LGBTQ mental health remains a critical challenge, with many young people experiencing anxiety, depression, and suicidal ideation at higher rates than their cisgender heterosexual peers.

INTRODUCTION

Mental health difficulties remain a common challenge for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. Compared to cisgender heterosexual people, LGBTQ people experience mental health difficulties across the lifecourse such as anxiety, burnout, depression, suicidal ideation, and suicide attempts (e.g., Clark et al., 2014; Fenaughty et al., 2021; Marshal et al., 2011; Mustanski et al., 2010, 2011; Russell & Fish, 2016; Treharne et al., 2020; Viehl et al., 2018). Many of these mental health issues emerge for LGBTQ people during adolescence or young adulthood (e.g., Clark et al., 2014; Fenaughty et al., 2021). Research in this area has commonly involved survey methods (e.g., Clark et al., 2014; Fenaughty et al., 2021; Krueger et al., 2018; Treharne et al., 2020, 2022a; Tan et al., 2022, 2023), which provides crucial statistical information but there is also a need for qualitative research to provide deeper insights into experience of mental health difficulties and support for LGBTQ people during youth.

Discrimination continues to be a contributor to mental health difficulties experienced by LGBTQ people across the lifecourse (Garcia et al., 2024; Poteat et al., 2011; Russell et al., 2014; Treharne et al., 2020, 2022a). A wide range of discrimination is experienced by LGBTQ youth, including direct verbal and physical aggression, indirect slurs, social rejection and isolation, and diminished social support (Garica et al., 2023b; Swearer et al., 2008; Treharne et al., 2020). A US nationwide survey by Kosciwet al. (2016) found that sexual orientation and gender diversity were the most common reasons for discrimination at schools. Cisheteronormativity in schools manifests through discrimination from other students and staff, and a discriminatory school curriculum which overlooks or devalues LGBTQ identities (Graham et al., 2022; Sexton, 2012).

Given the mental health difficulties experienced by LGBTQ youth, it is important to understand how to meet the related support needs. More research investigating support for LGBTQ youth in schools and universities has been called for (Garcia et al., 2025; Graham et al., 2022). Some past research has examined school-based support groups like gay-straight alliances or gender and sexuality support groups and suggests these groups can have lasting benefits for the mental health of LGBTQ youth (McGlashan & Fitzpatrick, 2018; Poteat et al., 2012; Toomey et al., 2011). Conversely, Elliott (2016) identified that GSA members were commonly met with ridicule, which contributed to further isolation. A lack of support from students and staff is a barrier to introducing GSAs and other group support for LGBTQ youth into schools (Painter & Keaney, 2009). The processes for understanding gender and sexual identities within support groups are always in flux and require careful facilitation (McGlashan & Fitzpatrick, 2018).

Support from school staff for LGBTQ students is still relatively uncommon because staff intentionally or unintentionally maintain a cisheteronormative environment (Graham et al., 2022; McGlashan & Fitzpatrick, 2018; Painter & Keaney, 2009). Participants in Sexton’s (2012) study reported that staff either ignored or participated in the teasing of LGBTQ students. However, when school staff are supportive, LGBTQ students feel safer and attend more often (Kosciw et al., 2016). Support from family and friends can also positively influence LGBTQ youth’s mental health (Elizur & Ziv, 2001; Matthews & Salazar, 2012; Ryan et al., 2010). Friends are often the first line of support for LGBTQ youth as they are typically the first people LGBTQ youth come out to (e.g., Mustanski et al., 2011). Support from fellow LGBTQ youth is particularly beneficial as they have often had similar experiences and are more sensitive and aware of possible difficulties (Schimanski & Treharne, 2019; Garcia et al., 2024).

Professional mental health support is often difficult for LGBTQ youth to access (Clark et al., 2014; Fenaughty et al., 2021; Garcia et al., 2025). Barriers to access include cost, discrimination from healthcare professionals, and a lack of appropriate services (e.g., Adams & Neville, 2023; Adams et al., 2013b; Elliott et al., 2015; Garcia et al., 2025; Sabin et al., 2015; Tan et al., 2022, 2023). Gahagan and Subirana-Malaret (2018) surveyed non-LGBTQ healthcare professionals with the majority reporting discomfort with raising LGBTQ-specific healthcare issues. More than half of LGBTQ and non-LGBTQ heathcare professionals surveyed reported never having received LGBTQ education. A similar pattern in healthcare training programmes is seen internationally (Obedin-Maliver et al., 2011; Parameshwaran et al., 2016; Taylor et al., 2018; White et al., 2015; Treharne et al., 2022b). Mental health professionals who have knowledge regarding how to best help LGBTQ clients can provide better care to their LGBTQ clients. Research with a specific mental health focus indicates that mental health professionals need more training and support when working with LGBTQ people (e.g., Garcia et al., 2025; Hayward & Treharne, 2022; Semp & Read, 2015).

In summary, LGBTQ youth are affected by mental health difficulties more so than cisgender heterosexual youth. There is evidence that the support available for these difficulties has substantial problems, which makes adequate support difficult to access. Greater exploration of LGBTQ youth’s perception of mental health, what contributes to their mental health, and related support is necessary for addressing existing issues. Qualitative research is necessary for exploring the experiences of LGBTQ individuals as it allows for descriptions of the complex and unique experiences that members of LGBTQ communities face. LGBTQ young adults are in an ideal position to reflect on their experiences during youth with the extra insight that comes from having moved on from high school. Therefore, the present study explored younger LGBTQ adults’ perspectives on their mental health experiences and the perceived effectiveness of the support they have available. Given our focus on the meaning of experiences, we adopted a phenomenological approach to explore the following research questions:

1) What aspects of mental health experiences and support during youth are considered important by LGBTQ young adults?

2) What factors do LGBTQ young adults believe contribute to mental health and well-being of LGBTQ youth?

3) How effective do LGBTQ young adults perceive the support to be that is available for LGBTQ youth experiencing mental health difficulties?

METHODS

Research Design

The present study applied a phenomenological qualitative approach to hearing from LGBTQ youth about their perspectives on mental health and availability of support. Focus groups were used to hear from LGBTQ young adult’s experiences of mental health and support during youth, and our phenomenological approach involved centring these experiences and associated perspectives. Focus groups are an ideal technique for obtaining qualitative data as they allow participants to discuss with one another, to expand on ideas suggested by others, and to choose which questions they answer, which can help them to feel comfortable discussing potentially emotive topics (Krueger & Casey, 2015).

The research team consisted of six people. For each focus group, one member of the team acted as the lead facilitator, with another one or two members conducting administrative tasks and notetaking as well as asking prompting questions as they saw fit. The focus groups were held in two phases. After the first seven focus groups, the questions were refined as a planned part of the methodology (see Appendix 1 for all planned questions during the two phases of recruitment). Refinement is an established process in qualitative research that allows for further exploration of early patterns identified in the data and the inclusion of questions targeting issues raised by participants in the initial groups (Charmaz, 2006). After 11 focus groups were completed, we concluded that the information being obtained was covering similar thematic ideas and the groups were concluded.

Participants and Recruitment

Ethics approval was obtained from the ethics committee of the university where the study was conducted. LGBTQ participants were purposefully sampled to be young adults so that they could reflect on their experiences throughout their youth. The age range of participants was 17 to 30, with a mean age of 21. Six participants were older than 24. Participants were recruited through advertising on the university campus, and snowball sampling. A grocery voucher was offered to participants to cover expenses, with an additional voucher to those who organised a group of people to participate.

Forty-six participants took part across the 11 focus groups. A summary of participants’ sexual orientations, genders, and ethnicities is included in Table 1 along with information about the composition of each focus group. Twelve participants reported a trans or non-binary gender and 34 reported a cisgender gender. Six participants were Maori, four were Asian, and 36 were White or New Zealand European/Pakeha only. Thirty-one participants (67%) reported having experienced a mental health condition. The most common mental health difficulties reported were anxiety or depression (22 reports of each). Other difficulties included eating disorders (n=6), stress-related difficulties (n=3), obsessive-compulsive disorder (n=2), post-traumatic stress disorder (n=1), alcohol use issues (n=1), borderline personality disorder (n=1), and psychosis (n=1). The nature of these difficulties was not probed in the focus groups as the aim of the study was to explore general perspectives on mental health experiences and availability of support rather than understanding the range of specific mental health presentations.

ANALYSIS AND COMMENTARY

Two themes were identified, both with two subthemes as depicted in Figure 1 and explained within the following sections on each theme and subtheme. The term ‘mental well-being’ is used throughout this section to capture the general experience of mental health and well-being as described by participants. The use of ‘negative’ and ‘positive’ refers to participants’ subjective experience of their mental well-being.