Student Well-Being

Most LGBTQ Youth Can’t Access Mental Health Care. How Schools Can Help

By Lauraine Langreo — January 03, 2023 3 min read
People wave pride flags and hold signs during a rally in support of LGBTQ students at Ridgeline High School, April 14, 2021, in Millville, Utah.
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A majority of LGBTQ students in every state except two said they sought mental health care but were unable to access it, according to a Trevor Project report.

In Vermont and Minnesota, 45 percent and 49 percent of LGBTQ youth, respectively, were not able to get the mental health care that they wanted, the report found. In all other states, the percentage of LGBTQ youth who were not able to access mental health care ranged from 50 percent to 72 percent, with Nevada having the highest percentage of such students.

The Trevor Project report, which was published Dec. 15, is based on the organization’s 2022 survey of nearly 34,000 LGBTQ people ages 13 to 24. It comes as state legislatures across the country have introduced bills that target LGBTQ students by restricting access to books about LGBTQ topics, limiting participation on team sports, and not offering restrooms that align with their gender identity.

The results point to “systemic barriers in accessing critical mental health care for these young people, who already face a large number of mental health challenges and increased suicide risk,” said Keygan Miller, a public training manager at The Trevor Project.

In fact, in a majority of the states, at least 40 percent of survey respondents said they have seriously considered suicide in the past year and more than 50 percent reported experiencing symptoms of anxiety and depression.

In most states, many survey respondents said they were unable to access mental health care because they didn’t want to have to get their parent/caregiver’s permission or because they were afraid of talking about their mental health concerns with someone else.

LGBTQ-affirming schools report better mental health outcomes

Schools play a big role in ensuring LGBTQ students have access to supportive spaces and the mental health care they want and need, according to experts. The Trevor Project’s previous research has found that LGBTQ students who have access to LGBTQ-affirming schools report better mental health outcomes and lower rates of attempting suicide, Miller said.

But, on average, the report found that about 40 percent of LGBTQ students said their school was a “LGBTQ-affirming space,” or one where they can freely express their identity safely and without fear. In Mississippi, only 23 percent of LGBTQ youth said their school is an affirming space, compared with 53 percent in Delaware.

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“The reason it is so imperative for schools to be an affirming space is [because] school is the only place that young people have to go,” said Amy Cannava, the appointed chair of the National Association of School Psychologists’ LGBTQ+ committee and a school practitioner in Virginia. “Because they have to be there, it becomes our obligation to act, following what is considered to be empirically validated best practices, which is to be affirming. They legally have a right to be in a place that is safe and supportive and not going to endanger their mental or physical health.”

And because oftentimes students don’t have the support they need at home, school becomes “where they’re seeking therapy or coming out for the first time to an adult for support,” Cannava said.

But providing counseling and mental health services to students is not that simple, Cannava said. For one, school districts have a shortage of school-based health-care professionals. And not every school district job description for school counselors, social workers, or psychologists allows them to provide counseling in the school.

So what can middle and high schools do to support LGBTQ students? Here are some recommendations from Miller and Cannava:

  • Talk to students about what they need instead of assuming what they need, by conducting focus groups or surveys to hear what would make them feel physically and psychologically safe and able to learn;
  • Expand mental health counseling and extracurricular activities like Gender and Sexuality Alliances (GSAs);
  • Implement suicide prevention policies and intersectional mental health services that specifically consider the unique stressors and challenges faced by students who hold multiple marginalized identities;
  • Implement transgender-inclusive policies, such as access to sports and gender-inclusive bathrooms, inclusion in health curricula, and the ability to change one’s name and gender marker in school systems and documents;
  • Educate teachers and parents about LGBTQ identities and mental health and suicide prevention;
  • Implement zero-tolerance policies for anti-LGBTQ bullying and harassment.
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