Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Angela Weeks, director of the University of Connecticut School of Social Work’s National SOGIE Center at Innovations Institute, is urging behavioral health providers to ask people how they identify. The acronym SOGIE stands for sexual orientation, gender identity and expression.
There’s no consistent, structured way to collect identity data from people accessing mental health and substance use services, making it challenging to pinpoint how best to address inequity.
“One of the biggest gaps is just getting providers to ask people how they identify,” she said.
Providers assume, said Weeks, that the LGBTQ population is “very small” and not worth asking every person they serve about their sexual orientation and gender identity.
“But we don’t actually know the population size because we don’t ask.”
One area where there’s no ambiguity is how important family support is for LGBTQ youth. Dr. Caitlin Ryan’s research at The Family Acceptance Project has illustrated that youth from unaccepting homes have an increased risk of depression, suicidal thoughts, substance misuse and STDs. Highly rejected LGBTQ youth are eight times more likely to make a suicide attempt.
More family rejection increases risk, with the risk rising as rejection does. Families that pivot, adopting supportive, affirming practices, can reduce the risk of the youth dying by suicide.
“Family support is key to reducing those risks,” said Weeks. “Yet, across the nation, there’s no concerted effort to work with families.”
Organizations often focus on how to care for youth experiencing family rejection, like having a chosen family made up of supportive friends and family of origin. That’s necessary work, said Weeks, but it doesn’t move the marker toward support and safety in families or communities.
“People shouldn’t have to flee,” she said. “To make a larger scale change, families and communities need to be involved.”
Small movements toward affirming behaviors — like using a young person’s name and pronouns — can make a difference in their mental health. “Just using the name and pronouns of a young trans person has a drastic impact.”
Research by the Trevor Project has shown that transgender and nonbinary youth who have their pronouns respected by all people with whom they lived attempted suicide at half the rate of those who didn’t have them respected by any.
Even having one supportive adult in an LGBTQ young person’s life can reduce the risk of suicide. Yet, only 38% of LGBTQ youth who participated in the Trevor Project’s 2023 annual mental health survey felt that their home was LGBTQ-affirming.
“We know what helps,” said Weeks. “How do we get this information in front of families and caretakers in a way where they’ll use it?”
Most families fall somewhere in the middle, supporting young people in some spaces but not others. For example, a family might be fine with their child wearing nail polish at home but then force them to take it off when they go outside.
“They want to support the young person as much as possible,” she said. “They also have a lot of external fears about what their community might say.”
Fear is often at the center of a family’s unsupportive behaviors — concern that their child will be rejected or bullied. Parents also fear that they themselves will face judgment and rejection:
What will grandma say?
Is it my fault if something happens to my child because I allowed them to do this?
Is my church going to accept me? Are my friends?
Am I going to lose the people I love?
This is where mental health professionals can help, working with families to build trust and get to the root of what’s driving the fear. The fears are real, said Weeks.
“Even though we can work past them with the right clinical support, it doesn’t take away the very real risk of their child getting bullied in school. They might lose their community.”
Mental health professionals can help support the family and prepare for if their fears come to fruition, like how to find affirming communities and mitigate risks of bullying and advocate for their child if they are.
“We can talk through what happens if they, for example, lose their church community,” said Weeks, “and make sure they know they don’t have to give up their faith.” She added: “There are affirming faith communities out there.”
Middle and high school LGBTQ youth do experience higher rates of bullying. Data from the Trevor Project’s 2021 survey showed that more than half of LGBTQ youth in middle or high school reported being bullied. Children and adolescents in an affirming home, said Weeks, are more likely to tell their parents that they’re being bullied.
“If a young person is bullied at school and home is a supportive space, then they have a place to turn for help. That’s really important.”
In Weeks’ work, she’s developed modules on supporting providers and teaching families how to advocate for their children, like questioning schools about their policies and responses to bullying. When a family advocates for their child at school, therapists can help them encourage more LGBTQ visibility at school and safe spaces beyond Genders & Sexualities Alliance clubs.
“School mental health providers are also usually great people to go to and can be active about their allyship and support.”
When that doesn’t change the conditions at school, mental health professionals can teach families which levers to pull to hold schools accountable if the school is un- or under-responsive. Or if school leadership is contributing to the issue.
“We want to make sure families know where to go and how to report mistreatment,” said Weeks. “Right now, that’s a huge conversation in our country. We see a lot of schools rolling back their anti-discrimination policies.”
Several programs guide providers on how to help families support LGBTQ youth. Among them is the Family Support Model, which includes education on LGBTQ youth’s unique needs and how to increase protective factors — like relationships with accepting peers and adults — and affirming behaviors, such as talking to the youth about their identity. These models include assisting families to understand the adverse effects of not allowing youth to spend time with other LGBTQ youth.
“Families, when given the right kind of support and information, often open up and become advocates in their community, but there hasn’t been enough investment in this space.”
Funding is key, but getting the proper support to families and their young people requires funding and support from federal and state leaders. While there are funding streams for the deep-end systems like juvenile justice, child welfare and, increasingly, mental health crisis systems, Weeks believes more funding and attention also need to be given to the earliest points of care.
“Funders come with criteria and strings attached, some requiring programs to already have rigorous data sets,” she said.
Many programs serving specialized populations can take decades to be recognized as rigorously evaluated programs, but they have preliminary data to illustrate their positive impact on families and youth.
“Funding with fewer strings attached is needed to encourage providers to make services as accessible to families as possible.
“We have to understand that families are an incredible asset to young people’s health and wellbeing,” she said, “and if we want to see the disparities decrease and vanish, we have to invest in families and communities, and we need flexibility around that investment.”
