Bloomberg Law

LGBTQ mental health gets Biden push amid Red State attacks

LGBTQ suicide prevention efforts come in line with Biden administration funding boost as conservative state lawmakers launch legislative and policy attacks that health experts say undermine gay mental health and transgender people.

The Department of Health and Social Services distributed nearly $110 million in October and November for Vibrant Emotional Health non-profit to increase the 988 hotline. The main goal is to help 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 considering suicide in the past year, while 14% have tried 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 non-binary youth were concerned about state or local laws hindering access to gender-affirming medical care, while more than half of LGTBQ youth seeking care mental health could not access it.

The 988 hotline aims to be that service for LGBTQ communities. Launched in July, the service has recently rolled out specialist LGBTQ calling services, with other projects underway. But delivering targeted services is proving to be an uphill battle, health experts say.

Shortages of specialists versed in LGBTQ-specific mental health struggles and of medical professionals prepared to treat them are among the key barriers to more widespread services.

State Legislative Action

Meanwhile, conservative states across the United States have launched legislative attacks widely seen as targeting gay and trans people.

Lawmakers in Tennessee, Oklahoma, Arizona and Iowa each introduced at least 10 bills during the 2022 session deemed “anti-transgender” by the Freedom for All Americans campaign, while that more than 20 other states have also introduced bills. Similarly, “anti-LGBTQ bills” have been introduced in more than half of US states.

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 to school, as well as Texas’s decision to investigate parents of transgender youth for alleged child abuse.

Some conservative groups are strongly opposed to the initiatives of the Biden administration.

America First Legal President Stephen Miller called the Biden administration’s stance on gender issues “anti-science extremism.”

Similarly, American Principles Project President Terry Schilling said in a statement that “widespread transgender normalization has been fueled by a mix of factors: ideological capture by major cultural institutions, financial profitability for Big Pharma encourage gender transitions and well-funded lobbying campaigns in politics.

“Despite the overwhelming evidence that this movement harms the physical and mental health of countless children, its proponents continue to push forward, while illuminating the public about the horrific effects,” Schilling said.

“Political Football”

“”The combination of gay must-haves in Florida, with the state of Texas coming after parents of trans teens, all further speak to a society “where LGBTQ well-being is” a particular health concern. important,” said Leon Rodriguez, who served as head of the HHS Office of Civil Rights in the Obama administration.

“It makes a young person feel less safe, makes them feel like there’s something wrong with them,” said Hannah Wesolowski, advocacy manager for the National Alliance on Mental Illness. . This 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. Section 1557 of this law prohibits discrimination based on 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 to cover or provide gender transition care. The Biden administration then backtracked, proposing a rule to protect LGBTQ people from discrimination.

“It hurts people to be treated like political football,” said Kellan Baker, executive director of the Whitman-Walker Institute in Washington.

Find help

The National Alliance on Mental Illness has noted that lesbian, gay or bisexual adults are more than twice as likely experience a mental health problem 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 queer and trans people are still in parts of our society marginalized in different ways, and arguably certainly discriminated against and persecuted, it’s not entirely surprising that there are mental health needs distinct characteristics that accompany membership in this 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% were unable to obtain them in the past year. This 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 discussing mental health issues and lack of affordability, others were unique to the experience of LGBTQ youth, such as the fear of being revealed or the fear that their identity will be revealed. misunderstood,” said Myeshia Price, director of scientific research at the Trevor Project.

“Research consistently demonstrates that LGBTQ youth who have marginalized identities, including LGBTQ youth of color, often face even greater barriers to care compared to their peers,” Price said.

This fall, 988 launched a pilot program which provides expert call, chat and text support to 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 3:00 p.m. to 2:00 a.m. Eastern Time daily and 24 hours a day, 7 days a week by telephone, a schedule subject to change once capacity is reached. to provide all services 24 hours a day.

“The lifeline helps save lives,” Wesolowski said, although she said there was still work to be done.


A SAMHSA spokesperson said Lifeline 988 is made up of about 200 local crisis centers across the United States, among which staffing needs are generally “consistent.”

Finding professionals properly trained to deal with the needs of LGBTQ people is particularly tricky. “Historically, there hasn’t been a focus on LGBQTIA populations in medical schools,” Whitman-Walker’s Baker said.

SAMHSA recognized the need for better trained professionals. “Generally, some providers haven’t had the opportunity to get the training they need, some may not seek it out,” said Brian Altman, principal advisor at SAMHSA.

Altman said the agency is working with professional organizations to ensure they promote relevant information.

He also noted that SAMHSA plans to revise and update a Act 2015 support LGBTQ youth and oppose conversion therapy.

“Affirmative and Compassionate Support”

From an early age, LGBTQ people can be left alone to navigate their communities and schools, struggling to express themselves while dealing with other layers of trauma and hardship, Wesolowski said. What’s more, these people face “significant discrimination” when trying to access health care in general, which exacerbates suicidal ideation and depression.

When it comes to providing crisis services to LGBTQ people, “finding someone who has knowledge and can have a shared background in their experience is absolutely critical, and they often don’t experience it,” Wesolowski said. .

Miriam Delphin-Rittmon, HHS assistant secretary for mental health and head of SAMHSA, said the agency wants young people “who are experiencing a mental health or addiction crisis or who are feeling suicidal to know that they can call, text or chat on 988 without fear of judgement.”

She said LGBTQ youth should expect “when they ask for help, they receive affirming and compassionate support.”

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