Addressing the Flaws in our Mental Healthcare System Could Save Young LGBTQ Lives

To say that the past year has been challenging is an understatement. The pandemic completely uprooted people’s lives and left many grappling with more fear and uncertainty than ever before—bringing conversations around mental health to the national stage. Yet, marginalized groups who have long faced disparities in the mental healthcare system like LGBTQ youth —especially those who are transgender and people of color—are still too often left out of the conversation.

It was recently reported that overall suicides in the U.S. declined in 2020, but preliminary studies suggest these rates may have actually increased among people of color. LGBTQ youth also face disparities in mental health outcomes. According to new research from The Trevor Project, the suicide prevention and crisis intervention organization for LGBTQ youth that I lead, 42% of LGBTQ youth, including more than half of transgender and nonbinary youth, seriously considered attempting suicide in the past year, and that percentage only increases for youth of color. Yet, nearly half of all LGBTQ youth could not access the mental health care they desired.

There are very real, tangible steps we can take to end the mental health crisis among LGBTQ youth, but in order to get there, we need to implement stronger, intersectional data collection and use it as a basis to spark structural change across our mental healthcare system.

How can we identify and meet the needs of LGBTQ youth if we don’t have data that illuminates the true state of their mental health and suicide risk? The fact is very little research exists on LGBTQ youth, and the research that does exist has historically conflated all LGBTQ people, examining their experiences as one homogenous group. By taking an intersectional approach to data collection and uncoupling various groups within the community we can see data in a more meaningful and productive way. This ultimately helps us better understand the distinct experiences of LGBTQ people with different backgrounds, sexual orientations, gender identities, cultures, races, and ethnicities.

In an effort to establish this more sophisticated research, The Trevor Project recently conducted its third annual National Survey on LGBTQ Youth Mental Health, capturing the experiences of nearly 35,000 LGBTQ young people ages 13-24. With 45% being youth of color and more than 38% transgender or nonbinary youth, this is our most diverse sample yet.

We know that LGBTQ youth with multiple marginalized identities face unique stigma and stressors. In particular, LGBTQ youth who are Black and/or transgender have had to grapple with a hostile political climate and repeated acts of racist and transphobic violence over the last year. Most recently, The Trevor Project has been fighting back against an onslaught of anti-trans legislation across the country that threatens to restrict trans youth’s rights to receive best-practice, gender-affirming medical care, participate in school sports, and use the bathroom that aligns with their gender identity.

And our research shows that structural racism and increased experiences of discrimination contribute to suicide risk and gaps in access to care. For instance, out of the LGBTQ youth we surveyed this year, 12% of white youth attempted suicide compared to 31% of Native/Indigenous youth, 21% of Black youth, 21% of multiracial youth, 18% of Latinx youth, and 12% of Asian/Pacific Islander youth. Further, our research finds that LGBTQ youth who experienced more types of discrimination were at higher risk for having attempted suicide in the past year.

While it’s imperative that we continue to spotlight the mental health challenges LGBTQ young people have long-faced and advocate for more robust data collection, it’s also important to acknowledge the steps we can take on the individual level to make a positive impact and save young lives, such as advocating for LGBTQ-affirming spaces and practices. LGBTQ youth who have access to spaces that affirm their sexual orientation and gender identity report lower rates of suicide attempts. While nearly 7 in 10 LGBTQ youth report having access to affirming spaces online, only half reported that their school was LGBTQ-affirming and only 1 in 3 found their home to be LGBTQ-affirming. We must create safe, affirming environments in the spaces where LGBTQ youth spend most of their time.

And despite efforts on the state-level to go backwards on transgender rights, our research underscores that trans-inclusive policies and practices help save young lives. Among trans and nonbinary youth, respecting their pronouns and allowing them to change their name and/or gender marker on legal documents were both associated with lower rates of attempting suicide. Additionally, schools, public health officials, and all youth-serving mental health organizations must utilize an intersectional lens in developing programs and services to meet the specific needs of different communities.

We also desperately need systemic change to ensure that all youth have access to mental health care. As it stands, our mental healthcare system is not serving everyone equally, and oftentimes, the youth who need and want mental health care the most aren’t able to receive it. In the long term, policymakers must prioritize expanding access to public-funded mental health programs and culturally competent providers. This includes incentivizing the recruitment of a more robust mental health workforce that better reflects the diversity of our country’s young people and actively engaging community stakeholders who have lived experience before offering response strategies aimed at benefiting their communities.

In the short term, we need to continue investing in emerging technologies like telehealth and digital therapeutics that lower costs and help break down long-standing barriers to care like geographic disparities. States across the country should also develop licensing policies that allow mental health providers to treat youth under 18 without parental permission and across state lines. Significant progress was made on this front during COVID-19 as more and more people leaned into digital health, but we need to adopt and expand these solutions long-term so that all LGBTQ youth, regardless of where they live and who they live with, can access the affirming care they need.

Establishing a mental health care system that is equitable and effective will not be simple—it will require robust public funding and a wide variety of policy changes aimed at eliminating structural barriers. However, these changes are long overdue and could have a crucial impact on saving young LGBTQ lives. And on an individual level, we must all work together to advocate for LGBTQ-inclusive policies, programs, and practices, while actively confronting mental health stigma and helping to reduce fears around asking for help.