LGBTQ+ youth face a number of unique challenges to their emotional and physical well-being, and the COVID-19 pandemic has disproportionally affected the mental health of this vulnerable population. Last month, PolicyLab researcher Nadia Dowshen joined fellow providers and transgender youth in a conversation hosted by the Human Rights Campaign to discuss the important impacts of gender-affirming care and the obstacles LGBTQ+ youth are currently encountering. 

Below, we unpack recent data surrounding LGBTQ+ youth mental health and discuss how providers and health systems can help support these youth as we continue to understand the impact of the COVID-19 pandemic.

What the data tells us about LGBTQ+ youth’s mental health needs

According to The Trevor Project’s 2021 National Survey on LGBTQ+ Youth Mental Health, 70% of LGBTQ+ youth reported that they had “poor” mental health most of the time or always during the COVID-19 pandemic. About half of youth surveyed said that the pandemic impeded their ability to express their sexual orientation, and 60% of transgender and nonbinary youth reported the pandemic impeded their ability to express their gender identity. Over 80% of youth reported that the pandemic made their living situation more stressful. Nearly half of youth reported wanting to obtain mental health care but did not receive it.

Among LGBTQ+ youth surveyed, 42% seriously considered attempting suicide in the past year. Youth of color were overrepresented among those who considered suicide: 12% were White compared to 31% Native/Indigenous, 21% Black, 21% multiracial, 18% Latinx and 12% Asian/Pacific islander.

The Trevor Project also identified important factors that reduced risk of suicide for LGBTQ+ youth. Specifically, they found that transgender and nonbinary youth who were able to change their name on legal documents had a lower rate of attempted suicide compared to youth who did not have a legal name change. They also found that transgender and nonbinary youth who lived in a home where their pronouns were respected were less likely to attempt suicide than those who did not live in a pronoun-affirming space. These results indicate that youth who are supported in their identities are at a lower risk for attempted suicide.

How can health care providers and health systems better support these youth?

LGBTQ+ youth have unique mental health challenges in the wake of the COVID-19 pandemic. As providers within a pediatric health system, it is imperative that we continue to support these youth in a way that is inclusive and affirming. Through our experiences caring for these youth and their unique mental health needs in Children’s Hospital of Philadelphia’s (CHOP) Gender and Sexuality Development Program, we have seen firsthand the powerful effect that supportive gender-affirming care has on health, safety and quality of life. Many patients and their families describe gender-affirming care as "lifesaving,” highlighting the importance of gender-affirming care in all health care sectors.

Researchers at PolicyLab have also found that when children are experiencing a mental health crisis, it makes a difference when providers enter their space with a warm affect, are empathetic, and treat their patients with dignity and respect.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides detailed recommendations to organizations on how they can help support the mental health of LGBTQ+ youth and their families. These include strategies to integrate LGBTQ+ services and competencies within health care systems, deliver culturally competent services and supports, deliver quality care without bias or prejudice and advocate for LGBTQ+ rights in all spaces. Here are some examples of how health care providers can support LGBTQ+ youth within their practices:

• Ask youth for their preferred name and pronouns upon introduction and during confidential, individual interactions
• In a confidential meeting with youth, ask them for permission to document their pronouns in the electronic medical record if their caregivers are unaware of their preferences
• Train all staff to use preferred names and pronouns and implement sexual orientation and gender diversity training
• If gender neutral bathrooms are not available, post signage clearly indicating that patients and visitors can use the bathroom that aligns with their identity
• Display your own pronouns on a work badge
• Post LGBTQ+ friendly signs and posters in the clinic space

Looking beyond the clinic to support LGBTQ+ youth

CHOP is a leader in LGBTQ+ care and received the Human Rights Campaign Foundation’s “LGBTQ Health Care Equality Leader” designation in 2020. Research teams within CHOP have been dedicated to improving the lives of LGBTQ+ youth for many years. Our recommendations in this blog post outline best practices that we strive to have in place within our own settings for how health care providers can provide an affirming space for their patients, and our teams advocate for widespread implementation of these practices.

Amid progress on this issue, the Human Rights Campaign reports that more anti-LGBTQ+ bills are being passed in 2021 than in previous years, which has detrimental mental health effects on LGBTQ+ youth. A forthcoming PolicyLab brief will focus on the levers available to create a policy environment that is supportive of transgender and gender-diverse children and adolescents, particularly in relation to access to gender-affirming care. It will offer key recommendations for how health care providers, payers and policymakers can better support these vulnerable youth.