In the last couple of years, studies have shown that the state of mental health for LGBTQ+ youth is tumultuous. The Human Rights Campaign earlier in 2023 declared a state of emergency for LGBTQ+ Americans, and the rights and mere existence of queer and trans youth have been the basis of many legislative and educational discussions of late.
According to The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People, 41% of LGBTQ+ youth seriously considered attempting suicide in the past year. Youth who are trans, nonbinary and/or people of color reported higher frequencies of attempted suicide than their peers. The survey shows that approximately half of trans and nonbinary youth found their school to be gender-affirming; those who experienced a gender-affirming school reported lower rates of attempting suicide.
Plus, almost one third of LGBTQ+ youth survey respondents said that their mental health was poor most of the time or always because of anti-LGBTQ+ policies and legislation.
“I would say that it makes a lot of sense when we have these institutionalized policies, these sorts of systemic injustices, that they can contribute to worsened mental health outcomes,” said Dr. Xavier Diao, attending psychiatrist and assistant professor of clinical psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Diao has training in LGBTQ+ and adolescent mental health, though he currently works with adults, including transitional age youth and older adolescents.
Diao referenced the Ilan Meyer study “Prejudice, Social Stress and Mental Health in Lebian, Gay and Bisexual Populations: Conceptual Issues and Research Evidence,” which puts forth the minority stress theory.
“[Meyer’s] argument is not so much that because you identify as LGBTQ+ means that you are destined to have psychopathology or mental health challenges,” Diao said. “But it is mediated by systemic factors; things like discrimination [and] institutionalized factors that people internalize. Then it is through that process that increases the risk for mental health conditions.”
According to the Movement Advancement Project, North Carolina, Alabama, Kentucky, Iowa, Florida and Arkansas passed laws that outright censor discussions of LGBTQ+ people or topics in schools. In Alabama, Tennessee, Kentucky, Arkansas, Oklahoma, North Dakota and Idaho, trans people are prohibited from using bathrooms and facilities that align with their gender in K-12 schools.
Although there are no such laws in Pennsylvania, the state doesn’t have anti-bullying laws that protect youth based on gender identity or sexual orientation, nor does it have a law that requires Pa. curricular standards to include lessons on LGBTQ+ communities and culture.
Bryant Christie, director of clinical services at The Attic Youth Center, said that some overarching themes that he’s noticed in terms of mental health challenges for queer and trans youth at The Attic include some increase in suicidality.
“That can be active where there’s a plan and trying to have that happen,” Christie said. “And passive where it’s more just thinking about [suicide], maybe more pervasive thoughts.”
Christie has also picked up on the effect that anti-trans legislation has had on young LGBTQ+ people, which manifests in the form of internalized transphobia and dysphoria.
Some of the youth that utilize The Attic’s counseling services have encountered physical or sexual violence, as well as violence in their communities.
“We have youth coming in sharing stories around something [that] might have happened on their way coming in or something happened over the weekend,” Christie said.
Youth who seek mental health support from The Attic get the support they need, Christie said.
“Some of the biggest protective factors for some of the trauma that’s here [are] the relationships — fostering supportive relationships where youth can feel seen and feel heard. Unfortunately, that’s not always the case when they’re outside of the space.”
To help make youth feel seen and heard, The Attic has a youth leadership council, where young people can weigh in on some of the decisions that take place at the center.
“This is definitely a really stressful time to be growing up,” Christie said. “Some bigoted folks, unfortunately, they’re making their voices heard. It does a lot of harm to youth that are still forming different parts of their identity, that are vulnerable and questioning. So creating opportunities where [youth] can practice activism [and] practice having a voice is very important.”
Tim McKinney, LGBTQ+ resource and program director at Big Brothers Big Sisters Independence in Philadelphia, referenced a statistic from this year’s Trevor Project LGBTQ+ youth mental health survey. It says that 81% of LGBTQ+ youth respondents said that they wanted mental health care, but 56% of those in that group weren’t able to get it.
“Equity in a word means access,” McKinney said. “When we look at that data about folks who want access to mental health care but aren’t able to get it, there’s a lot of opportunity for us to step up our game.”
As a provider, Diao said that LGBTQ+ youth barriers to mental health support is an issue of too much demand and a dearth of child and adolescent psychologists. But another factor is that youth who are under 18 years old may be wary of their parents accessing their mental health records, especially for youth who might need services for family planning, drug use or gender-affirming health care, Diao pointed out.
Diao also acknowledged that stigma is a factor in perpetuating barriers to mental health care for LGBTQ+ youth. Stigma often leads to fear of rejection and discrimination when it comes to getting insurance or navigating pre-existing mental health conditions, Diao said.
Adults can take a variety of preventive measures to lower the overall risk and occurrence of mental health challenges for LGBTQ+ young people. McKinney referenced the School District of Philadelphia’s policy 252, which says that students and school staff must address students by the name and pronoun that align with their gender identity.
“Using people’s affirmed names and pronouns is suicide prevention, period,” McKinney said. “It doesn’t cost anything to be kind.”
Gender and Sexuality Alliances (GSAs) in schools also prove to be essential for LGBTQ+ students in the wake of so many harmful policies and laws, McKinney said. GSAs should serve as safe spaces where LGBTQ+ youth can ask questions to mentors.
McKinney said, “often, when I’m talking to adults, [I say]: ‘your young folks have questions; they are going to find the answers. Wouldn’t you rather it be from me?’ It’s an easy way to kind of bring adults into the conversation.”
Despite the fact that high percentages of LGBTQ+ youth in the U.S. are struggling with depression, anxiety and suicidal ideation, the patients that Diao sees in his practice show resilience, he said.
“I think just seeking out mental health treatment is a testament to their bravery,” Diao said. “I think that’s really commendable, and it’s something that we always turn to as a way to foster hope.”