It’s now common knowledge that global pandemics like COVID-19 are stressful and can heighten the overwhelming feelings associated with fear and anxiety, plus affect a person’s risk of suicide, according to the Centers for Disease Control and Prevention. But as experts use this time to reimagine ways to make mental health care more accessible for all, it’s also important to consider which populations experience disproportionate suffering.
Last month, the Trevor Project—a non-profit organization that focuses on suicide prevention for lesbian, gay, bisexual, transgender, queer, and questioning youth—released its 2020 National Survey on LGBTQ Youth Mental Health, and the results were worrisome, to say the least. The survey, which polled over 40,000 LGBTQ youth ages 13 to 24 across the U.S., found that 40 percent of LGBTQ youth “seriously considered” attempting suicide in the past year, and more than half of transgender and nonbinary individuals have seriously considered suicide. Additionally, 68 percent of LGBTQ youth reported symptoms of generalized anxiety disorder in the past two weeks, while 48 percent of youth engaged in self-harm in the past year. Eighty-six percent of the sample population also said recent politics—and bills that threaten LGBTQ livelihood, for instance—have negatively affected their well-being.
The survey not only includes more troubling data about the mental health of LGBTQ youth, but it provides insight into why this population is disproportionately less healthy, and how we can prevent suicide moving forward. “There’s not something about being LGBTQ in itself that causes challenges with mental health and suicide—it’s the way they’re treated and discriminated against,” says Amy Green, PhD, the Trevor Project’s director of research. “We need to be thinking about intersectionality and diversity within our community, and look at ways to stop discrimination, rejection, and victimization.”
“There’s not something about being LGBTQ in itself that causes challenges with mental health and suicide—it’s the way they’re treated and discriminated against.”
According to the survey, one in three LGBTQ youth have been physically threatened or harmed in their lifetime because of their sexual orientation and/or gender identity. Twenty-nine percent of LGBTQ youth have experienced homelessness, run away, or have been kicked out of their household. Also, about 60 percent of LGBTQ youth have said someone attempted to convince them to change their sexual orientation or gender identity—along the same lines, only one in five transgender and nonbinary youth report having their pronouns respected. As the study finds, LGBTQ youth who have experienced these examples of suffering (housing instability, physical abuse, language that does not affirm gender identity or sexual orientation) report higher rates of suicide.
So what can be done to improve the mental well-being of LGBTQ youth and implement widely-known suicide prevention strategies for them? The first step is simple.
Practice LGBTQ allyship
“The simple answer is acceptance, and acceptance that is loud and vocal,” says Dr. Green. “Within the LGBTQ community, visibility and positive representation helps—having adult role models within the community who are supportive and thriving and give hope for ways their lives might look.” In fact, the survey found representation in the media matters, with over 80 percent of youth reporting that positive celebrity role models made them feel better about being LGBTQ.
According to the survey, the suicide rates for LGBTQ youth who reported more support from family, friends or at least one special person were significantly lower than those with less support. One silver lining: 78 percent of LGBTQ youth reported having access to at least one in-person LGBTQ-affirming space, while 86 percent have high levels of support from at least one person.
While headline-making legislation such as the 2015 legalization of same-sex marriage sends LGBTQ youth a message of support and hope, that’s not part of their every day reality, says Stephen Russell, PhD, a professor in the Department of Human Development and Family Sciences at the University of Texas at Austin.
“Yes, you can now imagine yourself thriving as an LGBTQ person because we have role models. But you’re coming out knowing that who you are has been tested dramatically. Most kids don’t have unequivocally supportive contexts and support systems to encounter, and that’s compromising for their well-being,” says Dr. Russell.
Affirm gender identity for transgender and nonbinary youth
The Trevor Project’s survey found that transgender and nonbinary youth whose pronouns were respect reported half the rate of suicide attempts than those who did not have that experience. In addition, trans and nonbinary youth who had access to shapewear and clothing that affirms their gender also reported lower rates of attempted suicide.
This goes back to practicing allyship. Rather than settling after telling LGBTQ youth they’re supported, Dr. Green also suggests using assertive language, such as, “It’s great that you are trans and nonbinary,” or “It’s great that you identify as pansexual.”
Research your school district’s non-discrimination policies
One of the most troubling findings in the survey is that while LGBTQ youth are interested in accessing mental health care, they face huge barriers. Over 40 percent of participants surveyed reported they were unable to receive care because of a lack of permission from their parents. Almost half of transgender and nonbinary youth didn’t receive mental health care because they worried about a provider’s LGBTQ competency. And while cost was the greatest barrier to receiving treatment, other factors like the fear of being outed or even transportation difficulties prevent LGBTQ youth from getting the help they want.
Both Dr. Green and Dr. Russell agree that the answer to ensuring all LGBTQ youth have affordable access to mental health care is complex, however, focusing on policies and change at the state and local level is a good place to start.
“Research consistently shows that schools that have those policies seep into the culture over time,” says Dr. Russell. “Schools are the public space where we have an obligation to keep kids safe and teachers can set the tone for how to treat LGBTQ kids.”
Dr. Green specifically says that adults wanting to implement change can check to see whether schools have inclusive suicide prevention policies in place, along with mandates that prohibit bullying and other forms of discrimination. One example is to ensure LGBTQ youth—trans and nonbinary youth in particular—have safe spaces where they feel comfortable using the appropriate bathroom.
While Dr. Russell stresses that federal education policy for sexual orientation and gender identity and expression would positively impact LGBTQ youth, something as simple as suggesting amendments to a student handbook can improve the well-being of this population. GLSEN, an organization that helps implement non-discriminatory school policy, has a digital archive of resources for parents, teachers, and students who want to host local LGBTQ-affirming events, or simply learn more about coming out or asking about proper use of pronouns.
“Do we train teachers to be supportive? Do we create supportive gay-straight alliances at schools? The answer is yes—pick one and start doing it. Be involved. Call the local LGBTQ center. Find out what your kids need,” says Dr. Russell. “Everybody really could do one thing that could make a difference and it doesn’t have to be in relation to one individual kid.”
Keep suicide prevention hotlines handy
While suicide is the second leading cause of death among teens 15 to 19, according to the CDC, it’s essential to be equipped with resources that give LGBTQ youth, specifically, room to speak about their experiences. Dr. Green says that in addition to cost being a barrier for access to mental health care, there are also LGBTQ youth in rural regions with no way of finding or getting to a provider. For those instances, hotlines and organizations that use free technology to help are important to remember.
Dr. Green suggests LGBTQ youth in a crisis or simply interested in finding a safe space to talk reach out to the TrevorLifeline, which is available 24/7 at 1-866-488-7386, as well as Trevor Space, a digital community and social networking platform to find support. In addition, resources include the National Suicide Prevention Lifeline at 1-800-273-8255, and their Lifeline Crisis Chat.
Dr. Green stresses that while these hotlines aren’t replacements for mental health treatment from a professional, they provide knowledge and the resources necessary for finding what all LGBTQ youth benefit from: acceptance.
If you or someone you know is struggling with suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 or chat with a counselor online.