The Trevor Project — the world’s largest suicide prevention and crisis intervention organization for young LGBTQ people — has published the results of its third annual national survey on the mental health of LGBTQ youth. The findings reveal the consequences of the ongoing pandemic and call for urgent policy solutions to curb a mental health crisis.
The discrimination that LGBTQIA+ people routinely experience based on their sexual orientations and gender identities remains an alarming reality in 2021.
Being young can add a level of uncertainty and difficulty for people facing this discrimination. Discovering and owning one’s identity during adolescence is already a challenging process — and doing so while having this identity continually questioned or denied can threaten a young person’s mental health and well-being.
At the same time, intersectional identities raise additional, unique challenges for young LGBTQIA+ People of Color, people who come from historically marginalized groups, and people whose families do not have a high income, and so on. All of these factors play into a young person’s psychological well-being.
LGBTQIA+ youth are experiencing mental health issues at much higher rates than the general population, and the last year has added the pressures of the pandemic to an already worrying landscape.
So how is the mental health of LGBTQIA+ youth now, and how are young LGBTQIA+ people faring at this stage in the pandemic? To find out, The Trevor Project collected and analyzed responses from almost 35,000 LGBTQ participants aged 13–24 in the United States. The survey was carried out between October 12 and December 31, 2020.
The survey used the term “LGBTQ” to refer to “lesbian, gay, bisexual, transgender, queer, and questioning” people, and the report on the survey findings uses the term “transgender and nonbinary” as an umbrella term for a wide range of non-cisgender identities.
According to The Trevor Project’s CEO and Executive Director Amit Paley, when compared with previous years, the survey’s sample has been the “most diverse yet, with 45% being LGBTQ youth of color and 38% being transgender or nonbinary.”
In this feature, we review the survey’s findings. We also speak with two experts who helped us tease out the wider sociopolitical implications of the survey, particularly for LGBTQ youth of color: Dr. Myeshia Price-Feeney, a senior research scientist at The Trevor Project, and Dr. Kia Darling-Hammond, an author, mentor, and the director of education programs and research at the National Black Justice Coalition.
42% ‘seriously considered’ attempting suicide
The new survey found that an alarming number of respondents, 42%, had “seriously considered” attempting suicide in the last year. This included more than half of the transgender and nonbinary respondents.
Crucially, the survey uncovered further disparities in mental health along racial lines. Twelve percent of white respondents said that they had attempted suicide in the past year, whereas Black and multiracial youth had both attempted suicide at nearly twice the rate — 21%.
Furthermore, as many as 31% of “Native/Indigenous” survey participants reported having attempted suicide in the last year. Finally, 18% of Latinx youth and 12% of “Asian/Pacific Islander” youth reported having attempting suicide in the same time period.
‘Compounded identity can result in compounded hardship’
Being a young LGBTQ person of color carries an added layer of discrimination, as the survey indicates. Fifty percent of LGBTQ youth of color said that they had been discriminated against based on their race or ethnicity. This included 67% of Black LGBTQ youth and 60% of Asian/Pacific Islander LGBTQ youth.
People who experienced discrimination due to their sexual orientation, gender identity, race, or ethnicity reported much higher rates of suicide attempts: 36% of those who experienced discrimination said that they had attempted suicide, compared with only 7% of those who did not report discrimination.
Overall, more than half of the LGBTQ youth respondents reported discrimination based on their sexual orientation or gender identity in the last year, and 75% said that this had occurred at least once in their lifetime.
“Intersectionality goes beyond the idea that identities are additive, e.g., Latinx and nonbinary,” Dr. Darling-Hammond explained to Medical News Today. “It acknowledges that being a nonbinary Latinx person is its own unique phenomenon and is shaped by sociopolitical forces like cultural norms related to gender and ethnic identity, xenophobia, racism, misogyny, and so on.”
“Add being young in age to this list, and the magnitude of possible disempowerment grows. With this in mind, the numerous humans who are both ‘of color’ and gender and/or sexuality expansive are bombarded by powerful oppression.”
“Compounded identity can result in compounded hardship,” Dr. Darling-Hammond emphasized, noting that Black LGBTQ+ youth are also less likely to receive professional help.
“Even when Indigenous, Black, and Latinx LGBTQ+/SGL [same gender loving] people do manage to access mental healthcare, they have to contend with a predominantly white, cis-hetero, and affluent provider corps that is not only a product of a bigoted society, but has received little to no corrective training and usually cannot provide responsive support.”
– Dr. Kia Darling-Hammond
Although representation is key, Dr. Darling-Hammond went on to explain, “some identity affinity, like having a Black therapist,” does not guarantee that a “Black LGBTQ+/SGL client will receive the empathy and guidance they need.”
Queer and Trans People of Color face unique challenges
The Trevor Project’s Dr. Myeshia Price-Feeney echoed similar sentiments and spoke to us about the unique challenges that Queer and Trans People of Color (QTPoC) in particular have faced during the past year.
“[QTPoC] have had to endure an incredibly hostile political climate and near-constant news images of racist and transphobic violence, which can negatively impact one’s mental health and sense of self.”
“We also know that communities of color were disproportionately impacted by COVID-19 and that QTPoC may be particularly vulnerable to negative mental health impacts associated with the pandemic, as they already faced significantly increased risk for attempting suicide largely due to increased experiences of victimization.”
These heightened risks come on top of already disproportionate rates of unemployment, homelessness, and lack of access to mental healthcare, Dr. Price-Feeney noted.
Dr. Darling-Hammond also observed that “While only about 10% of the youth population identifies as LGBTQ+/SGL, they make up between 40–50% of the unhoused youth population.”
“The top reasons for their displacement are: family rejection (and being kicked out) and fleeing family abuse,” she added.
LGBTQ acceptance halves suicide rates
The new Trevor Project survey also emphasizes the importance of LGBTQ-affirming practices and living environments, as well as the importance of having a support network and being surrounded by people who respect one’s identity.
For example, only 1 in 3 LGBTQ youth said that their home was LGBTQ-affirming, and 49% of transgender and nonbinary respondents said that no one they lived with respected their pronouns.
Young people whose households fully respected their pronouns (29%) reported attempting suicide at half the rate of those whose pronouns were not respected at all.
Also, young people who were able to change their name, gender, or both on legal documents had much lower rates of attempted suicide.
“Respect and use pronouns and preferred names — this indicates respect for people’s humanity and authority over their own identities. It affirms to young people that they are seen, and it also helps them to develop a strong sense of self-awareness, self-love, and self-trust.”
– Dr. Kia Darling-Hammond
By contrast, discriminatory and abusive practices, such as conversion therapy, were linked with much higher suicide rates, the survey found.
Transgender and nonbinary youth were subjected to conversion therapy twice as often as cisgender LGBTQ youth, and they were twice as likely to attempt suicide as those who were not subjected to the practice.
Affirming actions: What each of us can do to help
“We all can play a role in making the world a better place for LGBTQ youth,” Dr. Price-Feeney said. “Start by educating yourself and spreading awareness among your friends and family on LGBTQ issues to help take the burden off of LGBTQ people, who constantly have to explain themselves to others.”
“Actively foster the creation of LGBTQ-affirming environments in your everyday life, whether it be at home, school, or online, where LGBTQ youth can feel accepted and thrive. And practices as simple as asking for someone’s pronouns and listening to them without judgment when they need support can have a profound impact on an LGBTQ young person.”
Dr. Darling-Hammond also spoke about actions that each of us can take to help support the mental health of LGBTQ youth in general and that of QTPoC more specifically.
“Affirm, affirm, affirm!” she said. “Be vocal and unapologetic about your support for QTNB-PoC community members as whole people who are experts on their (developing) selfhood and needs.”
“Educate yourself about QTPoC histories and cultures,” she added. “We have always been here.”
“Work on your biases — embrace the lifelong challenge of unlearning beliefs that oppress and disadvantage others and act to eliminate structural and interpersonal bias, stigma, and discrimination.”
– Dr. Kia Darling-Hammond
The impact of COVID-19 on LGBTQ youth
The Trevor Project’s 2021 survey also dug deeper into the impact of the pandemic on the mental health of LGBTQ youth. Unsurprisingly, the pandemic has had negative economic consequences, putting a strain on the respondents’ financial certainty, which in turn, has affected their mental health and well-being.
Almost half of those surveyed said that COVID-19 has affected their ability to express their sexual orientations, and more than 80% of LGBTQ youth said that it has made their living situations more stressful.
Furthermore, nearly 60% of nonbinary and trans youth said that it has impacted their ability to express their gender identities.
The pandemic has also contributed to food insecurity, which is, in turn, a risk factor for suicide. LGBTQ youth who reported food insecurity in the past month, 30% of respondents, were twice as likely to attempt suicide than youth who did not report this.
Here too, disparities along racial lines were stark. Fifty percent of all Native/Indigenous LGBTQ youth and more than 1 in 3 Black and Latinx LGBTQ youth reported experiencing food insecurity in the past month.
“The past year has been incredibly difficult for so many LGBTQ young people because of multiple crises, from the COVID-19 pandemic to the hostile political climate and repeated acts of racist and transphobic violence,” says Amit Paley. “This data makes clear that LGBTQ youth face unique mental health challenges and continue to experience disparities in access to affirming care, family rejection, and discrimination.”
Proposing intersectional policy solutions
Paley gives clear guidance to policymakers in light of the survey’s findings. “Affirming a young person in their gender identity is strongly associated with lower suicide risk,” he says. “That’s why we should be expanding systems of support and implementing more inclusive policies, not denying trans youth access to affirming spaces and care.”
“To all the lawmakers considering anti-transgender bills across the county — we urge you to take a hard look at this evidence and take time out of your day to actually meet with the transgender and nonbinary youth who would be harmed by your misguided proposals.”
– Amit Paley, CEO and executive director of The Trevor Project
MNT asked its experts about intersectional policy solutions to the problems highlighted by the survey.
“Schools, public health officials, and all youth-serving mental health organizations must take a comprehensive, intersectional approach to mental health and suicide prevention,” said Dr. Price-Feeney from The Trevor Project.
“That means tailoring programs and services to meet the specific needs of different communities to be more effective — because a one-size-fits-all approach won’t cut it.”
“And in developing mental health programs for QTPoC, always include input from the community stakeholders who know best before offering external response strategies aimed at benefiting their communities.”
The importance of cultural competency, representation, affordability
“Lack of cultural competency and affordability are major barriers to care among QTPoC,” Dr. Price-Feeney told MNT, “so we need policymakers to invest in public-funded programs and to incentivize the recruitment of a more diverse mental health workforce.”
The representation of Black LGBTQ+ people as therapists and in other mental health services also plays a key role. “It’s critical that mental health providers can understand or share the lived experiences of the youth they serve,” the senior researcher pointed out.
“In past research, LGBTQ youth of color have reported concerns related to mental health stigma within their culture as well as concerns about the ability of predominantly white providers to understand their identities and the impact of racism on their mental health.”
“There is a need to develop a more diverse mental health workforce, through increased recruitment and inclusive training programs, as well as for the existing workforce to engage in ongoing professional development around anti-racism and in affirming LGBTQ identities.”
– Dr. Myeshia Price-Feeney, a senior research scientist at The Trevor Project
“If young people see themselves in their therapist or counselor, they might be more willing to open up and feel like they will be understood.”
Economic relief ‘most critical starting point’
Dr. Darling-Hammond referred to more comprehensive federal programs providing economic relief as “the most critical starting point.”
“Eliminating existential stressors like housing and food insecurity can free up significant psychological and physical energy, which is part of what’s needed to build a more empathetic society,” she said. “To that end, federally enforced wealth redistribution will be key.”
Furthermore, “Federal legislation like the [Pursuing Equity in Mental Health Act] could anchor efforts toward both advancement and repair, as it would instate some long-needed civil rights protections while modernizing others.”
Dr. Darling-Hammond also points to positive and hopeful examples in existing legislative efforts that could offer a good model to follow.
“There’s a bill moving through Congress, the [Pursuing Equity in Mental Health Act], that authorizes an $805 million investment in research, provider pipeline development and training, and stigma reduction programs. Its focus is on Black children and youth, with some attention to Black LGBTQ+/SGL young people. This kind of legislation is essential and establishes a firm foundation for additional policy infrastructure.”
“In education, we have seen advances toward inclusive curriculum from California (ethnic studies) to Illinois (LGBTQ curriculum), so there’s hope,” she added.
If you or someone you know needs help or support, The Trevor Project’s trained crisis
counselors are available 24/7 at 1-866-488-7386, via chat at TheTrevorProject.org/Help, or by texting START to 678678.
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