Tag: LGBTQIA++

Mental Health of LGBTQ+ Youth and The Trevor Project’s 6th National Survey 

The Trevor Project’s 6th National Survey on Mental Health of LGTBQ+ Young People is a must read for all health and behavioral health professionals. The mandate is clear: sustainable programming and intervention must be developed and expanded to ensure psychologically safe and concordant care is readily accessible for all youth who want it, as well as for their family members, and other allies.

The Trevor Project recently published its  6th National Survey on the Mental Health of LGBTQ+ Young People. The annual report is a must read at any point in time, and particularly for those engaged in the health and well-being of pediatric patients and their families. However, it holds special significance during Mental Health Awareness Month. In the spirit of patient-inclusive care, every person deserves to feel safe, seen, heard, and valued.

The experiences of over 18,000 LGBTQ+ young people (ages 13 -24) across the US are detailed in this seminal report. There is one big disclaimer: caring human beings will be overwhelmed by the current level of mental health risk for youth who identify within this community. 

Key Themes

This year’s report reflects several key themes, including profound levels of trauma, victimization, and a disproportionately high risk of suicide for those surveyed. It is challenging enough for youth to acknowledge and present their authentic self to others, let alone identify as part of the LGBTQIA++ community. The intersectionality of minoritized and vulnerable identities (e.g., racial, ethnic, socioeconomic, ableist) easily prompts discrimination and oppression. The layering of these marginalities only exacerbates a person’s exclusion from social connection, resources, and opportunities to engage in mainstream society; fear of stigma, rejection, and abandonment by family, peers, teachers, and other individuals is a reality for far too many individuals.

A high volume of LGBTQIA+ youth are unable to access the mental health care they need, and when they need it most. The widening gaps in treatment accessibility and availability trouble me greatly. I had a strong visceral reaction to this data during my initial read, especially as a fierce ally of the community, a behavioral health professional, and one who cares deeply about the human condition. Preliminary conversations with colleagues and friends yielded equally powerful reactions. Here are the data high points for your own reflection and consideration:

Access to care:

  • 84% of all respondents wanted mental health care
  • 50% were unable to access it

For youth who wanted mental health intervention but were unable to access it: 

  • 42%: Scared to discuss their mental health concerns with others
  • 40%: Unable to afford it
  • 37%: Unable to obtain parental or caregiver’s permission
  • 34%: Worried they would not be taken seriously
  • 31%: Fearful of being hospitalized involuntarily
  • 24%: Not yet out and worried being outed 
  • 22%: Concerned that treatment providers would not understand their sexual orientation or gender identity
  • 20%: Had a prior negative experience with a clinician

Suicidality:

  • 46% of ages 13-17 considered suicide in the past year, while 16% attempted.
  • 33% of ages 18-24 considered suicide, while 8 % attempted

For all youth who considered suicide:

  • 52%: Transgender Men
  • 47%: Transgender Women
  • 43%: Nonbinary/Genderqueer
  • 42%: Questioning
  • 31%: Cisgender Women
  • 27%: Cisgender Men

LGBTQ+ Youth of Color reported increased suicidal attempts vs. Whites:

  • 24% :Native American/Indigenous youth
  • 16%: Multiracial youth
  • 14%: Black/African American youth
  • 14%: Middle Eastern/North African youth
  • 13%: Hispanic/Latinx youth
  • 10%: Asian American/Pacific Islander youth

Mental Health and Well-being:

  • 90%: Well-being was negatively impacted by recent politics.
  • 45% of transgender/nonbinary young people: Reported their family considered moving to a different state due to anti-LGBTQ+-related politics and laws.
  • 49%: Experienced bullying in the past year
    • Those who reported being bullied had significantly higher rates of attempting suicide in the past year vs. those who did not experience bullying.


Gender-affirming treatment

  • 62% of youth on Gender-affirming hormones were concerned they would lose access to this care.

Bullying and At Risk of Physical Harm

  • 23%: Were physically threatened or harmed due to sexual orientation or gender identity
  • 28% of transgender and nonbinary young people: Were physically threatened or harmed in the past year due to their gender identity

The concerns intensify when this data point is broken down by sexual orientation, racial, and ethnic status. Prevalence increases by up to 20% when looking at gender identity by group:

  • 40%: Asian Americans
  • 36%: Blacks
  • 44%: Latinx
  • 43%: Middle Eastern
  • 55%: Native American
  • 48%: Whites

Ten Actions for Peers and Allies to Show Support

The Trevor Project identifies how to support youth, including through providing psychological safety and a sense of belonging by : 

  • Ensuring availability of gender-affirming spaces 
  • Providing access to gender-affirming clothing, gender-neutral bathrooms at school, and respect of pronouns by those they live with 
  • Having at least one adult in their school or academic setting who is supportive and affirming of their authentic self
  • Have an affirming space at home, school, work, place or worship, community, and/or social media (online)

In addition, respondents were queried on their 10 top priorities for how peers and allies can actively convey support:

  1. Trust the person knows who they are (88%)
  2. Stand up for the person (81%)
  3. Not support politicians who advocate for anti-LGBTQIA+ legislation (77%)
  4. Look up things about LGBTQ+ identities on their own to better understand (62%)
  5. Respect pronouns (59%)
  6. Show support for how the person expresses their gender (57%)
  7. Ask questions about LGBTQ+ identities to better understand (56%)
  8. Accept their partner (55%)
  9. Show support on social media (44%)
  10. Have or display pride flags (43%)

Resources to support LGBTQIA+ Youth

Prior blogs have addressed these valued resources: 

  • GLADD provides a clearinghouse of population-specific resources for advocacy, legal, and other general information. 
  • The Human Rights Campaign  advocates and promotes equity for all persons within the movement. Their massive resource database empowers allies and other community stakeholders how to support individuals with coming out, maneuvering college, elections, hate crimes, health and aging, parenting, religion and faith, and workplace support. 
  • Outcare Health offers concordant care directories with a 50-state community resource directory for LGBTQIA++ affirming practitioners, primary care, mental health, youth groups, shelters, support groups, and STI testing. They also provide an interactive map on U.S. legislation targeting LGBTQIA++ rights across the states.
  • SMYAL offers locale-based housing programs that ensure safe, LGBTQ-affirming support through tiered residential options: transitional housing, extended transitional housing, and rapid re-housing. 
  • The Trevor Project provides 24/7 information, support, and resource connection for LGBTQIA++ Youth around the globe. There is immediate access to trained counselors via call, text, or chat, and linkage to an international community for LGBTQ young people
  • LGBTQ+ Healthcare Directory provides a listing of LGBTQ+ informed and welcoming health, mental health and other providers and practitioners across the U.S. and Canada.

Readers of this blog are encouraged to add resources in the comments area below.

Data Must Yield Actionable Solutions

I echo the sentiment of my colleagues in that the industry has substantial data to validate the severity of this mental health crisis. Actionable and sustainable programming and intervention must be developed and expanded to ensure psychologically safe and concordant care is readily accessible for all youth who want it, as well as for their family members, and other allies. The risks and consequences for youth unable to access needed mental health support and intervention are far too great to ignore.

Wholistic Health Equity Determinants and the LGBTQIA++ Community

Too little emphasis has historically been placed on this population’s challenges in addressing these determinants, as in accessing quality concordant health and behavioral health care, managing their psychosocial health and reflective resource needs, and activating action to mitigate their abysmal health outcomes. Systemic racism further perpetuates each of these disparities, triggers trauma that activates physical illness, while also compromising individual safety. It is time to shift this trend.

A number of this blog’s followers expected me to review the recent (May 2023) Federal Reserve Report, The Economic Well-being of US Households in 2022 this week. The report poses interesting implications about the Wholistic Health Equity Determinants discussed in my last post. While this topic is of interest to my health equity lens, a more critical focus beckons.

With PRIDE in full stride, the dire needs of the LGBTQIA++ community will receive prime attention today, and for my next several blog posts. Too little emphasis has historically been placed on this population’s challenges in addressing these determinants and continues to be the norm. The community still struggles in accessing quality concordant health and behavioral health care, managing their psychosocial health and reflective resource needs, and activating action to mitigate their abysmal health outcomes. Systemic racism further perpetuates each of these disparities. It triggers trauma that further exacerbates physical and behavioral health, while also compromising individual safety. Time to shift this trend.

Recent Realities

The recent article in Health Affairs by Auerbach & Fox nailed it: “significant evidence suggests that virtually all LGBTQ++ populations are at elevated risk of preventable illness, injury, and death.” This article and previous works by the Kaiser Family Foundation, University of Wisconsin’s Institute for Research and Poverty, and HRC arm us with considerable data to advance action!

Poverty and Food Insecurity

An increasing incidence of the LGBTQIA+ community live close to the federal poverty level:

  • 34% have incomes below 200% (of the FPL) vs. 25% of non-LGBTQIA++ people.
  • 39% earn $30,000 a year or less annually. 
    • 28% of lesbian and bisexual women compared to 21% of heterosexual women. 
    • 23% of gay and bisexual men compared to 15% of heterosexual men.
  • 32% of transgender persons earned an annual income of under $10,000 compared to 23% of heterosexual persons.
  • Lesbian couples have the highest poverty rates followed by heterosexual couples and male same sex couples.

In general, across the community:

  • 30% are unable to pay their bills.
  • 67% used all or most of their savings for healthcare expenses.
  • 52% had trouble paying medical bills in the past 12 months or had difficulty paying for necessities (e.g., food, heat, or housing) 
  • 41% borrowed money from family or friends.
  • 2x as likely to experience food insecurity than other populations at rates upwards of 30% of the population. One recent study reported female sexual minorities as: 
    • 52% more likely to experience nutrition obstacles, and
    44% more likely to report household SNAP assistance than their heterosexual counterparts. 

Unemployment

Unemployment rates loom large for the community:

  • 22% of adults vs. 16% of straight and cisgender counterparts
  • 29% of transgender adults, 30% of bisexual women

Amid the pandemic these numbers soared with surveys revealing as high as:

  • 28% of LGBTQIA+ report that they, or another member of their household experienced a job loss vs. 23% of the rest of the population, and
  • Close to 50% report their work hours reduced.
  • 45% of the population reported challenges paying their rent or mortgage vs. 32% of the remaining population.

Quality of and Access to Necessary and Concordant Care

The Kaiser Family Foundation yielded concerning results in the context of chronic illness management:

  • 47% have an ongoing health condition that requires regular monitoring, medical care, or medication.
  • 21% have a disability or chronic disease that keeps them from participating fully in work, school or housework.
  • 34% of those on Medicaid with a disability or limiting chronic disease report the following experiences with providers:
  • Not believe they were telling the truth (16% )
  • Suggest they were personally to blame for a health problem (13%)
  • Assume something about them without asking (21%)
  • Dismiss their concerns (29%)

Trauma and Chronic Illness Exacerbation

The community’s higher rates of exposure to psychosocial stressors contribute to higher rates of chronic and autoimmune illnesses. The higher incidence of individuals to poverty, unemployment, homelessness, interpersonal violence, as well as family and peer abandonment, contribute take their toll across LGBTQIA++ populations.

Research notes high incidence and prevalence reported for the onset and exacerbation of migraines, respiratory issues, HIV/STIs, diabetes, heart attacks, hypertension, arthritis, visual/hearing impairment, and stomach/gall bladder trouble, along with substance use and addiction. Neurological symptoms can be especially fierce in response to the expansive psychosocial stressors faced by individuals.

But Wait, There’s More

The pervasive WHED struggles of the community contribute to higher rates of discrimination, trauma, and, ultimately, more intense behavioral health conditions and mental illness. The incidence of suicidal ideation, gestures, and completed actions are at record levels, and for the youngest members of the LGBTQIA++ community. This topic deserves its own blog post and where I’ll go next time.

In addition, there must be defined recommendations for industry action. Reports have noted a variety of recommendations that ensure protective factors are in place for members of the community; these may include having healthcare providers and practitioners promote inclusion and belongingness, as well as expanding access to concordant treatment specialists. Emphasis has also been placed on individuals reducing isolation, leaving rural areas and residing in more urban areas, seeking higher levels of education, being employed, being married, not growing up in poverty or becoming a parent at a young age. 

These  factors make for a nice wish list but may not directly eliminate the immense disparities that have plagued the community for centuries. More can and must be done. Stay tuned for my next bi-weekly post.