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Mental Health Among LGBTQ Youth

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AHPI Intern Perspective

Suicide is the second leading cause of death among all young people 10 to 24 years old. Like other particularly vulnerable groups such as rural, Indigenous, and Black youth, LGBTQ youth are among the many subpopulations who are at increased risk for experiencing mental health issues and attempting suicide. Many LGBTQ youth fall into multiple vulnerable identity groups, further increasing risk of suicide. Thus, there is a demonstrated need for intersectional, culturally competent, and accessible mental health services for youth. The purpose of this blog is to summarize policy actions being made to expand youth mental health services and keep them accessible to all individuals who need them.

Some have sought policy change via the courts, including challenges to laws reflecting a widespread trend of stigmatism and influence from religious groups that make policy changes difficult. For example, in May 2021, The American Civil Liberties Union (ACLU) filed a lawsuit in an Arkansas federal district court, requesting that the court strike down a state law  forbidding medical providers from “providing gender confirming hormone treatment, puberty blockers or sex reassignment surgery to anyone under 18 years old, or from referring them to other providers for such treatment.” The lawsuit claimed that the law threatened the health of transgender youth, violating their constitutional rights. U.S. District Court Judge Jay Moody temporarily blocked the ban on gender affirming services—a huge win for transgender youth. 

Communities can adopt various strategies to intervene and prevent youth suicide. First, communities can build a strong suicide prevention infrastructure by implementing Garrett Lee Smith funded gatekeeper training and adopting state laws to support the 988 suicide prevention hotline.  The Garrett Lee Smith Memorial Act (2004) creates grants for implementing early intervention youth suicide prevention programs among campuses, states, and tribes. Program activities integrate strategies and tools from the Zero Suicide approach, a model with a foundational belief that “suicide deaths in health care systems are preventable.” The national 988 suicide prevention hotline is a result of model legislation proposed by Representative Seth Moulton with a goal to combine the nation’s existing suicide prevention and mental health hotlines to increase accessibility. Moulton said “when your house is on fire, you can get help by calling 9-1-1… we set a goal to make it just as easy to get help in a mental health emergency.”  This ease of access changes the reality for anyone experiencing a mental health crisis. 

Also, policy makers can increase access to services by integrating mental health services into primary care and expanding telehealth services. Telehealth is a valuable tool to increase the percentage of people experiencing mental illness who seek help. Telehealth services are associated with improved client and provider experiences, decreased costs, and more accessible care for vulnerable groups, particularly in rural communities. Recent bills, responding to an increased need for telehealth services during the COVID-19 pandemic, permit expanded behavioral telehealth services, and have made it easier to get help for mental health challenges. 

Legislators can involve the community by requiring teachers to be trained in suicide prevention. The Jason Flatt Act, model legislation originally passed in Tennessee, requires “all educators in the state to complete 2 hours of youth suicide awareness and prevention training.” The act is now adopted by 21 states and is approved by all the states’ Departments of Education and Teachers’ Associations. The Jason Foundation’s goal “is to empower youth, educators and parents to help recognize when young people are in pain and know to get professional help involved as soon as possible” by engaging students, teachers, and parents in a Triangle of Prevention. Other examples of community engagement in suicide prevention are the American Foundation for Suicide Prevention’s (AFSP) programs, such as More Than Sad. This program teaches students and teachers how to spot signs of depression and be proactive about mental health; this program can be delivered by local AFSP chapters in-person or virtually, and is available in Spanish, thus this is an accessible resource. 

Legislators can also remove barriers to mental health treatment by revising parental consent laws, as many youth are discouraged from seeking help over worries that their parents will find out and react poorly. For example, in Colorado, House Bill19-1120, the Youth Mental Health Education And Suicide Prevention act, “allows a minor 12 years of age or older to seek and obtain psychotherapy services with or without the consent of the minor’s parent or guardian if the mental health professional determines the minor is knowingly and voluntarily seeking the psychotherapy services” and the services are deemed necessary. The act also creates a mental health education literacy resource bank available to the general public. In addition, it requires that the state’s Department of Education adopt suicide prevention standards. Lastly, the bill appropriates $116,550 to the Department of Education to implement these provisions. 

New York recently enacted a public health law that increases access to mental health services at children’s summer camps by expanding the types of healthcare professionals the camp can employ. Under this law, camps can now hire mental health therapists, social workers, and speech and occupational therapists to accommodate campers with developmental disabilities. This legislature comes after the COVID-19 pandemic increased awareness of youth mental health issues and the need for accessible treatment services. 

These cases highlight how policy changes can help improve access to mental health services and reduce the stigma surrounding these topics. Despite these steps forward, in many places finding accessible and affordable mental health services is a challenge. Overall, many people seeking help–especially in the LBGTQ community and other vulnerable groups–experience discrimination, financial, and geographic barriers, implicating the need for more structural changes and policy actions.

Erin Green, University of Arizona Senior

Erin Green is a University of Arizona senior working with the Applied Health Policy Institute for her internship. She is majoring in public health with a minor in government and public policy. Erin is very involved with the university community; she serves as a Campus Ambassador and has a job working on communications at the MEZCOPH Administration Department. She also did and internship at the Asthma and Airway Disease Research Center. Erin is particularly passionate about youth mental health, especially for LGBTQ people and would like to improve communities through policy and health communications.

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