The Britannica Dictionary defines pride as “a feeling that you respect yourself and deserve to be respected by other people.” There is no doubt that for people to achieve wellbeing and thrive, individuals must respect themselves and be respected by others. When one does not respect oneself or does not feel respected by others, their behavioral health is impacted. This Pride Month, I want every lesbian, gay, bisexual, transgender, queer, questioning, and intersex (LGBTQI+) person to know that SAMHSA respects you, honors you and is working every day to ensure that you receive equitable access to high quality care.
SAMHSA has a multi-pronged approach to addressing the behavioral health needs of LGBTQI+ individuals with, affected by, or at risk for mental health and substance use conditions, which builds on the President’s Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals (EO 14075).
EO 14075 called for a whole-of-government approach to addressing exposure to the harmful practice of so-called “conversion therapy.” At SAMHSA, we refer to this discredited practice as sexual orientation and gender identity change efforts (SOGI change efforts), because the practice neither converts anyone’s sexual orientation or gender identity nor is it therapeutic in any way. On Transgender Day of Visibility this year, SAMHSA issued a report: Moving Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth. The report provides an overview of effective and ineffective therapeutic practices for working with LGBTQI+ youth and provides an update to our 2015 publication, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth.
The new report is based on a thorough review of the current scientific evidence, guidelines from medical and other professional associations, and a professional consensus by a diverse panel of experts. The report offers guidance and resources for healthcare providers, educators, families, community leaders, and others. It finds that SOGI change efforts:
- Are based on the inaccurate belief that diversity in sexual orientation, gender identity, or gender expression is an illness or shortcoming.
- Aim to change (or suppress) a person’s sexual orientation or gender identity — in an attempt to align with being heterosexual, to express one’s gender in a stereotypical way, and/or have a gender identity that’s the same as one’s sex assigned at birth.
- Are harmful, ineffective, inappropriate, and should never be provided to youth.
- Have been rejected by every major medical, psychiatric, psychological, and professional mental health organization.
In contrast, the report finds that gender-affirming care supports the health and well-being of gender-diverse youth ― and should not be withheld or prohibited. Gender-affirming care, as described in the report:
- Recognizes that variations in sexual orientation, gender identity, and gender expression are normal, healthy aspects of human diversity.
- Supports youth — without seeking any predetermined outcomes related to sexual orientation, gender identity, or gender expression.
- Is highly individualized.
- Provides education about gender and sexuality that is appropriate to age and developmental level.
- Is appropriate and beneficial for many gender-diverse youth, and may include social transition (e.g., changing one’s name, pronoun, and/or appearance).
- Addresses individual adolescent’s needs that may include some form of medically necessary gender-affirming medical care. Any decisions about providing gender-affirming care should be reached with the involvement of an adolescent’s parent or legal guardian.
As a clinical psychologist, I would stress that affirming is a professional practice that is not unique to sexual orientation or gender issues. It is about caring, and meeting individuals where they are — while honoring all aspects of their identity.
Executive Order 14075 also calls for promoting family counseling and support of LGBTQI+ youth as a public health priority of the United States. I am pleased that SAMHSA currently has a notice of funding opportunity (NOFO) announcement open until July 3rd called the LGBTQI+ Family Support NOFO. This program will provide grants to prevent health and behavioral health risks and to promote well-being for LGBTQI+ youth in the context of their families/caregivers, cultures, and communities by establishing LGBTQI+ family counseling and support programs and training providers on effective provision of these evidence-based services. Having even just one caring adult can make a significant, and even lifesaving, difference in the life of an LGBTQI+ youth.
Finally, EO 14075 also requires that we take steps to prevent LGBTQI+ suicide. Last fall, SAMHSA launched an LGBTQI+ youth specialized services pilot to the 988 Suicide & Crisis Lifeline ― which offers 24/7 call, text, and chat access to trained crisis counselors. Those who reach out to the 988 Lifeline can press 3 to opt-in for this specialized service, which aims to support young people who want to call or text 988 as well as via chat.
SAMHSA is not new to doing work in the LGBTQI+ space. Since 2007, the Sexual and Gender Minority Interest Group has been SAMHSA’s in-house professional development team for educating colleagues about the mental health and substance use disorder related needs of the LGBTQI+ population. SGMIG members share best practices, coordinate programs and policies across SAMHSA, plan activities in recognition of key LGBTQI+ observances and help develop outward-facing materials, such as the Moving Beyond Change Efforts report.
From our report to our suicide prevention efforts to our new grant program, SAMHSA continues to make strides in our ongoing support for LGBTQI+ people. June, as Pride Month, may be just one month in the year, but our work and our commitment to the LGBTQI+ community is year-round. To learn more about SAMHSA’s work that aims to enhance all LGBTQI+ individuals’ pride, please visit SAMHSA’s LGBTQI+ webpage.