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Behavioral Health

“Behavioral health” is an umbrella term that includes issues and services related to mental health, suicide, and substance use/misuse. This section discusses information relevant to these two subject areas as they intersect with LGBTQ+ youth.

Mental Health and Suicide

As the Institute of Medicine has noted, LGBT youth are typically well adjusted and mentally healthy.1 However, they experience higher rates of mental health challenges and increased health complications arising from these challenges compared to their heterosexual peers.2 Research on transgender youth outcomes as separate from lesbian, gay, and bisexual youth outcomes is more limited, though growing. Some recent nonrandom surveys of self-identified transgender people indicate that up to one-third reported attempting suicide at least once, with higher rates for youth and young adults than for older adults.3 Moreover, suicide is the third leading cause of death among youth ages 15 to 24, and LGBT youth are more likely to attempt suicide than their peers.4 This does not mean, however, that LGBT identity itself is the cause of these challenges. Rather, these higher rates may be due to bias, discrimination, family rejection, and other stressors associated with how they are treated because of their sexual identity or gender identity/expression.5 These challenges, which researchers refer to as “microaggresions,”6 can contribute to anxiety, depression, and other mental health challenges, as well as to suicide and self-harming behavior.

Research has found that lesbian, gay, and bisexual youth have much higher levels of suicidal ideation than their heterosexual peers.7 Also, recent population-based studies suggest that the reported rates of suicide attempts for high school students who identify as LGBTQ+ are two to seven times higher than rates among high school students who describe themselves as heterosexual.8 LGBTQ+ youth are also twice as likely to have thoughts about suicide.9 

The Trevor Project’s 2021 National Survey on LGBTQ Youth Mental Health surveyed nearly 35,000 LGBTQ youth ages 13-24 and found several revealing insights on the state of LGBTQ+ youth mental health in the U.S.:

  • 42 percent of LGBTQ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth.
  • 31 percent of Native/Indigenous youth attempted suicide, 21 percent of Black youth did so, 21 percent of multiracial youth, 18 percent of Latinx youth, 12 percent of Asian/Pacific Islander youth, and 12 percent of white youth.
  • More than 80 percent of LGBTQ youth stated that COVID-19 made their living situation more stressful.
  • 70 percent of LGBTQ youth stated that their mental health was "poor" most of the time or always during the COVID-19 pandemic.
  • Nearly half of LGBTQ youth reported they wanted counseling from a mental health professional, but were unable to receive it in the past year.

There were also findings that support the importance of welcoming and safe environments, resources, and services for LGBTQ+ youth and their mental health:

  • Transgender and nonbinary youth who were able to change their name and/or gender marker on legal documents, such as driver’s licenses and birth certificates, reported lower rates of attempting suicide.
  • LGBTQ youth who had access to spaces that affirmed their sexual orientation and gender identity reported lower rates of attempting suicide.
  • Transgender and nonbinary youth who reported having pronouns respected by all the people they lived with attempted suicide at half the rate of those who did not have their pronouns respected by anyone with whom they lived.10

Strategies to improve mental health and prevent self-harming behavior and suicide include:

  • providing safe and supportive environments, particularly through affirming relationships with family and peers11
  • enacting legislation to protect the safety of LGBTQ+ youth
  • re-evaluating institutional practices that undermine positive youth development
  • building community awareness and capacity to understand and address stressors that LGBT youth may experience13

Substance Use

LGB youth may be more likely to use substances to cope with bias and stress and may be more likely to experience increased rates of depression and anxiety than their non-LGB peers.13 Challenges such as family rejection of, or anticipated reaction to, one’s LGBT identity are also associated with substance use.14 National prevalence data show that high school students in the U.S. who identify as LGB engage in substance use at significantly higher rates than their heterosexual peers.15

Through national surveys, LGB high school students and young adults recently reported two to three times greater rates of ever using hard drugs (e.g., cocaine, ecstasy, methamphetamine, heroin), compared to their heterosexual peers.16

Transgender youth have a high risk for developing substance dependency issues. Transgender individuals have higher rates of usage for some drugs and may have higher rates of methamphetamine, injectable drugs, and tobacco usage.17

Reducing the rates of bias, discrimination, and victimization that LGBTQ+ youth experience can help reduce substance use. A related strategy includes creating safe spaces for LGBTQ+ youth in drug-free environments, such as community centers. Also, accepting/positive family behaviors toward LGBTQ+ youth during adolescence can protect against not only suicide and depression but also substance use.18

Resources

National Suicide Prevention Lifeline: 800-273-TALK (8255)
hotline The National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. When you call 1-800-273-TALK (8255), you are connected to the nearest crisis center in a national network of more than 150 that provide crisis counseling and mental health referrals day and night. The Lifeline also provides informational materials, such as brochures, wallet cards, posters, and booklets. Prestamos servicios en español (1-888-628-9454). Translators speaking approximately 150 languages are available.

A Guide for Understanding, Supporting, and Affirming LGBTQI2-S Children, Youth, and Families (PDF, 8 pages)
This guide provides information for service providers, educators, allies, and community members who seek to support the health and well-being of children and youth who are lesbian, gay, bisexual, transgender, questioning, intersex, or two-spirit (LGBTQI2-S) and their families. This guide can support efforts to promote full and affirming inclusion of LGBTQI2-S youth and families in communities and provider settings (e.g., child welfare, juvenile justice, mental health, schools). The guide includes a section for organizations to add their endorsement electronically. Both the National Association of School Psychologists (NASP) and the National Association of Social Workers (NASW) have endorsed the guide.

Gender-Affirming Care and Young People (PDF, 2 pages) 
This resource provides information on gender-affirming care, what it looks like, why it matters, and offers additional resources related to transgender and gender diverse children and adolescents. A glossary of common terms to know when providing gender-affirming care is also included. 

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
This report concludes that future research and data collection must address LGBT individuals because current lack of research yields an incomplete picture of the health status and needs of LGBT people.

Healthy People 2030 Goal: Improve the Health, Safety, and Well-Being of Lesbian, Gay, Bisexual, and Transgender People
This goal focuses on collecting data on LGBT health issues and improving the health of LGBT adolescents in particular.

Lesbian, Gay, Bisexual, and Transgender Health
This webpage contains specific health topics for the LGBT community, with specific resources for gay and bisexual men, youth, lesbian and bisexual women, transgender persons, and health services.

Lesbian, Gay, Bisexual, and Transgender Health: Youth
This webpage focuses on information for LGBT youth, highlighting the experiences that LGBT youth face and providing information for schools and parents related to responding to violence against LGBT students.

Medline Plus: Gay, Lesbian, and Transgender Health
This website provides resources and information for the specific health issues related to gay, lesbian, bisexual, and transgender individuals.

National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families
The National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families supports and enhances services for children and youth who are LGBTQI2-S. The workgroup guide federal efforts to develop policies, programs, materials, and other products that address the needs of children and youth who are LGBTQI2-S. The workgroup has developed a system of care toolkit of more than 150 resources from various organizations and has delivered learning events at conferences/meetings and in communities to build capacity to improve services and outcomes for LGBTQI2-S youth and their families.

Practice Brief 1: Providing Services and Supports for Youth Who Are Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, or Two-Spirit (PDF, 8 pages)
This practice brief outlines key information for working with, and providing culturally and linguistically competent services to LGBTQI2-S youth.

A Practitioner's Resource Guide: Helping Families to Support Their LGBT Children (PDF, 18 pages)
This resource offers information and resources to help practitioners throughout health and social service systems implement best practices in engaging and helping families and caregivers to support their LGBT children.

A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals (PDF, 214 pages)
This manual seeks to inform administrators and clinicians about appropriate diagnosis and treatment approaches that will help the development or enhancement of effective LGBT-sensitive programs. A 22-module training curriculum accompanies this publication.

Recommended Actions to Improve the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Communities
This statement addresses recommended actions to address and improve the health and well-being of the lesbian, gay, bisexual, and transgender communities.

SAMHSA Office of Behavioral Health Equity
This website provides a variety of LGBT-focused data and resources on substance abuse and mental health.

Suicide Risk and Prevention for Lesbian, Gay, Bisexual, and Transgender Youth (PDF, 63 pages)
This report highlights the higher risk of suicidal behavior among LGBT youth and provides recommendations for youth services (e.g., schools, health practices, suicide prevention programs) and funders to promote the health, safety, and inclusion of LGBT youth.

Talking about Suicide and LGBT Populations (PDF, 4 pages)
This guide provides key recommendations for talking about suicide in safe and accurate ways with LGBT youth. Learn more about how the mental health system can support LGBT youth by reading endever*'s story.

Top Health Issues for LGBT Populations Information and Resource Kit (PDF, 100 pages)
This toolkit presents an overview of current health issues among LGBT populations. Although many challenges exist regarding the availability of data, this toolkit aims to create awareness among prevention specialists and healthcare providers of the needs, experiences, and health status of LGBT Americans.

The Trevor Project
The Trevor Project provides crisis and suicide prevention services to LGBT and questioning young people ages 13 to 24. It operates the only accredited, nationwide, around-the-clock crisis and suicide prevention helpline for youth who are LGBTQ at 866-4-U-TREVOR (866-488-7386); TrevorChat, an online messaging service that allows youth in crisis to live chat with volunteers who can provide support; and TrevorText, a free, confidential messaging service. The Trevor Project also facilitates TrevorSpace, a peer social networking site for LGBTQ youth and their allies; AskTrevor, an online forum through which youth can anonymously ask experts questions about sexuality and gender issues; the Lifeguard Workshop Program, which educates participants through a structured curriculum about recognizing and responding to the warning signs of depression and suicide; and additional resources for youth, families, and educators.

References

1 Institute of Medicine, 2011
2 American Psychological Association, 2011; National Alliance on Mental Illness, 2011
3 Lombardi & van Servellen, 2000
4 Centers for Disease Control and Prevention, 2019
5 Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Haas et al., 2011; U.S. Department of Health and Human Services, n.d.
6 Sue, 2010
7 Suicide Prevention Resource Center, 2008
8 Haas et al., 2011
9 Haas et al., 2011
10 The Trevor Project, 2021
11 Mustanski & Newcomb, 2011
12 Horvath, Remafedi, Fisher, & Walrath, 2012
13 Marshal et al., 2008
14 Ryan, 2009
15 Kann et al., 2018
16 SAMHSA, 2019; Kann et al., 2018
17 Xavier, Honnold & Bradford, 2007
18 Ryan, 2009

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