LGBTQ suicide prevention efforts are in line for Biden administration funding boosts as conservative state lawmakers launch legislative and political attacks that health experts say compromise queer and transgender mental health.
The Health and Human Services Department doled out nearly $110 million in October and November for nonprofit Vibrant Emotional Health to ratchet up the 988 hotline. The main focus is to help those at risk for suicide and marginalized groups, including LGBTQ communities, for whom the need for services is high.
Forty-five percent of LGBTQ youth have seriously considered suicide in the past year, while 14% attempted it, according to a 2022 survey from the Trevor Project, a nonprofit that focuses on crisis support efforts for LGBTQ youth. That same survey found that nearly 95% of trans and nonbinary youth were concerned about state or local laws hindering access to gender-affirming medical care, while over half of LGTBQ youth looking for mental health care couldn’t access it.
The 988 hotline aims to be that service for LGBTQ communities. Launched in July, the service has recently rolled out LGBTQ specialized call services, with plans for more underway. But providing targeted services is proving to be an uphill battle, health specialists say.
Dearths in specialists versed in LGBTQ-specific mental health struggles and medical professionals prepared to treat them are among the major barriers to more widespread services.
State Legislative Action
Meanwhile, conservative states across the US have launched legislative attacks widely seen as targeting gay and trans people.
Lawmakers in Tennessee, Oklahoma, Arizona, and Iowa each have introduced at least 10 pieces of legislation during the 2022 session deemed “anti-transgender” by the Freedom for All Americans Campaign, while over 20 other states have put forth bills as well. Likewise, “anti-LGBTQ bills” have been put forth in over half of US states.
The most high-profile actions include Florida’s Parental Rights in Education Act—the so-called “Don’t Say Gay” bill—limiting discussion of gender identity and sexual orientation in school, along with Texas’ move to investigate parents of transgender youth for alleged child abuse.
Some conservative groups are in staunch opposition to Biden administration initiatives.
America First Legal president Stephen Miller has called the Biden administration’s position on gender issues “anti-science extremism.”
Likewise, American Principles Project president Terry Schilling said in a statement “the widespread normalization of transgenderism has been fueled by a mix of factors: the ideological capture of key cultural institutions, the financial profitability to Big Pharma of encouraging gender transitions, and well-funded lobbying campaigns in politics.”
“Despite the enormous evidence that this movement is damaging the physical and mental health of countless children, its advocates continue to press forward, while gaslighting the public as to the horrible effects,” Schilling said.
“‘The combination of the don’t-say-gay stuff in Florida, the state of Texas coming after parents of trans teenagers, all of this still bespeaks a society” where LGBTQ wellness is “a particularly significant health issue,” said Leon Rodriguez, who served as chief of HHS’ Office for Civil Rights in the Obama administration.
“This is making a young person feel less safe, making them feel like there’s something wrong with them,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. That makes the need for 988 “more urgent than ever.”
In a 2016 rule, the Obama administration said the Affordable Care Act intended to bar discrimination based on sexual orientation, gender identity, and transgender status. Section 1557 of that law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability by entities that primarily provide health care and receive federal funding.
The Trump administration, however, “very clearly tried to roll back” that protection, said Rodriguez, now a partner at Seyfarth Shaw LLP.
In 2020, President Donald Trump’s HHS finalized a rule that would allow insurance companies, hospitals, and health-care workers receiving federal funding to refuse covering or providing gender transition-related care. The Biden administration later reversed course, proposing a rule to protect LGBTQ people from discrimination.
“It hurts people to be treated like a political football,” Kellan Baker, executive director of the Whitman-Walker Institute in Washington, said.
The National Alliance on Mental Illness noted that lesbian, gay, or bisexual adults are over twice as likely to experience a mental health condition than heterosexual adults. Transgender individuals are nearly four times as likely as those whose gender identity is the same as that of their birth sex.
“In a world where both queer and trans people are still in parts of our society marginalized in different ways, and arguably certainly discriminated against and persecuted, it is not completely surprising that there would be distinct mental health needs that go with being in that group,” Rodriguez said.
For LGTBQ people, access to mental health services has been significantly limited. More than 80% of LGBTQ youth wanted such services, the Trevor Project found, while 60% weren’t able to get it in the past year. That includes almost three in five trans and nonbinary youth.
“While some of the most common reasons for not receiving care included universal experiences such as fear of discussing mental health concerns and lack of affordability, others were unique to the LGBTQ youth experience—such as fear of being outed, or fear of their identity being misunderstood,” said Myeshia Price, director of research science at the Trevor Project.
“Research consistently demonstrates that LGBTQ youth who hold marginalized identities, including LGBTQ youth of color, often face even more severe barriers to care compared to their peers,” Price said.
This fall, 988 launched a pilot program that provides specialized call, chat, and text support for LGBTQI+ youth and young adults. According to the HHS’ Substance Abuse and Mental Health Services Administration, which oversees 988, chat and text specialized services are available from 3 p.m. to 2 a.m. Eastern time daily and 24/7 by phone, a schedule set to change once the capacity is reached to provide all services around the clock.
“The lifeline does help save lives,” said Wesolowski, though she said there’s more work to be done.
A SAMHSA spokesperson said the 988 lifeline is composed of around 200 local crisis centers across the US among which staffing needs are generally “consistent.”
Finding properly trained professionals for treating the needs of LGBTQ individuals is particularly tricky. “Historically there has not been any focus on LGBQTIA populations in medical school,” said Whitman-Walker’s Baker.
SAMHSA acknowledged the need for better trained professionals. “In general, some providers haven’t had the opportunity to get the training that they need—some may not seek it out,” said Brian Altman, senior adviser at SAMHSA.
Altman said the agency is working with trade organizations to ensure they promote relevant information.
He also noted that SAMHSA plans to revise and update a 2015 document supporting LGBTQ youth and opposing conversion therapy.
‘Affirming, Compassionate Support’
From an early age, LGBTQ individuals may be left alone in navigating their communities and schools, struggling to express themselves while facing other layers of trauma and difficulty, Wesolowski said. What’s more, such individuals face “significant discrimination” when trying to access health care generally, exacerbating suicidal ideation and depression.
When it comes to providing crisis services for LGBTQ individuals, “finding somebody that has familiarity and may have shared background in their experience is absolutely critical, and they often don’t experience that,” Wesolowski said.
Miriam Delphin-Rittmon, HHS assistant secretary for mental health and SAMHSA leader, said the agency wants youth “who are experiencing a mental health or substance use crisis or who are feeling suicidal to know they can call, text or chat 988 without fear of judgment.”
She said LGBTQ youth should expect “that when they do reach out for help, they are met with affirming, compassionate support.”