BackgroundEffective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced.MethodsLongitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources.ResultsThe study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities.ConclusionUK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries.

Conflict with the family about sexual orientation and gender diversity is a key risk factor associated with poor mental health in youth populations. Findings presented here derive from a UK study that employed an interdisciplinary critical mental health approach that de-pathologised emotional distress and conceptualised families as social and affective units that are created through everyday practices. Our aim was to explore how family relationships foster, maintain or harm the mental health and well-being of LGBTQ+ youth. Data were generated through exploratory visual, creative and digital qualitative methods in two phases. Phase 1 involved digital/paper emotion maps and interviews with LGBTQ+ youth aged 16 to 25 (n = 12) and family member/mentor interviews (n = 7). Phase 2 employed diary methods and follow-up interviews (n = 9). The data analytic strategy involved three stages: individual case analysis, cross-sectional thematic analysis and meta-interpretation. We found that family relationships impacted queer youth mental health in complex ways that were related to the establishment of their autonomous queer selves, the desire to remain belonging to their family and Article Health 00 (0) the need to maintain a secure environment. The emotion work involved in navigating identity, belonging and security was made difficult because of family heteronormativity, youth autonomy and family expectations, and had a stark impact on queer youth mental health and well-being. Improving the mental health of LGBTQ+ youth requires a much deeper understanding of the emotionality of family relationships and the difficulties negotiating these as a young person.

a centre of Gender and Women's Studies, Lancaster university, Lancaster, uK; b division of Health Research, Lancaster university, Lancaster, uK

This article will explore how LGBTQ+ young people sustain, and in some cases survive, family relationships. We develop the concept of ‘paradoxical family practices’ and use this to demonstrate the ways in which LGBTQ+ young people manage family life through everyday emotion work. This highlights: (1) how families ordinarily navigate heteronormativity and ‘issues’ of gender/sexuality; (2) the efficacy of ‘paradoxical family practices’ as a conceptual tool; (3) the value of emotion-centred multiple qualitative methods to explore the lives of LGBTQ+ young people and mental health. Findings derive from a small-scale UK study funded by the Wellcome Trust (UNS39780) and were generated through a two-stage methodology comprising digital/paper emotion maps and qualitative interviews with LGBTQ+ young people aged 16–25 (n = 12) followed by diary methods and follow-up interviews (n = 9). Interviews were also completed with ‘family members’ (n = 7).

Young people who identify as lesbian, gay, bisexual, transgender and queer/ questioning (LGBTQ+) experience higher rates of mental health distress than reported in the general population, yet are far less likely to seek support services. Factors such as homophobia, biphobia and transphobia, cis-heteronormativity, fear of judgement and lack of sta awareness of LGBTQ+ identities are barriers to help seeking. This paper reports on the rst stage of a study that investigated and mapped current LGBTQ+ youth speci c mental health service provision across the UK. An online and o ine service mapping exercise was undertaken to locate services. 111 services were identi ed across the search strategies, the majority in urban settings in England. There were three signi cant characteristics of LGBTQ+ child and adolescent mental health UK provision. Firstly, there was an absence of mainstream NHS support that speci cally addressed the needs of LGBTQ+ young people. Secondly, the majority of LGBTQ+ youth mental health support was provided by voluntary/community organisations. Thirdly, there was a rare model of service based on collaborative working between NHS trusts and community/voluntary organisations. The results of this mapping exercise suggest that there is a reliance on the voluntary/community sector to provide mental health provision for LGBTQ+ young people. Furthermore, there was a distinct divergence in the approaches of the support provided by the voluntary/community sector and those from within the NHS. The a rmation of LGBTQ+ identities that is pivotal to the support provided by voluntary/community services contrasted with the 'treating everyone the same' approach prevalent in mainstream service provision. NHS mental health services must recognise that to tackle LGBTQ+ youth mental health inequality, statutory mental health support must address speci cally the mental health needs of LGBTQ+ young people.