LGBTQ suicide prevention efforts are in line for funding increases from the Biden administration as conservative state lawmakers launch legislative and policy attacks that health experts say compromise queer and transgender mental health.
The Department of Health and Human Services distributed nearly $110 million in October Y November for the non-profit organization Vibrant Emotional Health to increase the 988 hotline. The primary focus is helping people at risk of 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 last year, while 14% tried, 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 non-binary youth were concerned about state or local laws that hinder access to gender-affirming health care, while more than half of care-seeking LGBTQ youth mental health were unable to access it.
The 988 hotline aims to be that service for LGBTQ communities. Launched in July, the service has recently launched specialized LGBTQ calling services, with plans for more in the works. But delivering targeted services is proving to be an uphill battle, health specialists say.
The shortage of specialists versed in LGBTQ-specific mental health issues and of medical professionals trained to treat them are among the main barriers to more widespread services.
state legislative action
Meanwhile, conservative US states have launched legislative attacks widely seen as targeting gay and trans people.
Lawmakers from Tennessee, Oklahoma, Arizona and Iowa have each introduced at least 10 laws during the 2022 session deemed “anti-transgender” by the Freedom for All Americans Campaign, while more than 20 other states have also introduced bills. In addition, “anti-LGBTQ bills” have been introduced in more than half of the US states.
Higher-profile actions include Florida’s Parental Rights in Education Act, the so-called “Don’t Say Gay” bill, which limits discussion of gender identity and sexual orientation in school, along with Texas measure to investigate parents of transgender youth for alleged child abuse.
Some conservative groups strongly oppose the initiatives of the Biden administration.
America First Legal President Stephen Miller has I call the Biden administration’s position on gender issues “anti-scientific extremism”.
Likewise, the president of the American Principles Project, Terry Schilling said in a statement “The widespread normalization of transgenderism has been driven by a combination of factors: the ideological capture of key cultural institutions, the financial returns to Big Pharma from encouraging gender transitions, and well-funded political lobbying campaigns.”
“Despite the overwhelming evidence that this movement is harming the physical and mental health of countless children, its advocates continue to push forward, while criticizing the public about the horrifying effects,” Schilling said.
“’The combination of the things of not saying gay in Florida, the state of Texas going after parents of trans teens, all of this still speaks to a society” where LGBTQ well-being is “a particularly important health issue,” Leon said. . Rodriguez, who served as head of the HHS Office for Civil Rights in the Obama administration.
“This makes young people feel less safe, that they feel like something is wrong with them,” said Hannah Wesolowski, director of advocacy 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 was intended to prohibit discrimination based on sexual orientation, gender identity, and transgender status. article 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 funds.
However, the Trump administration “clearly tried to reverse” that protection, said Rodriguez, now a partner at Seyfarth Shaw LLP.
In 2020, President Donald Trump’s HHS ended a rule that would allow insurance companies, hospitals and health care workers that receive federal funds to refuse to cover or provide care related to gender transition. Later, the Biden administration reversed course, proposing a rule to protect LGBTQ people from discrimination.
“It hurts people to be treated like a political football,” said Kellan Baker, executive director of the Whitman-Walker Institute in Washington.
The National Alliance on Mental Illness noted that lesbian, gay, or bisexual adults are more than twice as likely experience a mental health condition than heterosexual adults. Transgender people are nearly four times more likely than those whose gender identity is the same as their birth sex.
“In a world where both queer and trans people are still marginalized in parts of our society in different ways, and possibly certainly discriminated against and persecuted, it is not entirely surprising that there are different mental health needs that go along with being in that group. Rodriguez said.
For LGBTQ people, access to mental health services has been significantly limited. More than 80% of LGBTQ youth wanted those services, the Trevor Project found, while 60% were unable to get them last year. That includes nearly three in five trans and non-binary youth.
“While some of the most common reasons for not receiving care included universal experiences such as fear of speaking up about mental health issues and lack of affordability, others were unique to the experience of LGBTQ youth, such as fear of being found out or the fear of having their identity questioned. misunderstood,” said Myeshia Price, director of scientific research for the Trevor Project.
“Research consistently shows that LGBTQ youth who have marginalized identities, including LGBTQ youth of color, often face even more severe barriers to receiving care compared to their peers,” Price said.
This fall, 988 released a pilot program providing 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, specialized chat and text services are available from 3 p.m. to provide all services 24 hours.
“The lifeline helps save lives,” Wesolowski said, though he said there is more work to be done.
A SAMHSA spokesperson said the 988 lifeline is made up of about 200 local crisis centers across the US, among which staffing needs are generally “consistent.”
Finding professionals who are properly trained to address the needs of LGBTQ people is particularly difficult. “Historically, there hasn’t been any focus on LGBQTIA populations in medical school,” Whitman-Walker’s Baker said.
SAMHSA recognized the need for better trained professionals. “Overall, some providers haven’t had the opportunity to get the training they need; some may not look for it,” said Brian Altman, SAMHSA senior advisor.
Altman said the agency is working with trade organizations to ensure they promote relevant information.
He also noted that SAMHSA plans to review and update a 2015 document supporting LGBTQ youth and opposing conversion therapy.
‘Compassionate, Firming Support’
From a young age, LGBTQ people can be left alone in their communities and schools, struggling to express themselves while dealing with other layers of trauma and difficulty, Wesolowski said. Additionally, these people face “significant discrimination” when trying to access healthcare in general, exacerbating suicidal ideation and depression.
When it comes to providing crisis services for LGBTQ people, “finding someone who is familiar and may have a 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 leader of SAMHSA, said the agency wants young people “who are experiencing a mental health or substance use crisis or who are feeling suicidal to know that they can call, text text or chat at 988 without fear of being judged. .”
She said LGBTQ youth should expect “that when they do seek help, they are met with compassionate and affirming support.”