Abstract:
Considerable research points to an elevated prevalence of mental health problems and
suicide for men who have sex with men (MSM). Yet there is little research on how public
mental health services (PMHS) does, or could, address the needs of MSM. When such
literature does appear, a common suggestion is that queer staff will be necessary to improve
PMHS for MSM through a process of ‘matching’. Yet, no research has specifically explored
the views of queer staff or MSM clients on this. Further, a positivist trend within the
existing literature contains individualising and essentialising assumptions that limit our
understanding of relationships between MSM and PMHS. Adopting a critical social
constructionist perspective, I argue that Foucauldian theory and its analysis of the
relationships between discourses, power, and subjectivity, enables research to focus on the
social and structural processes constructing mental health care for MSM. This thesis
explores the discursive construction of the relationships between MSM and PMHS, and the
implications of this for practice.
My analysis begins by explicating commonly circulating discourses of homosexuality, and
of mental health, in New Zealand. These discourses are evidenced in (but not limited to)
academic literature, governmental documents, and queer and mainstream media. They
provide a framework for the analysis of interviews with 12 queer staff and 13 MSM clients
of PMHS. The analyses illustrate the multiple discourses informing the MSM’s
subjectivities as homosexuals and show the predominant discourses they draw on to
account for their mental health problems. I suggest the term ‘homonegative trauma’ to
denote this. Analyses of the staff and clients’ accounts around the ‘disclosure’ of
homosexuality within PMHS reveal discursive power relations which restrain staff, and
some clients, from acknowledging homosexuality.
I consider two strategies for disrupting this heteronormative silence within PMHS. I
contend that the notion of ‘matching’ queer clients and staff is a minoritising one, with
limited ability to counter heteronormativity. In contrast, a universalising approach requires
all staff to initiate conversations with all clients about sexuality. Making a comparison
between staff inquiring about sexuality, and the currently recommended practice of staff
asking about sexual abuse, I argue that this analogy provides useful resources to support
such a universalising move.
I conclude by arguing for systemic and structural changes in PMHS to support staff to
routinely enquire about sexuality. If done with an awareness of the discursive complexity
involved, such a shift has the potential to disrupt heteronormative practices within PMHS.
My analysis suggests that the power of the medical discourse in particular, will be a
significant restraint to such a change. However, if heteronormative practices within PMHS
remain unchallenged they will continue to silence some MSM clients, thereby, maintaining
the homonegative trauma described by most of the MSM clients interviewed. This would
reproduce a tendency within the medical discourse to focus on individual pathology and to
evade the ways in which social marginalisation and oppression can be constructive of
mental health problems.