LGBTQ+ children and young people: Experiences of local health and wellbeing services

1 Executive summary

1.1Background

NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) commission services across Nottingham and Nottinghamshire that contribute to the local children and young people’s (CYP) emotional health and wellbeing (EHW) early support pathway. In October 2025 a review took place of the ICB-commissioned EHW services which provide a range of evidence-based clinical treatments including counselling, Cognitive Behavioural Therapy (CBT) and group intervention.

There are five emotional health and wellbeing services:

is an early interventions service for children and young people who experience mild to moderate mental health and emotional wellbeing needs, for ages 0–25 in Nottingham City and Nottinghamshire excluding Bassetlaw.
25 in Bassetlaw) is a free and anonymous space for young people to find online support and counselling.
18 in Nottingham City and Nottinghamshire.

A recommendation from this review was that services prioritise the needs of inclusion cohorts, beginning with LGBTQ+ children and young people as a key focus from 2026. Plans include upskilling staff who work in core EHW services so that practitioners have the competencies required to provide culturally competent, inclusive and responsive care.

This approach will enable greater access to evidence-based treatment for children and young people across Nottingham and Nottinghamshire and will support the delivery of equitable, high-quality mental health support aligned with national priorities and statutory equality commitments.

The ICB were keen to gather meaningful feedback and insights from children and young people aged 11–25 who identify as LGBTQ+ to inform future service improvements. The areas of focus were access to services, service environments and capturing both positive and negative experiences of care.

The listening exercise ran from 5 January and concluded on 2 February 2026. A number of engagement methods were used, including an online survey, online focus groups, feedback via telephone and a visit to a community group. The ICB Engagement Team heard from 41 individuals.

1.2 Key findings

Over half of respondents (52%) preferred to describe their sexual orientation in a free‑text box rather than selecting from a standard list. An even larger proportion (68%) preferred a free‑text option to state their gender identity. Similarly, 68% indicated a preference for the inclusion of pronouns rather than titles on referral and monitoring forms.
Feedback highlighted that many healthcare professionals lack adequate understanding of LGBTQ+ identities and experiences.
For some service users, repeated negative experiences within healthcare provision around misgendered identity and knowledge around LGBTQ+ communities directly contributed to mental health deterioration, including feelings of hopelessness and suicidal ideation. Service users emphasised that inadequate LGBTQ+ awareness among healthcare staff can have life‑threatening consequences and is an area that requires urgent improvement.
Feedback from the focus group and survey respondents consistently highlighted positive experiences with LGBT+ Service Nottinghamshire. Participants expressed appreciation for the one‑to‑one support available, describing the service as highly valued.
children and people who identify as LGBTQ+ to feel comfortable in healthcare settings, there was a preference for a number of measures to enable an inclusive welcoming environment. Staff being trained in LGBT+ awareness emerged as the highest priority, followed by gender neutral toilets and staff showing that they are LGBTQ+ allies by wearing rainbow lanyards and badges. Respondents also highlighted the importance of being asked which pronoun is preferred, the presence of friendly staff and having a safe place to talk to someone, different support options, being met by or introduced to peers and including LGBTQ+ symbols on letters and paperwork. These insights emphasise the value and importance of creating a safe and inclusive environment.

1.3 Next steps

This report will be submitted for consideration through the relevant ICB making process. A copy of the final report will be published on our website and shared with those who have participated. The recommendations from this report will be used to embed inclusive and responsive care in services for children and young people living in Nottingham and Nottinghamshire.

2 Conclusions and recommendations

Conclusion 1: When completing referral forms to access services, 52% of survey respondents would prefer a free text box to write in their sexual orientation preference rather than a standard list. Similarly, 68% of survey respondents would prefer a free text box to share their gender identity. 68% of survey respondents had a preference for pronouns rather than titles to be included on referral and monitoring forms.

Recommendation 1: NHS Nottingham and Nottinghamshire ICB to communicate the preferences for free text boxes for sharing sexual orientation and gender identity and inclusion of pronouns on referral and monitoring forms to providers of emotional health and wellbeing services for children and young people, to review and adjust the forms in line with the feedback.

Conclusion 2: A number of service users described encounters where staff demonstrated unprofessional attitudes and reacted in ways that made individuals feel unsafe disclosing their identity. Repeated negative experiences have directly contributed to mental health deterioration in individuals, created barriers to honest communication and discouraged service users from seeking further care.

Recommendation 2: Healthcare settings to implement specific training to promote respectful communication and reduce discrimination, to create an environment where children and young people feel safe, respected and receive nonjudgement and compassionate care.

Conclusion 3: Several service users reported being misgendered by healthcare professionals, even after providing clear information about their identity.

Recommendation 3: Ensure LGBTQ+ awareness training is readily available to healthcare professionals and develop mechanisms to assess whether the training is effectively reducing instances of misgendering and improving the experience of children and young people.

Conclusion 4: The majority of individuals who received support from LGBT+ Nottinghamshire expressed appreciation for the one‑to‑one support available, describing the service as highly valued.

Recommendation 4: NHS Nottingham and Nottinghamshire ICB to highlight the positive experiences of receiving one-to one support as an LGBTQ+ child or young person. Explore opportunities for sharing good practice across emotional health and wellbeing services for children and young people who identify as LGBTQ+ to ensure these insights inform the future design of these services.

Conclusion 5: To help children and people who identify as LGBTQ+ to feel comfortable in healthcare settings, there are a number of measures that enable an inclusive welcoming and safe environment. Staff being trained in LGBTQ+ awareness, gender neutral toilets, staff LGBTQ+ allies, being asked which pronoun is preferred, the presence of friendly staff and having a safe place to talk to someone, different support options, being met by or introduced to peers and including LGBTQ+ symbols on letters and paperwork.

Recommendation 5: Share the report and information regarding the measures that have been identified as helpful in enabling children and young people who identify as LGBTQ+ to feel comfortable in healthcare settings, with commissioners and providers of emotional health and wellbeing services for children and young people, to enable them to take appropriate action.

Recommendation 6: Providers of emotional health and wellbeing services to actively encourage staff to take part in LGBTQ+ awareness training or allyship programmes to support the delivery of inclusive care.

Conclusion 6: Feedback from professionals throughout the listening exercise indicated a clear hesitancy and in some cases reluctance among children and young people from the LGBTQ+ community to engage with the listening exercise.

Recommendation 7: For future listening exercises the Engagement Team could consider adapting its approach to engaging children and young people and use other avenues such as TikTok to improve engagement as survey methods are not yielding high response rates. The team should continue engaging with children and young people at the annual Shadow overnight orienteering event to help reduce barriers between children and young people and the NHS, ensuring the LGBTQ+ community are represented and listened to.

Conclusion 7: Feedback indicated widespread issues related to communication, both in terms of how to access services and how healthcare teams share information. Service users reported confusion around processes, inconsistent messaging, and a perception that services did not effectively coordinate care for LGBTQ+ patients.

Recommendation 8: Healthcare services treating children and young people to ensure that pathways are clearly communicated so that people know how to access services and what to expect.

3 Glossary of terms, abbreviations and acronyms

4 Background

4.1 Introduction

Supporting the mental health and wellbeing of children and young people (CYP) is a recognised priority within Nottingham and Nottinghamshire[1], reflecting both national and local evidence of need.

4.2 Existing research and insights

4.2.1 Mental health trends

Recent data provides an overview of mental health trends among children and young people in England, highlighting changes in prevalence, common conditions and patterns of service use:

Overall Prevalence of Mental Disorders: In 2023, approximately one in five children and young people aged 8 to 25 had a probable mental health condition[2]. This is a substantial increase from about one in nine (10.8%) children aged 5 to 16 in 2017.
Anxiety and Depression: Emotional disorders, including anxiety and depression, are among the most common mental health problems in this age group, with NHS anxiety referrals for children doubling since before the pandemic, reaching over 500 daily by late 2024[3].
Self-Harm: The prevalence of self-harm has increased across all age groups in recent years. In 2023, almost one-third (32.8%) of 17 –24 year olds reported having self-harmed or attempted to self-harm at some point. Rates are significantly higher in young women than young men[4].

Prevalence and incidence of mental disorders are difficult to determine locally for a number of reasons: some conditions may fall below diagnostic thresholds for specialist support (and therefore not be recorded in a meaningful way), whilst some children and young people may not seek help, due to factors which may include lack of awareness of support available or stigma, for example. It is estimated that 8,718 children in Nottingham city[5] and 17,600 children in Nottinghamshire[6] have a diagnosable mental health disorder at any one time.

The national data underlines the scale of mental health challenges facing children and young people overall, but certain groups experience even greater vulnerability. LGBTQ+ children and young people are disproportionately affected, with significantly higher risks of poor mental health outcomes compared to their peers.

A 2024 UK survey[7] of over 9,600 LGBTQ+ young people found that 70% reported symptoms of anxiety, 62% reported symptoms of depression, and 58% had self-harmed in the past year. 58% had seriously considered suicide, and 19% had attempted suicide during the same period. Discrimination and victimisation are key contributing factors. Two thirds of respondents reported experiencing discrimination based on sexual orientation, and 68% reported discrimination related to gender identity. These experiences are strongly associated with higher rates of suicidal ideation and attempts.

Further, data from the Office for National Statistics indicates that LGBT+ young people aged 16–24 are almost four times more likely to self-harm and nearly three times more likely to attempt suicide compared to heterosexual peers[8].

4.2.2 Barriers to accessing health and care services

Children and young people who identify as LGBTQ+ often navigate a complex landscape of social, emotional and structural challenges when trying to access health and care services. The following section is drawn from findings presented by the LGBT Foundation[9].

From an early age, many learn to anticipate judgement or exclusion, shaped by experiences of bullying, stigma or invalidation in schools, communities or even within their own families. These early encounters can create deep‑rooted fears about how adults in positions of authority, including healthcare professionals, may treat them, leading many young people to delay or avoid seeking the help they need.

A lack of consistent LGBT‑inclusive education compounds these difficulties. When children and young people grow up without access to accurate, affirming information about sexual orientation, gender identity and related health matters, they may struggle to understand or articulate their needs. This absence of supportive learning environments also fuels misinformation, internalised stigma and confusion at critical developmental stages. In turn, it limits their confidence when approaching healthcare professionals, who may themselves have had limited training in LGBT‑inclusive practice.

Insufficient understanding among health professionals remains a major barrier for LGBTQ+ children and young people accessing health and care services. Many LGBTQ+ young people report feeling misunderstood or dismissed by clinicians who lack the knowledge or confidence to support them appropriately, particularly those seeking gender‑affirming care. Experiences of misgendering, outdated assumptions or unclear care pathways can leave young people feeling unseen and unsupported.

These factors intersect with significant mental health pressures. LGBTQ+ young people disproportionately experience anxiety, depression, self‑harm and other mental health challenges, yet they often face long waiting times, under‑resourced services and non‑affirming environments when trying to access support. Many fear that disclosing personal information will expose them to stigma or unwanted attention, including the possibility of being ‘outed’. The stress of navigating these risks frequently leads to young people disengaging from services entirely.

Taken together, these experiences show that LGBTQ+ children and young people encounter challenges that go beyond the routine steps involved in accessing health and care services.

[1] NHS Nottingham and Nottinghamshire JFP

[2] Mental Health of Children and Young People in England, 2023 – wave 4 follow up to the 2017 survey – NHS England Digital

[3] Children’s Commissioner responds to new figures on children referred to mental health support for anxiety | Children’s Commissioner for England

[4] Mental Health of Children and Young People in England, 2023 – wave 4 follow up to the 2017 survey – NHS England Digital

[5] Emotional and mental health needs of children and young people aged 0 – 25 years (2022) – Nottingham Insight

[6] Emotional and Mental Health of Children and Young People (2021) – Nottinghamshire Insight

[7] 2024 United kingdom Survey on the Mental Health of LGBTQ+ Young People

[8] Self-harm and suicide by sexual orientation, England and Wales – Office for National Statistics

[9] Hidden Figures: LGBT Health Inequalities in the UK

4.3 Current service provision

NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) commission services across Nottingham and Nottinghamshire that contribute to the local children and young people’s (CYP) emotional health and wellbeing (EHW) early support pathway. In October 2025 a review took place of the ICB-commissioned EHW services which provide a range of evidence-based clinical treatments including counselling, Cognitive Behavioural Therapy (CBT) and group intervention.

There are five emotional health and wellbeing services:

Be U Notts is an early interventions service for children and young people who experience mild to moderate mental health and emotional wellbeing needs, for ages 0–25 in Nottingham City and Nottinghamshire excluding Bassetlaw.
Talkzone offers counselling and mental health support for ages 11-25 in Bassetlaw.
Kooth (ages 11–25 in Bassetlaw) is a free and anonymous space for young people to find online support and counselling.
Mental Health Support Teams in Schools for ages 5–18 in Nottingham City and Nottinghamshire.
Targeted Child and Adolescent Mental Health Services support for under 18s in Nottingham City.

A recommendation from this review was that services prioritise the needs of inclusion cohorts, beginning with LGBTQ+ children and young people as a key focus from 2026. Plans include upskilling staff who work in core EHW services so that practitioners have the competencies required to provide culturally competent, inclusive and responsive care.

This approach will enable greater access to evidence-based treatment for children and young people across Nottingham and Nottinghamshire and will support the delivery of equitable, high-quality mental health support aligned with national priorities and statutory equality commitments.

Prior to the listening exercise commencing, the Engagement Team met and discussed this work with the ICB Staff LGBQT+ Network to provide guidance, help and support. We also met with the network to share this work, receive feedback on the survey and it provided an opportunity to raise any feedback. The network also shared the listening exercise opportunities with colleagues, provided feedback on our communications and engagement plan and also had sight of our stakeholder mapping. We would like to acknowledge and thank the network for their support. The engagement team will also be returning to the network’s meeting in March to provide feedback.

4.4 Engagement aims and objectives

The aim of this listening exercise was to gather meaningful feedback and insights from LGBTQ+ children and young people aged 11–25 to inform future service improvements. This can be broken down into the following areas of focus:

a) Access to services
• Understand whether young people have accessed services and the timeframes involved.
• Explore how self-referral and monitoring forms can be made inclusive and accessible for LGBTQ+ young people.
• Identify best practices for representing gender identity, sexual orientation, preferred names and pronouns appropriately on forms.

b) Service environments
• Determine what factors help LGBTQ+ children and young people feel safe, accepted, and supported when accessing services (e.g., inclusive approaches, visible signs, symbols, or resources).

c) Experiences of care
• Capture both positive and negative experiences to inform service improvements, staff training, and best practice development.

d) Additional feedback
• Gather any further comments or suggestions related to access, environment, and experiences.

The insights gathered through this listening exercise will inform the recommendations set out in this report, which will be used to embed inclusive and responsive care in health and wellbeing services for children and young people living in Nottingham and Nottinghamshire.

5 Methods

The listening exercise commenced on 5 January and concluded on 2 February 2026.

The ICB Engagement Team specifically wanted to hear from children and young people who identify as LGBTQ+. A range of different methods were used to listen to individuals to understand their views.

All engagement activity was undertaken in line with our statutory duties and with the Gunning Principles, which are that:

Engagement must be a time when proposals are still at a formative stage.
The proposer must give enough reasons for any proposal to permit intelligent consideration and response.
Adequate time is given for consideration and response.
The product of engagement is conscientiously taken into account when finalising the decision.

To ensure meaningful engagement with patients and the public, we:

Tailored our methods and approaches to specific audiences as required and make all public information accessible, in line with the Accessible Information Standard.
Worked with our Staff LGBTQ+ Network to ensure our questions and information were relevant and correct for the cohort of communities.
Worked with children and young people to test the survey prior to launching the listening exercise.
Offered accessible formats, including translated versions relevant to the audiences we wanted to engage with.
Identified and used the best ways of reaching the largest amount of people and provided opportunities for underserved groups to participate.
Produced a poster to promote the engagement opportunities.
Undertook equality monitoring of participants to review the representativeness of participants and adapted activity as required.
Used different virtual/digital methods or direct and 1 – 1 telephone activity to reach certain communities where we become aware of any under representation.
Ensured stakeholder mapping considers underserved communities and smaller communities.
Attended relevant groups where and when necessary.
Ensured that any meetings that were held have meeting notes recorded including a record of comments and questions.
Provided language interpreters (including BSL) at meetings and common language translations where necessary and on request.
Included equality monitoring data on surveys and feedback forms.
Included information in our Staff Newsletter and intranet.
Requested System Partners share information in their relevant newsletters and social media platforms.

A comprehensive activity and impact log was produced to evidence all communication and engagement activity during the engagement period.

Adjustment to our approach during the listening exercise
Following feedback from professionals working with children and young people who identify as LGBTQ+, it became clear that some young people were hesitant to engage. In response, the Engagement Team made additional efforts to reach out to Youth Workers and specific groups, reiterating the offer to attend sessions within their own settings to ensure young people could participate in an environment where they felt most comfortable.

Negative social media comments were noted on Facebook at the start of the listening exercise. As a response to this, on the advice of the ICB’s Staff LGBTQ+ Network, the facebook post was removed and shared via the Bluesky platform instead.

In total, 41 individuals shared their views:

29 people completed the survey.
2 people attended online focus groups.
9 people attended an in-person focus group.
1 telephone conversation

One response received has not been included in the analysis as it appeared to be malicious.

5.1 Survey

An online survey was developed and reviewed by the Nottingham and Nottinghamshire ICB LGBTQ+ Staff Network (see Appendix 1). Before launching the listening exercise, the survey was also tested by a small group of children and young people. Alternative versions and formats of the survey, including in languages other than English, were available upon request.

The invitation to be involved in the listening exercise was shared electronically with organisations and contacts who directly support this community or have an interest in their health/care needs (see Appendix 2).

One response received has not been included in the analysis as it appeared to be malicious.

5.2 Focus Groups

An open invitation to visit community groups and forums to facilitate focus groups and gather feedback was communicated via the launch email and included within the survey introduction (see Appendix 3).

5.3 Engagement Practitioners Forum

The Engagement Team presented details of the listening exercise to the Engagement Practitioners Forum, a space where system partners working with people and communities collaborate, share resources, knowledge and expertise. The listening exercise was shared with the forum for awareness and onward sharing to their networks and communication channels.

5.4 ICB Staff LGBQT+ Network

The ICB Engagement Team met with the ICB Staff LGBQT+ Network to share details of the listening exercise and our approaches and to also receive feedback on the survey. A return visit is planned in March to share the insights and recommendations of the listening exercise.

5.5 Ongoing engagement activity with Children and Young People

The ICB Engagement Team are regular contributors to Shadow, an overnight orienteering event that offers a valuable opportunity to engage with young people. Activities such as bingo, giant boardgames and a feedback board enable meaningful interactions with 350 young people aged 3–19 (aged 24 for Special Educational Needs (SEN) participants).

The Nottinghamshire County Show is also attended annually as part of the ICB Engagement Team’s ongoing engagement work, providing further opportunities to hear about and understand the experiences of children and young people accessing health and care services.

During this listening exercise, new relationships have formed with partners who support children and young people, which will further strengthen collaboration and add value to future work.

5.6 Data analysis and reporting

Written notes taken from focus groups, interviews and qualitative responses from the survey data were thematically analysed. Quantitative data was analysed to produce descriptive statistics.

6 Survey demographics

7 Findings

This section presents the analysis from the responses received through the survey, online interview, online focus groups, and in person focus group. The statistics presented in this report are related to the quantitative data collected in the survey and the themes were developed from the qualitative data.

7.1 Theme 1: Inclusivity of services, representing people who identify as LGBTQ+ on forms and within services

Completing forms

The table below shows in order most to least what respondents feel would demonstrate that they are understood and respected when completing forms. Including pronouns on forms was most important indicated by 14% (n = 11) of respondents. 13% (n = 10) survey respondents indicated that inclusive language was important. A prefer not to say option on sensitive questions was selected by 11% (n = 9) respondents. Being able to skip questions and space to self-describe was equally indicated by 10% (n = 8) respondents. Not being forced to pick labels that don’t fit, was important to 9% (n = 7). A clear promise that answers are private was selected by 8% (n = 6). A message saying everyone is welcome was indicated as important by 8% (n = 6). 6% (n = 5) selected, I can write my own answer if the options don’t fit. 5% (n = 4) would like LGBTQ+ symbols on forms for example a rainbow flag. 3% (n = 2) would like pictures that show different kinds of people and families included on forms and 1% (n = 1) would like to see pronouns included on forms.

“Other” answers indicated by 4% (n = 3) stated additional points, firstly explaining why people are being asked to complete certain fields on forms could help people to understand why the information is needed. Making it clear that answers are kept confidential may encourage more people to answer the questions. When referring to gender it was recommended to ask if a person’s gender matches the gender assigned at birth rather than referring to “biological” sex. It was suggested to also include a question on the form that asks if an individual identifies as LGBTQ+ or not.

Table 1. Lists what is important to be include on forms when asking for help to ensure that people who identify as LGBT+ feel understood and respected. (n = 25)

Response	%	Number of respondents
Include preferred pronouns on forms	14%	11
Inclusive language (no assumptions about gender identity or sexuality)	13%	10
Prefer not to say option on sensitive questions	11%	9
I can skip questions I don’t want to answer	10%	8
Space to describe myself in my own words	10%	8
Not being forced to pick labels that don’t fit me	9%	7
Clear promise that my answers are private	8%	6
A message saying everyone is welcome	8%	6
I can write my own answer if the options don’t fit	6%	5
LGBTQ+ symbols on the form for example a rainbow flag	5%	4
Other	4%	3
Pictures that show different kinds of people and families	3%	2
Include preferred pronouns on forms	1%	1

Including sexual orientation on forms

The table below shows the preferences for how sexual orientation could be asked about on forms. 68% (n = 17) would prefer a free text box to write preferences. 28% (n = 7) preferred a list of options for example, girl/woman, boy/man, trans woman, trans man, intersex, nonbinary, 4% (n = 1) preferred not to say.

Table 2. Shows the preferences for how sexual orientation could be asked about on forms (n=25)

Response	%	Number of respondents
Option 2 – A free text box to write your preference	52%	13
Option 1 – A list for example: Asexual, bisexual, gay, heterosexual/straight, lesbian/gay woman, pansexual?	36%	9
Other	8%	2
Prefer not to say	4%	1

“Other” comments explained that by providing a list demonstrated that LGBTQ+ identities were accepted, whereas a free text box might leave someone unsure. Conversely, another commented that a free text box is preferred and that it would be okay for professionals to ask, if they were unfamiliar with the terminology.

Including gender identity on forms

The table below shows respondents preferences for how gender identity could be asked about on forms. 68% (n =17) indicated a preference a free text box to describe their gender identity.

Table 3 showing how people would like gender identity to be asked about on forms (n= 25)

Response	%	Number of respondents
Option 2 – A free text box to write your preference	68%	17
Option1 – Girl/woman, Boy/man, Trans woman, Trans man, Intersex, Nonbinary	28%	7
Prefer not to say	4%	1

Including pronouns or title on forms

The table below shows whether respondents would prefer to share their pronouns or title when completing forms. Nearly three quarters of respondents 68% (n = 17) preferred to share their pronoun, while just over one quarter 20% (n = 5) preferred to share for their title with “other” comments making up 12% (n = 3). Two comments stated that a title does not always match the pronoun and that including both options could be more inclusive.

Table 4 showing whether respondents would prefer to share their pronouns or title when completing forms (n=25).

Response	%	Number of respondents
Your pronoun? A pronoun is a word used to describe ourselves and other people, he/him, she/her they/them, he/they/ she/they	68%	17
Your title? A title is used to indicate gender identity or marital status, Mr, Mrs, Miss, MX	20%	5
Other	12%	3

Several service users reported being misgendered by healthcare professionals, even after providing clear information about their identity. Examples included being referred to with incorrect pronouns, being labelled inaccurately in written communication, and being addressed in ways that contradicted their gender identity. For some, this repeated misgendering felt intentional or malicious, significantly undermining trust and engagement with services.

How to make services more welcoming for children and young people who identify as LGBTQ+

The table below presents the options respondents would like to see included in health and wellbeing services to help children and people who identify as LGBTQ+ to feel comfortable. Staff being trained in LGBT+ awareness was a top priority for 16% (n = 2) respondents. Gender neutral toilets were preferred by 14% (n = 10) respondents and staff showing that they are LGBTQ+ allies by wearing rainbow lanyards and badges was indicated as important by 12% (n = 9) respondents. Being asked which pronoun is preferred, friendly staff and having a safe place to talk to someone all were all indicated as important by 11% (n = 8) respondents. 7% (n= 5) of respondents selected different support options, being met by or introduced to peers and including LGBTQ+ symbols on letters and paperwork, for example a rainbow flag. Don’t know and other was selected by 3% (n = 2) each.

Table 5. Presenting the options that can make it easier for children and young people who identify as LGBTQ+ to feel comfortable accessing health and wellbeing services (n = 25)

Response	%	Number of respondents
Staff being trained in LGBTQ+ awareness	16%	12
Gender neutral toilets available	14%	10
Staff showing that they are LGBTQ+ allies by wearing rainbow lanyards and badges.	12%	9
Being asked which pronoun you prefer	11%	8
Friendly staff	11%	8
Having a safe place to talk to someone	11%	8
Different support options	7%	5
Being met by or introduced to peers	7%	5
LGBTQ+ symbols on letters and paperwork for example a rainbow flag	7%	5
Don’t know	3%	2
Other	3%	2

“Other” comments stated additional points, that it was important not to make people feel different and that the suggestion of symbols such as the rainbow flag to be used by services was offensive. It was stated that there is greater feeling of safety and not being judged by LGBT+ specific services and that more need to be made available. In addition, making LGBT+ awareness training essential/mandatory for staff. A further point to this was that LGBTQ+ training can help to a degree; however, individuals may still harbour their own views or not fully understand LGBTQ+ identities. Peer support and dedicated spaces provided by people with a true understanding of the terminology, issues and experiences of the LGBTQ+ community were preferred.

Positive experiences of accessing health and wellbeing services as an LGBTQ+ young person

Service users reported positive interactions with professionals who demonstrated a respectful approach to gender identity. Respondents commented they took time to explain the medical aspects of transition and supported informed consent. Language was adapted sensitively based on individual comfort, with staff changing terminology when requested and responding without judgement.

Several individuals noted meaningful experiences where clinicians listened to their needs and made appropriate adjustments to their care. For example, one person described a significant moment when a doctor readily agreed to change their contraceptive prescription based on their preferences regarding hormone levels, helping them feel respected and deserving of appropriate healthcare.

7.2 Theme 2: Lack of Understanding and Awareness of LGBTQ+ Identities

Feedback highlighted that many healthcare professionals lack adequate understanding of LGBTQ+ identities and experiences. Some individuals had never been asked about their identity, while others felt that staff appeared unfamiliar or unprepared to support LGBTQ+ patients. This contributed to feelings of being judged, misunderstood, or treated differently compared to other service users.

It was clear from the feedback of the survey and focus group sessions that staff need to be trained in understanding the health and wellbeing needs of children and young people who identify as LGBTQ+, as well as having sufficient knowledge and understanding of those communities.

For some service users, repeated negative experiences directly contributed to mental health deterioration, including feelings of hopelessness and suicidal ideation. Service users emphasised that inadequate LGBTQ+ awareness among healthcare staff can have life‑threatening consequences and is an area that requires urgent improvement. Several service users reported being misgendered by healthcare professionals, even after providing clear information about their identity. Examples included being referred to with incorrect pronouns, being labelled inaccurately in written communication, and being addressed in ways that contradicted their gender identity. For some, this repeated misgendering felt intentional or malicious, significantly undermining trust and engagement with services.

“We need to be accepted for who we are, no pressure to change. Should know names and pronouns to address us and avoid making jokes or assumptions. We should be able to feel free, not feel bullied, not receive harassment or discrimination”

7.3 Theme 3: Waiting Times and Referral Pathways

It was noted that waiting times are lengthy for patients with some taking the option to pay privately to seek the treatment needed. There was also a lack of understanding from healthcare professionals as to where to refer patients to so that they could obtain help and support.

7.4 Theme 4: LGBT+ Service Nottinghamshire

The table below shows how many survey respondents have used LGBT+ Service Nottinghamshire either currently or in the past. Just over half, 52% (n = 12), had not used the service. Around a third, 35% (n = 8), were currently using it. A further 9% (n = 2) have used the service but not in the last three months and 4% (n = 1) had used it previously but within the last 2 years.

Table 6 shows how many respondents to the survey have accessed LGBT+ Service Nottinghamshire (n = 23)

Response	%	Number of respondents
No	52%	12
Yes, I currently use the service	35%	8
Yes, but I have not used the service in the last 3 months	9%	2
Yes, but I have not used the service in the last 2 years	4%	1

Despite negative experiences elsewhere, service users expressed strong appreciation for specialist LGBTQ+ support services such as The Centre Place Worksop. These services were described as understanding, non‑judgemental, and able to offer support that other organisations could not. Individuals who had engaged with multiple services felt that mainstream providers were often less equipped to meet their needs.

Service users consistently highlighted positive experiences with local LGBT+ support services. Participants expressed strong appreciation for the one‑to‑one support available, describing the service as highly valued. Young people in particular reported finding sessions at Centre Place helpful and supportive.

Feedback emphasised that staff at Centre Place were welcoming and provided high‑quality support. The environment was described as safe, contributing to strong engagement and positive ongoing relationships with the service.

Service users stated that there are no comparable local services offering this level of specialist support. Centre Place was seen as a vital resource for LGBTQ+ communities, with other areas (e.g., Coventry) reaching out to seek guidance or partnership.

In addition to face‑to‑face support, service users noted that online support is available for times when individuals cannot attend in person. This flexibility was appreciated and ensured continuity of care.

Staff at Centre Place highlighted that referrals can be made by GPs and other professionals, although many people choose to self‑refer. This accessibility contributes to the service being approachable and easy to engage with.

“They changed my life I was in such a bad place and hated myself and everything about me helped me understand who I am and only when I’d done that could I start to get better. This is the least judgmental and most supportive place I’ve have ever been. I know I wouldn’t be here today if they hadn’t helped me, they saved my life! I went every week for 8 months and am a changed person now and I don’t need that weekly support anymore”

7.4.1 Professionals referring to or receiving training from LGBT+ Services Nottinghamshire

When asked if professionals had received training from LGBT+ Service Nottinghamshire, 3 people responded to the question, of those 2 had not received training from LGBT+ Service and 1 did not know.

As indicated by respondents, one professional is currently referring to LGBT+ Service Nottinghamshire. One has referred previously but not used the service in the last 6 months and one has not referred children or young people to the service.

8 Acknowledgements

9 Appendices

9.1 Appendix 1: Survey questions

Introduction

NHS Nottingham and Nottinghamshire is carrying out a listening exercise to hear the experiences of children and young people who identify as LGBTQ+ and those who support them (for example a parent, teacher, professional, youth worker) in accessing emotional health and wellbeing services.

NHS Nottingham and Nottinghamshire would like to hear from you!

If you’re aged 11 to 25 and identify as LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, non-binary and those who are exploring gender identity and sexual orientation), we want to know about your experiences of emotional health and wellbeing services. These services are delivered in line with the THRIVE framework and principles, and form part of the ‘getting advice’ and ‘getting help’ categories of the framework.

We want your feedback on:

Your current experiences of health and wellbeing services as an LGBTQ+ person: what is working well for you and what could be better?
What can health and wellbeing services do so that LGBTQ+ children and young people feel comfortable, safe and accepted?
Current experiences of referring into health and wellbeing services on behalf of children and young people who identify as LGBTQ+: what is working well and what could be improved?

Your feedback will help us improve support for you and others.

How to get involved

Fill in this this survey
Join an online focus group (Focus Groups are for Children and Young People)
If you are a professional or carer and would be interested in attending an online focus group, please email (our inbox) we can then schedule a date in the diary.
Or, if you’d like someone from our team to visit your community group or network to hear your feedback, please get in touch using the contact details below.
If you would you like to speak to the Engagement Team in private to share your thoughts or feedback email us at nnicbnn.engagement@nhs.net or call or text 07818 584 419.

Will my taking part be kept confidential?

Yes, your answers will be kept private. Some questions let you write freely – please don’t include your name, address, or anything that could identify you. We will record your answers, but they will be anonymous, so no one will know they are yours.

You can read more in our privacy policy visit https://notts.icb.nhs.uk/privacy-policy/.

If you have any concerns about completing this survey, please discuss with your parents or legal guardians. For more information about this engagement, please email nnccg.team.engagement@nhs.net or call or text 07818 584 419.

Need the survey in another format or language?

If you need a paper copy or the survey in a different format or language, please email nnicb-nn.engagement@nhs.net, or call 07818 584 419 to request a copy.

Completing the survey

You don’t have to answer every question.
Your answers are not shared individually – they are only used to help improve services.

We use the term LGBTQ+ to mean people who identify as Lesbian, Gay, Bisexual, Transgender, non-binary, genderfluid and those who are exploring gender identity and sexual orientation.

The survey is open from 6 January 2026 and will close on the 30 January 2026 at 11.59pm

We will collect all the feedback from this survey and other activities and make a report. This report will be shared on our website: Current and Previous Engagement & Consultations

About You

1. Which of the following best describes you? (Please tick all that apply)

I am a child or young person
I am a parent or carer
I am a leader of a support group/ forum for LGBTQ+ young people
I am a professional referring into/received support from LGBTQ+ Services
I am filling in this form on behalf of an LGBTQ+ person
Other, please state ______________________________

Filling in forms to ask for help

Sometimes if you need to ask for help with your health and wellbeing, you may need to fill in a form yourself. This is called a self-referral form. For the next few questions, we’d like you to answer some questions about this. Don’t worry if you’ve never filled in a form like this before.

2. When you fill in a form to ask for help, what could be included that would help you feel that who you are as an LGBT+ person is understood and respected? You can share your own ideas too.

Include a preferred pronoun on forms? A pronoun is a word used to describe ourselves and other people, he/him, she/her they/ them he/they, she/they
LGBTQ+ symbols on the form for example a rainbow flag
Prefer not to say” option on sensitive questions
I can skip questions I don’t want to answer
Not being forced to pick labels that don’t fit me
I can write my own answer if the options don’t fit
Inclusive language (no assumptions about gender identity or sexuality)
Space to describe myself in my own words
Pictures that show different kinds of people and families
A message saying everyone is welcome
Clear promise that my answers are private
Don’t know
Please write your suggestion here, if you have one_______________

3. Which option would you prefer when filling in a form? Pronoun or title?

Your pronoun? -A pronoun is a word used to describe ourselves and other people, he/him, she/her they/ them, he/they/ she/they
Your title? A title is used to indicate gender identity or marital status, Mr, Mrs, Miss, MX

4. How would you prefer gender identity to be asked about on self-referral forms?

Option 1 – A list for example:

Girl/woman
Boy/man
Trans woman (A person assigned male at birth and identifies as female)

Trans man (A person assigned female at birth and identifies as male)
Intersex (A person born with natural variations that do not fit doctors expectations of male or female body)
Nonbinary (An umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’
Other, you can specify if you wish _________________________
Prefer not to say

Option 2 – A free text box to write your preference

5. How would you prefer sexual orientation to be asked about on forms?

Option 1 – A list for example:
Asexual
Bisexual
Gay
Heterosexual/ Straight
Lesbian/ Gay Woman
Pansexual
Other, please state______
Prefer not to say

Option 2 – A free text box to write your preference

Getting help from health and wellbeing services

6. What can make it easier for children and young people who identify as LGBT+ to feel comfortable when accessing health and wellbeing support/services (you can tick as many boxes as you like)

LGBT+ symbols on letters and paperwork for example a rainbow flag
Friendly staff
Staff showing that they are LGBTQ+ allies by wearing rainbow lanyards and badges. (An ally is someone who supports and stands up for people who might be treated unfairly)
Staff being trained in LGBTQ+ awareness
Gender neutral toilets available
Being asked which pronoun you prefer
Different support options
Having a safe place to talk to someone
Being met by or introduced to peers
Don’t know
Other (please state)______________

About your experiences

LGBT+ Service Nottinghamshire

LGBT+ Service Nottinghamshire provide support services to LGBT+ young people aged 11-25 and their families. Support includes group support sessions, counselling and outreach sessions, support for parents and professionals. Services are also provided for professionals, including consultancy, specialist training and development of skills and knowledge.

7. Have you used any of the LGBT+ Services Nottinghamshire?

Yes, I currently use the service
Yes, but I have not used the service in the last 3 months
Yes, but I have not used the service in the last 6 months
Yes, but I have not used the service in the last 12 months
Yes, but I have not used the service in the last 2 years
No

8. If you have recently stopped using LGBT+ Services Nottinghamshire, could you tell us the reason?

Other services and support you may have accessed

9. If you have used any other services or support for your health and wellbeing and would like to tell us about this, please write your answer in the box below.

10. If you’ve had a positive experience of being supported by health and care services as an LGBTQ+ person, please tell us about it in the box below.

11. If you’ve had a negative experience of being supported by health and care services as an LGBTQ+ person, please tell us about it in the box below.

12. If there is anything else you would like to share, please tell us about this in the box below.

Questions for professionals

LGBT+ Service Nottinghamshire

LGBT+ Service Nottinghamshire provide support services to LGBT+ young people aged 11-25 and their families. Support includes group support sessions, counselling and outreach sessions, support for parents and professionals. Services are also provided for professionals, including consultancy, specialist training and development of skills and knowledge.

13. Have you referred children or young people to LGBT+ Services Nottinghamshire?

• Yes, I currently refer into the service
• Yes, but I have not used the service in the last 3 months
• Yes, but I have not used the service in the last 6 months
• Yes, but I have not used the service in the last 12 months
• Yes, but I have not used the service in the last 2 years
• No

14. If you have referred children or young people to the LGBT+ Services Nottinghamshire, please tell us about your experience in the box below.

15. If you have recently stopped referring into LGBT+ Services Nottinghamshire, could you tell us the reason?

16. Have you received training from Services LGBT+ Services Nottinghamshire?

• Yes
• No
• Don’t know
• Prefer not to say

17. If there is anything else you would like to share, please tell us about this in the box below.

Demographics

Answering these questions help us to ensure we are hearing from a wide group of people and will allow us to see where the gaps in our knowledge are.

Equality and diversity monitoring questions

18. Is it ok if we ask a few extra questions about yourself?

Yes
No

19. Which of these, best describes your gender identity?

Girl/woman
Boy/man
Trans man (A person assigned female at birth and identifies as male)
Trans woman (A person assigned male at birth and identifies as female)
Intersex ((A person born with natural variations in their chromosomes, hormones or genitals that do not fit typical definitions of male or female)
Nonbinary (An umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’)
Other, you can specify if you wish _____________________
Prefer not to say

20. Is the gender you feel you are now the same as the gender you were given when you were born?

Yes
No
Prefer not to say

21. Which of these, best describes your sexual orientation?

Asexual
Bisexual
Gay
Heterosexual/ Straight
Lesbian/ Gay Woman
Pansexual
Other , please state______
Prefer not to say

22. Which of these, best describes your ethnicity?

A White

English, Welsh, Scottish, Northern Irish, or British
Irish
Gypsy or Irish Traveller
Roma
Any other white background, please state ______

B Mixed or Multiple ethnic groups

White and Black Caribbean
White and Black African
White and Asian
Any other mixed or multiple background, please state __________

C Asian or Asian British

Indian
Pakistani
Bangladeshi
Chinese

Any other Asian background, please state ________

D Black, Black British, Caribbean or African

Caribbean
African background, please state ____________
Any other Black, Black British or Caribbean, write in
E Other ethnic group
Arab

Any other ethnic group, please state _____________

23. Which of these, best describes your religion or belief?

No religion
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Other religion, please state __________
Prefer not to say

24. Do you have have a health condition or disability that makes daily activities more difficult for you?

I don’t have a disability, health condition or learning difference
I have a health condition that lasts a long time (like diabetes epilepsy, cancer, HIV, heart disease)
I have a mental health difficulty like depression, or anxiety disorder
I have a physical difficulty like finding it hard to move around or needing a wheelchair or crutches
I have a learning difficulty, dyslexia, dyspraxia, ADD or ADHD
I am Blind or can’t see well even with glasses
I am Deaf or can’t hear well
I have difficulty with talking or understanding language, autistic spectrum disorder or Aspergers
I have a health condition, learning difference, or something else that isn’t listed above (you can tell us if you wish).
Prefer not to say

25. Are you a carer?

Yes, a paid carer
Yes, a carer providing unpaid support
No, I am not a carer
Prefer not to say

26. How old were you on your last birthday?

27. Where do you live in Nottingham or Nottinghamshire?

Nottingham City (this includes, Hyson Green, Bulwell, Basford, Aspley, The Meadows, Clifton, Wollaton, Mapperley, St Anns, Berridge, Bestwood, Bilborough, Dales, Arboretum, Leen Valley, Lenton, Radford, Sherwood)

Ashfield District Council (this includes Sutton-in-Ashfield, Kirkby-in-Ashfield, Hucknall, Annesley, Selston, Jacksdale, Underwood, Teversal and Skegby)

Bassetlaw District Council (this includes Worksop, Retford, Tuxford, Harworth Bircotes etc)

Broxtowe Borough Council (this includes Beeston, Stapleford, Eastwood, Kimberley, Chilwell, Toton, Attenborough, Bramcote, Nuthall)

Gedling Borough Council (this includes Arnold, Carlton, Mapperley, Colwick, Burton Joyce, Calverton, Ravenshead)

Mansfield District Council (this includes Mansfield Woodhouse, Forest Town, Pleasley, Warsop

Newark and Sherwood District Council (this includes Blidworth, Rainworth, Bilsthorpe, Clipstone, Ollerton, Farnsfield)

Rushcliffe Borough Council (this includes West Bridgeford, Bingham, Cotgrave, Radcliffe-on-Trent, Ruddington)

Prefer not to say
Other

28. How did you hear about this work?

Social media
Community group
Nottingham and Nottinghamshire Citizens Panel
A friend or relative
Through my work

Thank you for taking the time to fill out this survey

9.2 Appendix 2: Engagement log

Date	Description	Audience
December until end of listening exercise	Extensive stakeholder mapping exercise undertaken	Stakeholders
19 December 2026	Survey review and meeting	Staff LGBTQ+ network
19 December 2026	Survey review	Young people
5 January 2026	Launch e-mail	Full stakeholder list
07 January 2026	Social media posts	Citizens
07 January 2026	TeamNet	Primary care staff
07 January 2026	Intranet	ICB Staff
07 January2026	Children and Young People Services at Nottinghamshire County Council	County Council Staff
07 January 2026	NHS Nottingham and Nottinghamshire Website	Public
07 January 2026	Launch e-mail	VCSE Alliance
07 January	Launch e-mail	Engagement Practitioners Forum
08 January 2026	Launch e-mail	Intranet
08 January 2026	Launch e-mail	BCVS
09 January 2026	Launch e-mail	Shared by Ashfield DC
08 January 2026	Launch e-mail	Citizens’ Panel
09 January 2026	Launch e-mail	Shared by Rushcliffe Borough Council
13 January 2026	Attended LGBTQ+ Staff Network	Staff LGBTQ+ network
13 January 2026	ICB stakeholder communications e-mail	ICB Stakeholders
14 January 2026	Newsletter	ICB Staff news
15 January 2025	Presentation	Engagement Practitioners Forum
15 January 2025	Newsletter	Coxmoor residents
15 January 2025	Ashfield CYP update	Coxmoor residents
15 January 2026	Launch e-mail	Chilwell School Governor
15 January 2026	Launch e-mail	Equality, diversity & Inclusion lead at Fernwood School
15 January 2026	Newsletter	ICB DLN cluster staff
16 January 2026	Mid Notts Snippets	Mansfield residents
16 January 2026	ICB January Stakeholder Update	Citizens
20 January	Focus Group	Children and young people
21 January 2026	2^nd e-mail	Full stakeholder list
21 January 2026	E-mail	Virtual schools
21 January	E-mail	Secondary schools
21 January	E-mail	Education Welfare Services
22 January 2026	E-mail	Youth Forums and LGBT+ community groups, to arrange focus group
22 January 2026	E-mail	Youth workers to arrange focus groups
22 January 2026	E-mail	Base 51 to arrange focus groups
22 January 2026	E-mail	Youth Council
23 January 2026	WhatsApp post	Citizens
23 January 2026	E-mail	Nottinghamshire County Council parents & carers coffee morning
23 January 2026	E-mail	Family Hubs
23 January 2026	E-mail	LGBT+ Society UoNSU
23 January 2026	E-mail	Nottinghamshire County Council Youth Service
23 January 2026	Meeting	Nottinghamshire County Council youth service and SEND officer
23 January 2026	E-mailed Winners Gym	Staff/customers
26 January 2026	Phone call	LGBTQ+ Survivor network
26 January 2026	Launch e-mail	Youth Services
26 January 2026	Phone Call	Base 51
26 January 2026	E-mail	Base 51
26 January 2026	Phone call	Parent feedback
27 January	Focus group	Children and young people
28 January 2026	Social media	Instagram and LinkedIn
28 January	Focus group with the Centre Place	Children & young people
29 January 2026	E-mail	Pride shop

9.3 Appendix 3: Focus group questions

If you have used LGBT+ service Nottinghamshire, please tell us about your positive experiences. What did you like?
Is there anything you didn’t like?
If you’ve had a positive experience of being supported by other health and care services as an LGBTQ+ person, please tell us about this, if you would like to. What did you like?
Is there anything you didn’t like? Please tell us about this if you would like to.
What do you think is important to be included in healthcare services to ensure people who identify as LGBTQ+ feel included and respected?
What can make it easier for children and young people who identify as LGBTQ+ to feel comfortable when accessing health and wellbeing support/services? Here are some examples, we want to hear your ideas too:

Symbols letters on paperwork,
Staff showing that they are LGBTQ+ allies (An ally is someone who supports and stands up for people who might be treated unfairly)
Staff being trained in LGBTQ+ awareness
Being asked which pronoun you prefer
Having a space to talk to someone
Being met by or introduced to peers