“Affirming a transgender child’s identity is one of the best things a parent, teacher, or doctor can do to help keep children from harm….” President Biden

As a clinical psychologist, academician, and government leader, I have focused on ensuring that mental health care services and policies are culturally responsive, evidence-based and in the best interest of those receiving services. Providing timely, appropriate, and evidence-based treatment vastly improves outcomes and can help save our young people from suicide ideation and attempts. I want to share what we know works to best engage Lesbian, Gay, Bisexual, Transgender, Queer/Questioning and Intersex (LGBTQI+) youth as well as the resources we have for them, their families, providers, community organizations, and government agencies.

Lesbian, gay, bisexual, and other sexual orientations are normal variations of human sexuality and are not mental disorders. Similarly, transgender, non-binary, and other gender identities are normal variations of human gender and are not mental disorders. 

We know that supporting and affirming LGBTQI+ youth are the best actions mental health providers, families, friends, school personnel, and community leaders can take. Strong evidence shows that family acceptance helps protect against depression, suicidal behavior, and substance use as well as promote self-esteem, social support, and overall health experience for LGBT youth.¹ We also know that family rejection can lead to significant inequities in LGBT youth behavioral health.² LGBT young adults who reported high levels of family rejection during adolescence were:

• 8.4 times more likely to report having attempted suicide
• 5.9 times more likely to report high levels of depression; and 
• 3.4 times more likely to use illegal drugs

compared with peers from families that reported no or low levels of family rejection.³   

Research also indicates that higher rates of substance use and suicidality are partly explained by experiences of discrimination, victimization, and higher rates of depressive symptoms reported by transgender and gender diverse adolescents as compared to those who do not identify as transgender or non-binary.⁴ For example, implementation of a state-level nondiscrimination policy prohibiting private health insurers from discriminating based on gender identity appears to be associated with decreased or no changes in suicidality among gender minority individuals living in states that implemented these policies.⁵ 

Following the research and encouraging best practices for engaging LGBTQI+ youth are central to SAMHSA’s efforts. SAMHSA has a webpage dedicated to resources on the LGBT population that includes national survey reports, agency and federal initiatives, and related behavioral health resources. On the website, behavioral health providers can find a resource guide for helping families support their LGBTQI+ children; an overview for families and caretakers on how to support LGBTQI+ children; and a comprehensive report that includes therapeutic practices related to LGBTQI+ youth.

SAMHSA is continuing to engage in efforts to advance the science and evidence base related to LGBTQI+ behavioral health. Last November, the White House noted that SAMHSA is updating the 2015 publication Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth to reflect the latest research and state of the field. The revision will include updated professional consensus statements; information on health inequities and resilience among LGBTQI+ communities; and information on the latest recommended therapeutic interventions and supports for sexual and gender minority youth, their families, and the communities in which they live.  

SAMHSA also supports the Center of Excellence on LGBTQ+ Behavioral Health, which provides behavioral health practitioners with vital information on supporting the LGBTQI+ population. For example, the Center will soon host webinars on topics such as: How to Signal to Youth that You are an LGBTQ+ Affirming Provider; How to Respond When a Young Person Discloses their SOGIE; Supporting Families of LGBTQ+ Youth; and Safety Planning for LGBTQ+ Students.

Implementing evidence-based practices can often be done through SAMHSA grant programs. Recently, SAMHSA announced funding opportunities to address youth and young adult suicide prevention as well as school-based mental health promotion. Applicants for these grant programs have an opportunity to indicate that LGBTQI+ youth will be a population of focus.

Finally, like the President and First Lady, I stand with the incredibly brave transgender children, their parents, and families throughout around the country. I encourage all Americans to support and affirm LGBTQI+ youth – when it comes to loving our children as they are and following the science, we should all be on the same page.

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¹ Caitlin Ryan, PhD, ACSW, Stephen T. Russell, PhD, David Huebner, PhD, MPH, Rafael Diaz, PhD, MSW, and Jorge Sanchez, BA, Family Acceptance in Adolescence and the Health of LGBT Young Adults, Journal of Child and Adolescent Psychiatric Nursing, Volume 23, Number 4, pp. 205–213.

² Caitlin Ryan, PhD, ACSW; David Huebner, PhD, MPH; Rafael M. Diaz, PhD; Jorge Sanchez, BA, Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults, Pediatrics (2009) 123 (1): 346–352.

³ Id.

⁴ Johns MM, Lowry R, Rasberry CN, et al. Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2018;67:1211–1215. DOI: http://dx.doi.org/10.15585/mmwr.mm6743a4external icon.

⁵Alex McDowell, Julia Raifman, Ana M Progovac, Sherri Rose, Association of Nondiscrimination Policies With Mental Health Among Gender Minority Individuals, JAMA Psychiatry. 2020 Sep 1;77(9):952-958. doi: 10.1001/jamapsychiatry.2020.0770.