels to garner Youth Perspectives and Priorities. This study formed part of a larger mixed-methods project, which will be reported in forthcoming articles.

As illustrated, this project sought to ensure the voice of young people remained at the heart of the collaboration [37,38], in order to identify policy and research implications, highlighting the “resonance” of the study [66]. This was underpinned by a commitment and accountability to the wider LGBT+ youth communities, with a view to the research “generating results and theories that are understandable and experientially credible both to the people being studied and to others” [68] (p. 221), therefore making a “significant contribution” [66].

2.3. Access, Recruitment, and Sampling

The first author was known to some YAG members through membership of the Oversight Committee for the Strategy. This insider ethnographic approach facilitated discussions of the potential of the YuPP☺ Project, with young people suggesting YAG members could make a unique contribution and provide valuable insights. LaSala refers to this as the “insider advantage” [62] (p. 15). Following further discussion, stakeholders expressed their interest and willingness to approach young people, who had been YAG members, disseminate information and provide introductions, validating the credibility of the YuPP☺ Project and facilitating access. A sampling strategy, comprising a mix of purposive, targeted sampling techniques was designed [67]. Considerable efforts were made to ensure all YAG members were aware of the YuPP☺ Project.

Table 1. Access, recruitment and sampling approach for involving LGBT+ youth and peer allies in the project.

Stage	Number of People	Number of Contacts
Access
Informal discussion	2 youth stakeholders	1 WhatsApp conversation 1 online ZOOM™ discussion
	2 adult stakeholders	3 emails 1 telephone calls
Formal contact	2 youth stakeholders	1 WhatsApp conversation 1 online ZOOM™ discussion
	7 adult stakeholders	14 emails 7 telephone calls
Recruitment
Informed of project	12 YAG members	Stakeholders’ liaison with YAG members and shared invitations to Information Sessions
Invitation to attend Information Sessions	2 youth stakeholders	6 WhatsApp conversations
	9 YAG members	9 email invitations with ZOOM™ links forwarded
Information Session	9 YAG members accepted invitation	2 half-hour Information Sessions convened and recorded via ZOOM™
Forwarded Recording of Information Session	1 youth stakeholder	Stakeholder liaison with YAG members via FB and WhatsApp and link posted to recording
	4 adult stakeholders	6 emails with attached link to recording 4 telephone calls 4 text messages
Expressions of Interest	9 YAG members expressed interest 2 YAG members unavailable 1 YAG member could not be contacted	9 emails forwarded with information sheets and consent form
Sampling
Follow up after cooling-off period	8 YAG members expressed interest 1 YAG member declined 1 YAG member did not respond	8 reminder emails re: consent 2 x telephone calls to adult stakeholder 2x text messages to adult stakeholder
Consent to be part of WhatsApp Group	8 YAG members	8 WhatsApp conversations
Invitation to attend Update Zoom presentation	8 YAG members	2 WhatsApp conversations 8 email invitations with Zoom links forwarded
Update Zoom presentation	8 YAG members	2 half-hour Information Sessions convened and recorded via ZOOM™
Forwarded Recording of Information Session	2 YAG members	2 emails with link posted to recording
Consent to be part of the YuPP☺ Project	7 YAG members	8 reminder emails 8 WhatsApp conversations
Attended consultations	6 YAG members	7 reminder emails 7 WhatsApp conversations

illustrates the process undertaken to ensure that young people were informed of the opportunity to participate.

Information was shared with twelve young people, while one young person could not be contacted. Nine former YAG members initially expressed interest, two were unavailable and one declined to participate. For this aspect of the YuPP☺ Project, seven LGBT+ young people were recruited, from across Ireland, with experience of involvement in policy-making for the Strategy, with six participating in online consultations.

2.4. Data Collection

The qualitative online consultation was the core data collection method, informed by Kvale and Brinkmann’s description of an InterView; an inter-change of views resulting in the co-construction of knowledge [69]. Further, Brewer suggests that ethnographic interviews ask people’s views and meanings, in their own words, with specific attention drawn to in-depth exploration of complex, taken for granted, and problematic meanings which are socially contextualized [60]. Online consultations were held via ZOOM™, underpinned by youth-centered and rights-based approaches [33,34,35,45]. A presentation and Q&A sought to ensure shared meanings, clarify understandings of questions and encourage participants to contribute to the iterative development of topic schedule. Online consultations facilitated attendance, despite geographic location, and initially took place in groups (4). Word clouds, polls, and MS PowerPoint™ prompts were used to generate discussion, with participants also invited to use the chat function or forward reflections via WhatsApp^TM and email. Each consultation provided topic areas for further discussion, with Likert scales used to further explore the young people’s views. While it was reiterated that attendance, in and of itself, is participation, some young people rarely spoke, with others sharing more readily. Following feedback, the group consultations were adapted and offered as one-to-one (8) or pair consultations (2). Between April 2021 and June 2022, four rounds of data collection took place, complemented by three rounds of member reflections [66]. Participants received gift cards, for each round of data collection, in acknowledgement of their time and contribution, with the value set above the hourly rate of the Irish minimum wage.

2.5. Data Management and Analysis

Online consultations were transcribed verbatim, facilitating full immersion in the data. Transcripts were imported into NVivo 12 and the first author read and re-read each transcript. Using reflective thematic analysis, which acknowledges the subjectivity of data interpretation, a top-down coding technique was initially applied to enhance familiarization and reduce the data into coding concepts and developing categories [70,71]. These codes sought to identify potential themes which were revised through a “critical friends” process, enhancing rigor [66,70,71,72]. Through conversations with the supervisory team, recurring patterns within the data were collectively explored and further refined [66,70,71,72]. Themes were identified iteratively, highlighting unprompted discussions, with codes subsequently cross-checked against the dataset, and a detailed analysis developed for each [66,70,71,72]. These categories permitted the presentation of individual stories to give ‘voice’ to both typical and unique experiences [70,71]. The first author presented an overview of these codes to the youth co-authors with detailed discussion specifically addressing the aim of this article [66,72]. Themes woven through the interviews and linking categories illustrated the differences and similarities within the participant group [59,70,71]. The analysis sought to demonstrate variation through highlighting data contradicting dominant ideas [66,70,71,72]. The project did not seek to move to ‘saturation’ [73]; rather the level of ‘information power’ within the purposive, targeted participant group was recognized [74].

2.6. Ethical Considerations

As this participant group was recruited specifically for their experiential expertize as LGBT+ youth, alongside their involvement in policy-making, there were particular ethical considerations, consistent with Tracy and Hinrichs [66]. Voluntary, informed consent was obtained prior to participation, with all youth co-authors. Additional protections included clearly outlining the limits on withdrawal from the study, particularly after analysis and publication. Specific attention was given to the limits on privacy and confidentiality and was made explicit in the information sheets and consent forms. In particular, participants were not asked about their personal experience, rather they were about their general views on the protective factors that promote LGBTI+ youth wellbeing. To maintain their privacy within the data, all data storage and analyses were completed as per university Data Protection and GDPR protocols. In order to address potential harm, following member reflections [66,72], it was agreed that no quotes would be attributed, rather these would be presented anonymously in tabular format. Specific consent was sought for dissemination in relation to future research, with participants offered the option of de-identification [66]. They unanimously chose to be named as co-authors. Complete ethical approval for the YuPP☺ Project was granted by a university Human Research Ethics Committee (see File S1).

Exploratory qualitative research is concerned with establishing patterns and themes [59,66,67,68,69,70,71]. The research design aimed to give voice’ to the variation of experiences, thus enabling “meaningful coherence” through interconnections between the literature, aims and objectives, findings and interpretations, now discussed below [66].

3. Results

This project provides the results from the policy analysis which critically reviews the literature informing the initiation of the Strategy. This is enhanced through the exploration of the views of six youth co-authors, with expertize by experience, and as YAG members.

3.1. Applying the Multiple Streams Approach to the Initiation of the LGBTI+ National Youth Strategy

In examining the formation of the LGBTI+ National Youth Strategy, Cairney and Jones’ critical review of Kingdon’s Multiple Streams Approach (MSA) was deemed best suited for this analysis [56]. MSA positions policy agenda-setting as contested, with ambiguity regarding which health and social care policy problems are prioritized, with potential interventions identified in response [56]. As such, policy initiation often occurs within a context of limited information and time, with a resultant impact on decision-making processes [56]. MSA facilitated examination of the initiation of the Strategy through the formulation of mental health disparities for LGBT+ youth as a problem requiring intervention by policy makers and professionals [26,36]. Using an MSA lens, this policy analysis reviews this window of opportunity and subsequent initiation of the Strategy as part of a cross-governmental commitment [6,36].

3.1.1. Problem Stream

MSA notes that this form of streaming commonly occurs where “attention lurches to a policy problem” [56] (p. 4). Thus, The LGBTIreland Report: National study of the mental health and wellbeing of lesbian, gay, bisexual, transgender and intersex people in Ireland [26], identified that, in comparison to the My World National Youth Mental Health Study [75], LGBT+ youth experienced twice the level of self-harm, three times the level of attempted suicide and four times the level of severe/extremely severe stress, anxiety or depression [26] (p. 3). The LGBTIreland Report Key Findings were disseminated nationally to health, social care and educational professionals, with the research commissioners concluding that LGBTI+ people continued to experience marginalization, stigmatization and discrimination in their day-to-day lives [76]. The main report concluded that there had been little change over a five-year period [26].

The report launched by former Irish President, Mary McAleese, described the findings as “horrifying” and “tragic,” while also suggesting that it was “solvable” [26] (p. 5). However, it should be noted that there was limited challenge to the validity of comparing two separate studies, conducted with different study populations, at different time periods, using different sampling approaches. Bryan highlighted concerns regarding comparison of “a nationally representative, random sample in the case of the My World Survey versus an online, convenience-based sample in the case of the LGBTIreland study” [77] (p. 260).

In this case, McAleese’s suggestion of a solution indicates a shift towards the policy stream.

3.1.2. Policy Stream

In MSA, the policy stream emphasizes the role of actors, in mediating between problem framing and policy solution. A core component of this policy stream anticipates future problems, draws attention to these, refining and presenting widely-accepted solutions [56] (p. 4). The attention to LGBT+ youth mental health concerns is long-standing [20,21,22,23,24,26,27,28]. Despite the intention to solve problems, policies can often remain trapped in negative connotations of the problem [78,79]. For example, the Supporting LGBT Lives: Study of the Mental Health and Well-being of Lesbian, Gay, Bisexual and Transgender People [80] was interpreted by the research commissioners as confirming the increased risk of self-harm and suicidality for LGBT+ communities [81]. Such interpretations were robustly critiqued by the Principal Investigators, who emphasized that it was impossible to determine this [82,83]. Despite their caution, a publication titled “Supporting LGBT Lives: Key Findings” was disseminated to all secondary schools across Ireland [81]. This included a Figure illustrating that the most common time for LGBT+ youth to ‘come out’ coincided with the most vulnerable self-harming and attempting suicide [81]. Such representations have been problematized and may inadvertently portray young LGBT+ lives through a trajectory, assuming self-harm and suicidality, with universal application to all sexual and gender minority youth [25,77,78,79,82,83,84].

There was further disquiet regarding LGBT+ youth wellbeing in 2017, following the publication of Young Lives in Ireland: A school-based Study of Mental Health and Suicide Prevention, as part of a European-wide research project [27]. This study reported that adolescents with concerns about their sexual orientation were 14.6 times more likely to have attempted suicide [27]. While this is an alarming finding, the study did not ask about identification, rather it asked respondents if they “have concerns” about their sexual orientation [27] (p. 32). The response may reflect the unconscious bias inherent in the survey question phrasing. It is possible that it was assumed that sexual orientation applies only to sexual minority populations, rather than everyone, including heterosexual youth. This perhaps reflects, often problem-informed, media coverage [52]. The question also fails to regard sexual orientation as demographic information, rather it suggests this is something that would potentially be a source of concern. This may be indicative of the dominant discourse and framing of LGBT+ identification as something that is inherently problematic [25,77,78,79,82,83,84], resulting in protectionist policies [85].

3.1.3. Political Stream

The political stream develops when policymakers have “motive” and “opportunity” [56] (p. 4). Of particular note is that political views and decision-making either converges with, or contradicts, policy processes. For example, significant public concerns emerged following publication of The LGBTIreland Report, reflected in the media coverage [86]. This was in stark contrast to concurrent legislative and policy measures that led to Ireland’s progress on LGBT+ rights through the constitutional amendment on marriage equality and gender recognition legislation [87]. MSA notes that garnering political motivation may require a change of government [56]. The year The LGBTIreland Report was published, an election resulted in a coalition government with no clear majority, providing a platform for consensus-style governing and political decision-making [88]. The announcement of the initiation of the Strategy referred specifically to The LGBTIreland Report as providing impetus for the political consensus, stating: “As a Government we must respond” [36] (p. 1).

Thus, a policy window of opportunity was created through a framing of the problem, and the available policy response, which in turn, informed the political consensus.

3.2. Interrupting the Potential for Unintended Negative Consequences

MSA suggests such approaches may regard policy processes as linear, evaluating progress through the achievement of formal objectives [56]. Such top-down policy initiation may adversely impact of the direction and focus of policy development [89]. However, the prioritization of YAG involvement, as central to strategic development, appears to have problematized such discursive assumptions [46]. Rather, participation sought to ensure that the strengths of LGBT+ youth were acknowledged [6,42,43,44,45]. This may have disrupted the potential for unintended negative consequences from top-down policy initiation [56,89]. This approach may also have had unintended positive consequences, further promoting youth participation [46], which may have consequently broadened the available policy response, informing the continued cross-governmental commitment to implementation of the Strategy [90]. This accords with the landscape review and research gap analysis commissioned as part of the implementation of the Strategy [90,91]. This identified the “prevailing focus” on risk and vulnerability as providing “a simplified and distorted picture” [91] (p. 143). This accords with research gaps which have been noted in relation to resilience, strengths and empowerment [23,29,82,83,84,91].

Complementing this policy analysis is the YuPP☺ Project, a participatory, exploratory qualitative study, which is now discussed.

3.3. The YuPP☺ Project

Three authors, all involved in the development of the Strategy, jointly presented the preliminary MSA policy analysis at national and international conferences (see File S1). They subsequently wrote a book chapter, with a reflective commentary on the experience of the two youth co-authors participation in policy-making [46]. While the YuPP☺ Project grew out of these collaborations, it was conceived as a project to explore YAG members experience of policy-making and in response to a request for feedback on better question placement and phrasing in data collection. This aspect of the YuPP☺ Project will be reported elsewhere. Through unprompted discussions, the youth co-authors expressed their awareness of the discursive assumptions representing young LGBT+ identities almost solely in relation to mental health risk, including the quantitative research informing the initiation of the Strategy [26]. This article reports on their rich observations.

3.3.1. Participants

Six Irish young people participated in the consultations as collaborators and co-authors. Half grew up in rural areas or towns in the North West, South West and Midlands of Ireland, while half are from Dublin, the capital city. All completed their primary and secondary education in Ireland. Participant characteristics are outlined in

Table 2. Participant characteristics.

Characteristic	Number of Participants
Sexual orientation	lesbian (n = 3) gay (n = 3) queer (n = 1) pansexual (n = 1) *
Gender	female (n = 3); male (n = 3)
Gender identity	transgender (n = 1); cisgender (n = 5)
Pronouns	she/her (n = 3); he/him (n = 3); they/them (n = 1) *
Age on recruitment onto the Youth Advisory Group	17 years (n = 3); 19 years (n = 3); 20 years (n = 1)
How recruited onto Youth Advisory Group	LGBT+ national youth service (n = 3); rural youth service (n = 2); urban youth service (n = 2); peer mentor (n = 2) media panel (n = 1); work placement (n = 1); *
Age on recruitment onto the YuPP☺ Project	21 years (n = 3); 23 years (n = 2); 24 years (n = 1)

* Due to multiple forms of identification and means, does not sum to six.

.

As illustrated in Table 2., participants became involved in the development of the Strategy through their involvement in youth groups across the country, and were encouraged to apply to become YAG members by a range of adult mentors. Some youth co-authors also sat on the Oversight Committee and subgroups, spoke at the report launch for the nationwide youth consultation, the stakeholder consultation, and at the Strategy launch [46]. Two youth co-authors were part of the delegation to World Pride for the presentation of a Luminary Award, in recognition of Irish leadership in support of LGBT+ communities [85]. They brought a unique perspective: as LGBT+ youth with lived experience and through reflection on their participation on the YAG, while they were adolescents. The youth co-authors are now aged 21–24 years, providing consent for participation in their own right.

The youth co-authors shared rich insights on three key themes–‘seen and heard’, ‘recognition by researchers and policy-makers’ and ‘expertize by experience’–that were identified following a detailed analysis of the data [70,71]. The following sections examine the theme of ‘seen and heard’ and discursive assumptions in relation to young LGBT+ identities; representations orientations and identities; and silence and (in)visibility in education.

3.3.2. Reflections on the Dominant Discourse in Relation to LGBT+ Youth Identities

As illustrated in

Table 3. Youth co-authors reflections on the dominant discourse and representations of young LGBT+ identities.

Representation of Young LGBT+ Identities	Quotations
Dominant discourse	“There has been a lot of pathologizing of LGBT+ young people”. “The assumption that young people are not fully formed, are adults in the making, and can’t make decisions. Then added to this, being LGBT+ is a phase”. “So, maybe just a bit of a hang-up that LGBT+ people are not right in the head”. “They would prefer if there was a box that said normal.”
Concerns conveyed in the discourse	“Back in the day, if you were LGBT+, you could be sent to the madhouse or to an asylum. I’m not sure that people still think this sort of way, maybe subliminally they do”. “And you have to take into consideration that maybe there would be fear: ‘What if I say something wrong, they might call my parents because they were worried about me’”. “I think it comes from years of hearing about LGBT+ people being kicked out or home and all this kind of stuff. That’s always in the back of your mind. And it’s like: ‘Oh well, this happened to that person, so my parents could do that to me’, or ‘This could happen to me when I’m out on the street’”. “Yeah, all these kinds of micro aggressions and macro aggressions”. “School might the worst thing, or their friends are bullying them. They might constantly feel suicidal”.
Potential impact of the discourse	“I feel that LGBT+ people have a baseline level of heightened risk of psychological distress. I suppose they’re predisposed to it because of the baseline almost”. “It’sreally setting them up for a fall from a very young age, like, how they perceive themselves”. “I meet people all the time that are like ‘well, I’m gay but I’m not part of the whole Pride Festival, the whole LGBT+ community’“. “A huge proportion of the community in Ireland never want to be counted–because of the fear of being outed, or the stigma that’s implied”.
Tensions within the discourse	“There’s a huge impact with that–you see it with mental health [pause]. Not that mental health and sexuality are connected. I’m not trying to say that, to be clear”. “If you’re LGBT+, you’re not just LGBT+. There’s other issues, rather than just the identity part. Young people are in school, or this is going on at home, or this is happening. They’re not like: ‘I just live my life being gay and everything is great at this moment in time’. Maybe being LGBT+ is the best thing in their lives”. “It’s certainly true that we don’t live single issue lives”. “Even if you have a great home life and get on great with your parents or guardians, there’s still this thing that’s looming over your head”. “If we were to say x% of LGBT+ young people have felt suicidal in the last six months. Then LGBT+ young people, absolutely need more mental health resources, and LGBT+ young people absolutely need more support and skills. But that same figure could be taken and misused to say ‘Clearly being LGBT+ is really bad for young people’”.

, throughout these conversations, the young people commented on the importance of representation. The youth co-authors reflected on the portrayal of young LGBT+ identities with discussions highlighting a dominant public discourse equating an LGBT+ identity as synonymous with mental health distress. The potential for such representations to be ‘pathologizing’ and imply that these youth populations are ‘not right in the head’ was emphasized. This stigmatization was contrasted with assumptions of heterosexuality as ‘normal’, with exploration of LGBT+ identities dismissed as ‘a phase’. It was recognized that this may sit within a broader discourse where youth are viewed as ‘not fully formed,’ consistent with the literature [1,19].

As can be seen in Table 3 the youth co-authors spoke of the concerns conveyed within the dominant discourse. This included the stigmatizing portrayal of LGBT+ identities almost solely in relation to risk [26]. Their narratives highlighted the potential for LGBT+ lived experience to be associated with homelessness as a result of ‘being kicked out of home,’ victimization ‘on the street’ or through ‘micro aggressions and macro aggressions,’ alongside the potential for bullying, particularly within the school context. As these conversations illustrate, the young people are acutely aware of the Minority Stress Model which acknowledges that mental health disparities may occur as a consequence of stigmatization, marginalization and discrimination [29]. This perhaps accounts for the perception of a ‘baseline level of heightened risk of psychological distress’.

The framing of young LGBT+ identities, with a particularly bleak portrayal of lived experience, and future possible selves, is both limited and limiting [25,77,78,79,82,83,84]. Further, the pervasiveness of the predominant focus on risk may have unintended consequences. The youth co-authors commented on the assumption of negative outcomes as ‘this thing that’s looming over your head’ and ‘always in the back of your mind’. It is perhaps unsurprising, in this context, that ‘maybe there would be fear’ in disclosing an LGBT+ identity as it could lead to ‘people being worried’. This is noteworthy in the context of the youth co-authors reflections that people may not wish to be associated with LGBT+ communities for ‘fear of being outed, or the stigma that’s implied’ or impact on ‘how they perceive themselves’. While the concept of a singular readymade “community” is contested, the promotive potential of connectedness for young people who are marginalized, is recognized [17]. This echoes the Minority Stress Model [29], and aligns with Honneth [33,34,35].

It is particularly worrying that young people are attempting to negotiate their lives against the backdrop of such narratives: ‘even if you have a great home life’ or where ‘being LGBT+ is the best thing in their lives’. The consultations with the youth co-authors reflect these tensions. Emphasis was placed on separating the conflation of sexual and gender minority identification and concerns about risk, noting: ‘not that mental health and sexuality are connected,’ and underscoring this: ‘I’m not trying to say that, to be clear.’ This perhaps reflects the importance of challenging such discursive assumptions [25,77,78,79,82,83,84]. Attention was drawn to the potential for the misuse of data and that concerns about suicidality could be framed as indicating that ‘being LGBT+ is really bad for young people,’ thus stigmatizing these identities.

The youth co-authors highlighted their understandings of intersectionality, a concept coined by Crenshaw, to refer to multiple co-existing identities which may compound forms of marginalization [92,93]. The young people recognize that ‘if you’re LGBT+, you’re not just LGBT+’. Such understandings, beyond ‘single issue lives’, highlight that other identities may have increased salience, as part people’s lived experience of disadvantage. These include, but are not limited to, age, socio-economic status, ethnicity, religion, alongside sexual orientation, gender and gender identity.

The youth co-authors gave consideration to these representations of their lived experience in relation to LGBT+ identities and orientations.

3.3.3. Representations of Orientations and Identities

As illustrated in

Table 4. Youth co-authors reflections on the representations of orientations and identities.

Representations of Orientations and Identities
Social change	“With people being more open, younger generations are saying that sexuality is not set in stone”.“It’s more of a continuum than an end-to-end binary thing” It’s much less of a kind of dichotomy’ “I think there’s much more openness and space for LGBT+ younger people, and younger people in general, and just people in general to not be so fixed around sexuality and gender. And there’s no sense of ‘Oh no, you can’t change’; that way it’s not a big deal, it’s just about understanding”. “The idea of sexuality as fluid wasn’t a way of thinking for older generations. I think that we could even see that around my generation, you know.So, I think, maybe, it is easier to reflect nowadays, than it would have been 30 years ago”.
Self-identification	“People should be able to self-identify, because identity isn’t assembled from people’s experiences, it’s how they choose to see themselves. Then people stop feeling they have to tick things off, like a checklist, they can just validate themselves”. “There’s no pressure, nobody’s making a big deal out of it, which is probably making it easier for young people who are questioning or exploring their sexuality or their gender”. “So, a lot of people may identify as non-binary or start using multiple pronouns. And that’s something that you never would have really seen five years ago when we were 16”. “I definitely think younger people now are more comfortable in being unsure: ‘I’m not sure yet, but it’s not a big deal’. They are way more accepting of the fluidity and the’ let’s figure it out’, rather than the’ let’s stress about it until we know for sure’”.
Fluidity in identity	“I think understanding and accepting that these change–the terms and definitions change, people’s identities change, that everything is fluid”. “I know as people grow into older stages of their lives, this changes, how they identify changes. If you were to ask them about their sexuality when they were younger, they would have been straight. A bit older, bisexual. By 17 they wouldn’t really have known at all. And by 20 were quite solid and secure in their identity”. “I wouldn’t be surprized if the same people, when they’re older again, how they identify changes”. “Because it’s fluid and ever changing how the LGBT+ community use these terms”.
Understanding of orientations and identities	“Part of the beauty of the LGBT+ community, as a whole, as a broader thing, is that it’s messy. Not every person who is a lesbian, has the exact same feelings about being a lesbian. Not everybody who’s gay or bi or trans has the same finite experience. People stop trying to get the fine print of their identity down”. “I think that identity is more complicated than the literal word-for-word definition of the label that you use to describe yourself. It’s absolutely more complex than that”. “Given that we’re seeing broad variation with sexual orientation, it’s quite likely that as things evolve and develop, there will definitely be different ways that people begin to identify regarding gender”.

the youth co-authors described their understanding of sexual orientation and gender identity as ‘more of a continuum than an end-to-end binary thing’ and ‘much less of a kind of dichotomy,’ noting specifically that orientations and identities are ‘not set in stone’. Increased understanding of these issues was attributed, in part, to the rapid social change in Ireland [87], making it ‘easier to reflect nowadays, than it would have been 30 years ago’. They noted that there was ‘much more openness and space’ to explore one’s orientations and identities. Such intergenerational differences were highlighted repeatedly by the young people, noting ‘it’s not a big deal’.

As illustrated in Table 4, self-identification was regarded as highly important: ‘it’s how people choose to see themselves’. This may counter stigmatized representations of LGBT+ identities, both by facilitating people to ‘validate themselves,’ adding that there is ‘no pressure,’ rather it is ‘making it easier’ for younger people to explore their identities and orientations. This may reflect a developmental stage in which young people are investigating how best to describe their sexual or gender identity, and accord with life span developmental approaches [2,3]. However, as these narratives suggest, orientations and identities are regarded as dynamic, with a corresponding openness [14,15,16,17,18]. The youth co-authors mentioned the word ‘fluid’ in describing the formation of LGBT+ identities and orientations. They noted that this may reflect intergenerational differences and other forms of social change, including: ‘terms and definitions’ and ‘people’s identities’. Contesting concepts of linear, fixed identity formation [4,5], the youth co-authors views point towards an embracing of ambiguity and complexity associated with sexual and gender minority identities and orientations [14,15,16,17,18]. They drew specific attention to the potential for shifts in identification, across the lifespan ‘when they’re older again’ and their expectation that ‘how they identify changes’. As these consultations suggest, the young people understood that there is breadth and diversity in forms of self-identification, noting the development of ‘feelings’ and ‘experiences’ where ‘people stop trying to get the fine print of the identity down’. They understood that the broad variation in how people identify will continue to ‘evolve and develop’.

These consultations speak to nuanced, sophisticated understandings of self-identification and self-expression, challenging assumptions of rigid sexual orientation labels and binary gender identities [14,15,16,17,18]. Again, this creates a space for ‘young people who are questioning or exploring.’ An important contrast was drawn between the ‘let’s figure it out’ with the pressure of ‘let’s stress about it until we know for sure’. They suggested that, even in a few short years, ‘younger people are more comfortable in being unsure’. This appears to provide further evidence of social change whereby young people may be reluctant to identify with a single label or, perhaps, reject the idea of labels entirely. In this way, young people, in the Irish context may be destigmatizing LGBT+ identities and holding a space, intergenerationally; a space that broadens available forms of identification across the lifespan.

Despite these discussions, the co-authors were aware that such perspectives may not be shared, or even well-understood, within wider Irish society. There was unanimous recognition of the pressing need for comprehensive puberty, sexuality and relationships education in schools.

3.3.4. Silence and (in)Visiblity within Education

The youth co-authors noted that LGBT+ identities were not seen or heard within the curriculum. This absence created invisibility of LGBT+ lives and future possible selves and was perceived as a potential contributory factor in ongoing stigmatization. This is illustrated in

Table 5. Youth co-authors reflections on the silence and (in)visibility of LGBT+ identifications and orientations within education.

(In)Visibility within Education
Familiarity with orientations and identities	“Sometimes you can forget that there are people who do not engage with the LGBT+ community at all, and are like ‘I don’t know and I don’t care’. Then there are those who don’t know what any of the words mean and don’t understand the language” “I think another element of that is the lack of familiarity with the terminology. There are going to be so many people who are not familiar with the language, options, labels–even within the LGBT+ community”. “People who are probably not LGBT+ may not understand questions that are well understood by those who identify as LGBT+”. “A key thing about this is the fact that not everyone has such a wide-scoping understanding of the LGBT+ identities”. “I think, making it more straightforward... [pause] So, this is straightforward from my perspective, but obviously it’s probably not for a younger person who hasn’t been involved in anything LGBT+ related”. “I would hear ‘sexuality’ used more often, I think, than, ‘sexual orientation’ when talking about identity; heterosexual people definitely have a sexuality”.
Gaps in understanding	“I feel like people seem to understand straight, gay and bi. If your one of those three, people understand that a bit easier. Beyond that it’s just so much more complex to explain, to go into a whole explanation of expression and identity. And then to start explaining about gender identity”. “We’ve sort of moved on now that people do actually recognize that they have a sexual orientation. We might not have completely moved on in terms of gender identity. It used to be: ‘Sexuality equals gay and I’m not gay, so I don’t have a sexual orientation’. Maybe we’re seeing that with pronouns and people saying they don’t have pronouns”. “I know a lot of people and they’ll say to me, ‘Am I heterosexual, or what am I?’ that kind of way. Not everybody understands even what they are. I feel like lots of cisgender, heterosexual people, might have heard the words ‘homosexual’ or ‘transgender’ but have never heard of ‘cisgender’ or ‘heterosexual’”. “I find lots of times people who may not be in the LGBT+ community are like: ‘I don’t have one of those labels’. They just see sexual orientation as: ‘I don’t have that’. And it’s the same for gender. People don’t think they have a gender identity. There’s the whole thing when people say: ‘I don’t have pronouns,’ and I say: ‘you do, we all do’”
Gaps in education	“I think the education system needs to educate young people. We can’t ask the questions, yet, because people don’t know what sexual orientation or gender identity is, what these things mean. I think that’s an emerging area. We don’t have great answers, yet. The answers, I think, are contingent on better education. We’re not just there, yet”. “I was talking to a class in their final school year and they did find it confusing. That was interesting to see as well–these were 17–18-year-olds, so they shouldn’t have issues. But that is a problem with our education system”. “So, it wasn’t it wasn’t something that was massively understood or seen as important”. “But, you know the fact that the correct level of education in this country is not there. People should know about sexuality, gender and pronouns. But they don’t because that’s not what they’re taught, at all”. “There’s a difference between information and education. They have the information but nobody is necessarily explaining things. There’s no person who is the conduit of that information. It’s not being taught; they’re just taking in information and trying to make sense of it themselves.”. “I know we’ve come on leaps and bounds, but if schools were more accepting, if there was comprehensive Relationships and Sexuality Education, it could help further destigmatize”.
Alternative sources of information	“I suppose, especially recently, we have this incredibly online world and LGBT+ communities are very online.Younger kids are more aware of being LGBT+ and these online communities. And they have more words to experiment with”. “Because obviously kids have questions and Google it”. “I think when they have access to the Internet and micro identities, and they’re too young to understand it, and it’s not in a context where people around them understand it, and they can’t have any help from family, or friends, or teachers, or school, and they’re not being taught any of it, and all their education comes from the Internet. That’s scary”. “If no one is teaching you something, you’re going to do the best with what you have. Or you make sense of it, the way you can. It’s nearly like there’s too much information, but there still isn’t the teaching element of giving kids the information directly and teaching them about it”. “I’ve usually seen it online, where people go into a live stream and ask: ‘What are your pronouns?’ and some people are like ‘I don’t have pronouns,’ and there’s the whole miseducation and misinformation”.
Young people as educators	“I know a lot of young people express that same thing–that they are the ‘go-to’ people for ‘the gay facts, the gay news’ [makes quote marks with fingers], you know”. “A social worker rang me and was like ‘I have this young person here and they’re saying that they are [pauses and carefully sounds out] pansexual. What’s that?’ And I had to explain the whole thing about gender and gender fluidity. “The year marriage equality happened, I was in my final year of school, and it was very topical. Home economics seemed to be the class that it was brought up the most. People would turn around and look at me, they would ask a question, and my teacher would look to me for an answer”. “I think it could be difficult for young people to have to explain; it could be perceived in astigmatizingway–they might take it as ‘what’s wrong with you?I’m very comfortable talking about everything. So, for me, I have no problem chatting about things like that”. “I’ve often I found that when people say you need to simplify this for people who are non-LGBT+ it ends up that LGBT+ communities aren’t actually being centered in the work”.

.

Despite the rapid social changes [87], and even with intergenerational differences, as Table 5 suggests, there may be limited knowledge for ‘a younger person who hasn’t been involved in anything LGBT+ related’. The youth co-authors were aware that ‘sometimes you can forget’ that ‘not everyone has such a wide-scoping understanding of the LGBT+ identities’. This ‘lack of familiarity’ extended to ‘language, options, labels’.

There were differing views on whether the social changes were fully reflected in understandings across the population [87]. It was suggested that Ireland had ‘sort of moved on’ in relation to understandings of sexual orientation, but ‘might not have completely moved on’ in relation to gender identity. This was echoed in the view that ‘people do actually recognize that they do have a sexual orientation’, while others commented that ‘not everybody understands even what they are’. Some wondered if people ‘just see sexual orientation as “I don’t have that”’. There were suggestions that even with some understanding, this was somewhat limited and that ‘people seem to understand straight, gay and bi,’ noting beyond this ‘it’s so much more complex to explain’. Others commented that people may not understand more formal terminology and ask: ‘Am I heterosexual, or what am I?’ This was understood to be as a direct consequence of the absence of Relationships and Sexuality Education (RSE) that is inclusive and comprehensive [50,51,54,55].

Despite these nuanced observations, there was unanimous agreement that even limited forms of understanding, did not extend beyond sexual orientation and that ‘people don’t think they have a gender identity’. It was noted that people ‘may have heard’ transgender but ‘have never heard’ cisgender. The young people described situations and comments from young people ‘saying they don’t have pronouns’ and having to educate, responding ‘you do, we all do’.

It was acknowledged that other young people ‘did find it confusing’ attributing such knowledge gaps to ‘a problem with our education system’. The youth co-authors unanimously identified the need for ‘better education’ and that ‘the correct level of education is not there’. It was emphasized that that ‘people should know about sexuality, gender and pronouns’ and that ‘it’s not being taught’. Such observations are echoed in the review of the provision of RSE [50,51]. This is vital, particularly as the youth co-authors equated the lack of visibility with poor understandings of issues that have direct relevance to LGBT+ communities. They noted ‘there’s a difference between information and education’. The youth co-authors suggested that there was a lack of attention within educational policy and practice to such issues and wondered whether it was not ‘seen as important’. These observations drew from their recent school experience, and reflect long-standing attention to this issue [54,55].

The young people emphasized that in the absence of inclusive and comprehensive RSE, young people turn to alternate sources of information when they have questions ‘and Google it’. The youth co-authors are aware that ‘we have this incredibly online world and LGBT+ communities are very online,’ and that such platforms may provide a potentially promotive effect [94,95,96,97,98]. Such benefits may not extend to non-LGBT+ youth [98]. Instead, the youth co-authors recognized that online access was a potential a source of concern as ‘it’s nearly like there’s too much information,’ particularly for those who were ‘too young to understand’. This was exacerbated if ‘all their education comes from the internet’ noting: ‘that’s scary’. It was suggested that in the absence of ‘the teaching element,’ young people ‘make sense of it, the way you can,’ with the potential for ‘miseducation and misinformation’.

The failure to provide opportunities for formal learning and the potential for a lack of understanding through online information, the responsibility may fall to LGBT+ young people. The youth co-authors have direct experience as educators and noted their experience as ‘the go-to people’ for facts about LGBT+ issues. They highlighted informal situations where classmates ‘would ask a question’ and in response the ‘teacher would look to me for an answer’. The young people were able to contrast such experiences with more formal approaches that involved ‘talking to a class in their final school year’ alongside contact from professionals and having to ‘explain the whole thing about gender and gender fluidity’. They drew a distinction between the responsibility placed on their younger selves, and the role that they now embrace. This is consistent with the potential for advocacy and activism to promote wellbeing at the individual and collective level [99,100,101,102], consistent with Honneth [33,34,35]. However, the youth co-authors recognized that it could be inappropriate and ‘difficult for young people to explain’. They expressed the view that placing LGBT+ young people in the role of educators had the potential to be ‘perceived in a stigmatizing way’ and taken as ‘what’s wrong with you,’ as examples of the personally enacted and structural stigma [30].

The openness and confidence that the youth co-authors have in their own identities and orientations was reflected in the comment ‘I’m very comfortable’ and have ‘no problem chatting about things like that’. However, it was stressed that attempts ‘to simplify this for people who are non-LGBT+’ can prevent LGBT+ communities ‘being centered in the work’. While the desire by the young co-authors to raise awareness and advocate for others, particularly LGBT+ youth, is commendable, it cannot replace the pressing need for comprehensive RSE in schools.

4. Discussion

The article provides a policy analysis which specifically explores the initiation of the Irish LGBTI+ National Youth Strategy [6]. Through the lens of the Multiple Streams Approach (MSA) it explores the convergence of the problem, policy and politics streams [56]. It concludes that the Strategy was initiated in response to the quantitative literature identifying worrying concerns in relation to psychological distress and suicidality for these youth populations [26,36]. It is noteworthy that the published Strategy placed priority on enhancing the research and data environment. This, perhaps, acknowledges that much of the research focus regarding LGBT+ youth has been quantitative in nature, with “the vast majority” focused on mental health outcomes as a result of minority stress [102] (p. 1.). As such, the quantitative literature not be synonymous with hearing the breadth and diversity of LGBT+ voices, and may grant authority to some young people’s accounts while others remain unheard [48,90,91,102].

This analysis is complemented by a qualitative exploration of the perspectives and priorities of six youth co-authors with experiential expertize as LGBT+ youth and as YAG members for the formation of the Strategy [6]. The findings suggest that current representations may result in stigmatization of young LGBT+ identities, with an inadvertent negative impact on policy and practice [91]. This qualitative participatory project does not claim to represent broader LGBT+ youth populations. Further, the youth co-authors recognize the limitations in the representation of diverse identities and voices on the YAG [46]. As such, the youth co-authors do not seek to speak to the breadth of lived experience of other sexual and gender minority youth, and acknowledge intersectional identities [92,93]. However, the accounts of the six co-authors underscore the impact of discursive assumptions in stigmatizing young LGBT+ identities, which accords with Honneth [33,34,35].

MSA suggests that as a consequence of the convergence of problem, policy and politics streams, policy efforts may remain trapped in negative connotations of the problem [56,89]. This, perhaps, provides an explanation for the persistence of protectionist policy and practice [85]. However, it appears that a counter to the dominant framing of young LGBT+ identities was achieved through the involvement of LGBT+ young people and peer allies in the co-production of the LGBTI+ National Youth Strategy. As such, youth-centered, rights-based participation offers powerful potential and may disrupt what MSA suggests is a forgone conclusion as a result of top-down policy initiation [56,89].

This potential has a parallel with recognitive justice, a form of social justice, as a pre-requisite for health and mental health [31,32]. Underpinned by Recognition Theory, the implications for practice, policy and research are now discussed in relation to these interconnected forms of interpersonal recognition, legal recognition of universal human rights and recognition of the unique contribution of community members [33,34,35].

4.1. Interpersonal Recognition

The rich insights of the youth co-authors highlight both their awareness of discursive assumptions and the impact of such problem-focused representations. They reflected on the portrayal of young LGBT+ identities almost solely in relation to psychological distress and suicidality, and the potential for stigmatization [25,77,78,79,82,83,84]. This stigmatization extends to identification (on the basis of sexual orientation or gender identity) and mental health (particularly mental ill-health). As such, LGBT+ youth may have an increased reluctance to disclose any mental health concerns due to this double stigmatization. The authors concur that universally ascribing increased vulnerability, and mental health risk, due to an LGBT+ identification may have an unintended negative consequence. This was confirmed by The LGBTIreland Report which noted that young LGBT people were worried that healthcare professionals would misunderstand a young person’s LGBT+ identity as the source of the problem [26]. In addition, respondents expressed anxiety at potentially being labelled as mentally ill, with a further fear of prescription of medication being the sole response to difficulties [26]. These concerns were attributed to the potential lack of understanding by health practitioners who lacked sufficient awareness of LGBT+ identities, or of the appropriate language and terminology to use [26]. While concepts of cultural competence are contested, the authors conclude that training, education and professional development for health and social care requires urgent prioritization [57]. This acknowledges that even with professions which emphasize engagement in reflective practice, there may be reluctance to reflect on sexuality as part of a broader commitment to anti-oppressive practice [103]. Bryan highlighted similar parallels for educators, identifying the need for the development of specific skills and knowledge to disrupt normative assumptions [84]. One example of the development of an LGBT + curriculum in health and social care education, The IENE projects (2008–2022), is underpinned by values of social justice, equity and promoting diversity, and offers potential transferability to other contexts, such as education and youth work [104].

There is a pressing need to move beyond education and training through the embedding of reflective practice and research reflexivity as an integral facet driving policy, practice and all forms of research with LGBT+ youth. This would facilitate engagement with nuance, detail, and complexity regarding LGBT+ youth wellbeing [84]. The failure to address such issues can have an inadvertent negative impact, reinscribing the enactment of personal stigma by providers and structural stigma within healthcare and education systems, and serve as a barrier to LGBT+ youth engagement [30].

The authors are in agreement that reflexivity and reflective processes are critically important in the interrogation of the personal beliefs and assumptions informing research, policy and practice, beyond acknowledgement of unconscious bias [58,60,61,66,68]. Rather, this offers opportunities for problematizing normative assumptions underpinning the dominant discourse [84]. While the importance of reflexivity is well recognized in qualitative research, more recently there have been calls to bring a reflexive lens to quantitative research [105]. Core aspects of reflexivity are to make transparent researcher subjectivity, positionality, and research ethics [60,105], to ensure “sincerity” [66]. The assumptions informing public discourse and research, such as those conflating sexual orientation with a sexual minority identity, with negative connotations, are stigmatizing [27,52]. Engaging reflexively offers the potential for interrogation of the influence of the dominant discourse on research relationships and processes [105]. This may foster anti-oppressive ways of working, and through the use of self, challenge inequity and injustice [103].

4.2. Recognition of LGBT+ Human Rights

The youth co-authors observations that the current Irish Relationships and Sexuality Education does not offer comprehensive and inclusive education encompassing puberty, sexuality and relationships, reflect the current curriculum review [50,51]. Further, the online student survey noted that the absence of focus on relational aspects had resulted in an over-emphasis on risk [50]. This risk-based focus provides a parallel with problem-focused representations of LGBT+ young identities, perhaps reflecting a broader pattern of problem-focused discourse in relation to youth [19]. The review and subsequent development of a draft curriculum for the junior cycle offers important potential [50,51]. However, the perception of the youth co-authors that curricular reform is not seen as important, may reflect longstanding attention to this issue [54,55].

The authors echo calls for comprehensive and inclusive puberty, sexuality and relationship education with relevance to sexual and gender minority youth [6,50,51,54,55,90,106,107]. This offers the potential to extend beyond health and wellbeing, to ensure representation of LGBT+ identities throughout the humanities and sciences. This underscores visibility within the curriculum as essential to holistic representations of LGBT+ youth lived experience and future possible selves, and accords with the LGBTI+ National Youth Strategy [6]. While the need to implement inclusive, comprehensive RSE has particular resonance, this is hardly unique to Ireland. Recommendations from other jurisdictions call for relevant and inclusive LGBT+ puberty, sexuality and relationships education as part of a commitment to embedding an ethos of diversity and inclusion within schools [106,107,108,109,110,111]. In addition, this article has resonance in the context of recent developments in the US with the introduction of what the media have termed the ‘Don’t Say Gay’ bill in Florida, and the legislation preventing affirming care for trans youth in Texas [112]. While this attests to an erosion of universal human rights [33,34,35], concerns have been noted at the silence and implied acceptance of such legislation [112]. The authors underscore the potential of curricular which is inclusive and comprehensive to contribute to de-stigmatizing and de-pathologizing LGBT+ youth identities, promoting wellbeing [48]. Such holistic representation may be further enhanced by youth centered rights-based provision of policies universally applied across educational contexts, alongside alliances for LGBT+ youth and allies, and extra-curricular opportunities, with potential promotive benefits for all students [48].

This article highlights the importance of the structural context in addressing this, and the authors call for greater research attention on all aspects of legal recognition, particularly the impact of the legislative and policy measures that erode and enhance universal human rights.

4.3. Community Recognition

The youth co-authors narratives point to the wealth of cultural and social capital embedded within LGBT+ youth networks. The young people’s comfort and confidence in discussing mental health contrasts with wider society; over 50% of the Irish population would consider hiding a mental health difficulty from family and friends, while one-in-five youth would delay seeking treatment if they felt people might find out [113]. The youth co-authors emphasized that anyone may experience compromised mental health, that this may be exacerbated by minority stress, and importantly, that this does not preclude wellbeing [29]. Such understandings highlight the potential for ‘learning with’ LGBT+ youth [58].

The openness and ease of the youth co-authors in discussing wellbeing, including mental health and ill-health, was noteworthy. All agreed that it was important not to diminish or under-represent the immediate and lasting factors that negatively impact upon the mental health of young people generally, and the needs of LGBT+ youth in particular. They highlighted their understandings of intersectionality, and multiple co-existing identities which may compound forms of marginalization [92]. Intersectionality has important implications in relation to health disparities [93]. The authors call for LGBT+ identities and experiences to be contextualised within intersectional understandings of the salience of identities that include, but are not limited to, sexual and gender minority orientations and identifications.

Reflecting similar findings with LGBT+ adult populations [114,115], these narratives suggest that LGBT+ youth in Ireland may be at the forefront of mental health promotion. However, when viewed through the lens of Honneth’s tripartite framework [33,34,35], the community contributions of these youth populations remain largely unrecognized. The importance of valuing the contribution of LGBT+ youth, both within and beyond LGBT+ communities, can provide complementary expertize to that of researchers, policy-makers and practitioners. Ensuring the meaningful impact on the health and wellbeing of LGBT+ youth requires investment in the development of policy-informed, research processes. The authors stress the importance of collaborative, participatory approaches [37,38], in particular those predicated on ‘learning with’ seldom-heard youth [58]. Such community recognition aligns with Honneth [33,34,35]. This also accords with Meyer’s emphasis on “stress ameliorating factors” within the Minority Stress Model, which included community affiliation [29] (p. 677). The authors draw specific attention to the impact of youth experiential expertize, knowledge and knowing, with the potential to contribute to mental health de-stigmatization.

Such ‘learning with’ marginalized and minority communities can be achieved through research practices. Patient and public involvement (PPI) with youth is increasingly emphasized as pivotal to health research through Youth Advisory Groups (YAG) [37]. Embedding YAG within research processes requires rights-based approaches to hearing these young voices [45], alongside recognition of their contributions [33,34,35]. The authors emphasize that research with seldom-heard young people, including LGBT+ youth, can be significantly enhanced through YAG, with particular application to quantitative research. This offers opportunities for more nuanced approaches to accessing seldom-heard voices, and aligns with participatory research methods that create spaces which are contextual, situated and co-produced [37,38]. Meaningful and impactful research can inform and improve the delivery of health, social care and education. This requires investment in relationships and research processes, and engagement that seeks to learn about what matters to these youth communities [66,67,68]. YAG participation may enhance research engagement, informed by holistic representations of LGBT+ youth identities. Such holistic representations associate LGBT+ identities with a broad range of indicators of wellbeing, including: positive identity formation; connectedness through social networks; alongside valuing of community contribution, enhancing self-esteem and social solidarity [48]. Such findings reflect the potential of connectedness through a marginalized identity, facilitating meaningful connections with others [17,48,102,116], and joy in embracing these identities [116].

While the limitations are acknowledged, these powerful accounts highlight the impact of invisibility and silence with the potential for stigmatization of LGBT+ youth identities. The critical insights of the youth co-authors, which complemented the policy analysis, enhanced the quality and relevance of this project.