ADDitude for Professionals

The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth

LGBTQIA+ youth who struggle to live their truth against a tide of outdated and unhealthy expectations are undoubtedly at risk for mental health issues. We can do better as health care professionals to guard and cultivate their physical and psychological well-being with inclusive care. Here is what that looks like.

By Elena Man, MD, Amy Dryer, MD, Rachel Sayer, LCPC, PCIT-C Verified Updated on April 28, 2023
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LGBT rainbow colors. People with flags
LGBT rainbow colors. People with flags

LGBTQIA+ youth face an elevated risk for experiencing serious mental health issues.1 Depression and anxiety impact more than half of all youth who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, or asexual, according to a 2022 survey by the Trevor Project.2 In addition, 45% of LGBTQIA+ adolescents and young adults say they have seriously considered attempting suicide in the past year, according to the same survey.2

To end this devastating trend and save lives, LGBTQIA+ youth need many things — primary among them is support. We know that societal mistreatment and stigmatization impair the mental health of this group, and that LGBTQ youth who live in accepting, affirming, and supportive environments experience fewer mental health issues than do their peers who do not.1 Health care providers must also do their part to provide inclusive care and reduce barriers to mental health care services for this group, as 60% of LGBTQ youth who wanted mental health care in the past year were not able to access it.2

It is normal and healthy for youth to explore or question their gender, sexuality, and other aspects of identity. These behaviors are not indicative of a mental health crisis. Youth navigating their gender and sexuality definitely need affirming health care – and they need compassionate and competent providers to meet them where they are.

Inclusive, Affirming Care for LGBTQIA+ Youth: Initial Steps for Providers

1. Create Inclusive, Supportive Spaces

A welcoming environment helps build patient trust and ultimately helps practitioners provide appropriate care. The following are a few ways providers can establish trusting relationships and practice allyship:

  • Post non-discrimination policies.
  • Use a patient’s chosen name and pronouns.
  • Ensure intake forms and rating scales are appropriate and use inclusive language
  • Be aware of and mitigate bias.
  • Avoid making assumptions or arriving to conclusions about a patient’s gender identity and/or sexual orientation. Doing so may invalidate a patient’s thoughts and experiences.
  • Recognize diversity within the LGBTQIA+ community, as well as intersecting identities and categories, from race and socioeconomic status to religion and disability.
  • Advocate for LGBTQIA+ youth locally and beyond. Anti-LGBTQIA+ legislation only adds to the existing mental health crisis in this group.

[Read: ADHD and Queerness — Living in the Neuroqueer Intersection]

2. Ensure Safety

Patient safety and confidentiality is paramount. It is not the role of providers to inform parents and guardians about a teen patient’s sexual identity and/or gender questioning. Ask the patient what has been shared with family members already and what they want to share or keep confidential for safety or other reasons. Safety should be defined by the patient, not the provider. Ask questions like the following:

  • Do you want your family to be involved in this conversation?
  • Knowing your family, how do you think they might respond to topics around gender, gender identity, gender expression, and/or sexuality?

For patients who do not feel safe speaking openly in their homes, providers can offer support by helping them identify and access safety in their community.

When families are involved, providers can emphasize the value of familial support, and help to ensure everyone can safely express their feelings in a judgment free space with active listening.

[Read: 12 Ways to Build Strong ADHD Families]

Additional Guidance for Patient Families

Research is clear that parental support significantly improves both quality of life and mental health for these youth. Parents, however, may experience a range of feelings, including fears and worries, along the way.

  • Encourage families to focus on their parental drive to love and support their child, acknowledging that they likely want a safe and happy life for them. Help parents acknowledge that coming out, for example, is evidence of a child’s self-awareness, acceptance, and trust. With this perspective, parents may realize that this can be a moment to be proud of their child.
  • Urge caregivers to process their emotions separately from their child. Some parents may benefit from seeing their own mental health professional to help process their emotions around their parental role, expectations, and their child’s identity. Acknowledging that a parent is navigating their own reactions can be validating and help avoid stressful confrontations at home.
  • Inform families of resources for parents of LGBTQIA+ children that address common concerns and FAQs. Families may benefit from a range of supports including inclusive community and cultural organizations, and support groups such as PFLAG.

3. Commit to Ongoing Education

Clinicians and other health professionals will best serve patients by educating themselves on current issues of gender, sexuality, and the challenges that LGBTQIA+ individuals may face. Although some patients may be open to enlightening you, it is respectful to remember that explanation of terms or identities is not a patient’s obligation or responsibility.

There are myriad resources to learn about the continuum of LGBTQIA+ identities, the queer community, and guidelines for providing quality care. (See the resource list below). Books, films, documentaries, and articles are all enriching ways to  broaden understanding. Being an informed clinician demonstrates allyship. At the same time, providers must acknowledge that LGBTQIA+ youth are ultimately the experts of their experiences regardless of prior education and personal backgrounds.

LGBTQIA+ Youth: Additional Resources for Providers, Patients, and Families

For Youth

Books

For Parents

Organizations

Books and Guides

Research and Articles

For Clinicians

LGBTQIA+ Youth: Next Steps

The Clinicians’ Guide to Differential Diagnosis of ADHD from Medscape and ADDitude

The content for this article was derived with permission from The Resource for Advancing Children’s Health (REACH) Institute, a non-profit dedicated to improving youth mental health care.

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View Article Sources

1 Lothwell, L. E., Libby, N., & Adelson, S. L. (2020). Mental Health Care for LGBT Youths. Focus (American Psychiatric Publishing), 18(3), 268–276. https://doi.org/10.1176/appi.focus.20200018

2 The Trevor Project. (2022). 2022 National Survey on LGBTQ Youth Mental Health. Retrieved from https://www.thetrevorproject.org/survey-2022/assets/static/trevor01_2022survey_final.pdf