: October 08, 2024
: LGBTQI+, Office of Behavioral Health Equity, Mental Health
: Emily Hassey, M.P.H., Public Health Advisor, Center for Mental Health Services

The lesbian, gay, bisexual, transgender, queer/questioning, and intersex (LGBTQI+) community faces unique challenges related to mental health conditions and substance use disorders yet is often underrepresented in discussions about behavioral health. The LGBTQI+ Behavioral Health Summit held on June 24-25, 2024, in Rockville, MD, was a ground-breaking event for the Substance Abuse and Mental Health Services Administration (SAMHSA). Over the course of two days, members of the LGBTQI+ community and other experts came together to address the mental health and substance use conditions that face the community today.

The attendees included representatives from national and local LGBTQI+ organizations, and project directors from SAMHSA’s LGBTQI+ Family Support Grant Program, along with various federal partners. The goal of the event was to build supportive communities and partnerships, optimize health and wellness across the lifespan, and eliminate behavioral health disparities and achieve health equity. Throughout the Summit, attendees participated in sessions that focused on identifying existing gaps and developing innovative solutions to address the unique behavioral health needs of LGBTQI+ individuals. Topics included lived-experience, research and data, preventative care, evidence-based practices and interventions, crisis care and services, innovations in care, and youth mental health. Of note, several key themes and action items emerged.

Uplift and Integrate Expert Voices in Federal Programming: Attendees emphasized that experts in the fields of research, clinical work, mental health and substance use treatment and prevention, peer support, and lived experience need to be at the federal table. These experts offer unique and intricate understanding of the needs of LGBTQI+ people across the states, territories, and tribal lands – and are willing to share their knowledge, skills, and expertise to enhance SAMHSA programming for the LGBTQI+ community. For this reason, it was suggested that, when creating service programs, SAMHSA utilizes expert and community voices.

Support and Sustain the LGBTQI+ and LGBTQI+ -serving Workforce: Many individuals who work with the LGBTQI+ community in behavioral health settings also identify as members of this community. The workforce is limited, and the burden of providing behavioral health services is heavy for these providers. Since many who work with the LGBTQI+ community have lived experience similar to the lived experience of those they care for, they put their hearts and souls into the work. Workforce shortages, coupled with compassion fatigue, can lead to burnout (PDF | 8.7 MB). It’s critical that staff be offered the appropriate breaks and mental health days, time off, and mental health check-ins. Knowing that staff burnout is a problem for the LGBTQI+ workforce, participants put forward the idea that service-provision organizations might want to consider preparing and changing organization policies to support these staff members so they can, in turn, continue to help others.

Protect and Promote LGBTQI+ Youth Mental Health: The call to action to help and protect LGBTQI+ youth was loud and clear. Participants shared concerns throughout the Summit about the safety and wellbeing of LGBTQI+ youth. In fact, conversations centered on adult services tended to circle back to youth and young adults. LGBTQI+ youth and young adults are struggling deeply with behavioral health concerns, exacerbated by environmental factors that reinforce discrimination and harassment including state laws limiting medical care, the banning of books containing LGBTQI+ representation, and hate spreading online and on social media platforms.

One of the most important ways to support LGBTQI+ youth is through family acceptance. Strong evidence shows that family acceptance helps protect against depression, suicidal behavior, and substance use and promotes self-esteem, social support, and overall health experience for LGBTQI+ youth. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health* found that LGBTQ youth who felt high social support from their family reported attempting suicide at less than half the rate of those who felt low or moderate social support.

During the Summit, one of the presenters emphasized the critical need to help families accept their LGBTQI+ children by educating clinicians on evidence-based approaches to family therapy that work towards acceptance. Another presenter discussed the need for increased positive LGBTQI+ representation in media, TV, and film. This representation can help show youth that there is a future for themselves, even if, in their community, they do not see others like themselves. Positive representation also provides an opportunity for those who might not be accepting of LGBTQI+ individuals to see these individuals as everyday people and not as “others.”

What SAMHSA is Doing

These action items and lessons learned will help refine SAMHSA’s existing LGBTQI+ focused programs and initiatives, as well as inform future efforts. Current efforts include the recent launch of the LGBTQI+ Family Support grant program, the 2023 release of a data report (PDF | 682 KB) examining lesbian, gay and bisexual behavioral health, as well as encouraging states to address the needs of LGBTQI+ youth through guidance (PDF | 115 KB) that provides examples of how states, tribes and communities are using SAMHSA funding for this purpose. Additionally, the 988 Suicide & Crisis Lifeline now has a specialized service for LGBTQI+ youth and young adults offering 24/7 call, text, and chat access to LGBTQI+-trained crisis counselors. And, since 2020, SAMHSA has funded a Center of Excellence for LGBTQ+ Behavioral Health Equity, which provides training, coaching, and technical assistance to behavioral health practitioners with the intent to implement change strategies to address disparities impacting the LGBTQI+ community.

SAMHSA also has a webpage dedicated to the LGBTQI+ population, featuring national reports, agency and federal initiatives, and other resources, including a SAMHSA report (PDF | 5.2 MB) featuring evidence and action to support and affirm LGBTQI+ youth.

Following the Summit, a SAMHSA grantee shared they were moved by the visibility and representation of LGBTQI+ individuals and allies committed to addressing LGBTQI+ behavioral health through federal public service. LGBTQI+ federal employees are working across programs and agencies to ensure equitable services in all realms of healthcare. The LGBTQI+ Behavioral Health Summit provided an opportunity for these employees and experts in the field to meaningfully and purposefully connect, strengthening the network of behavioral health services and supports for the LGBTQI+ community. As we recognize LGBT History Month this October, SAMHSA remains steadfast in its commitment to advance these efforts and address the unique behavioral health needs of the LGBTQI+ community.

Additional SAMHSA Resources

Please visit the resources below for more information on SAMHSA’s grant programs and initiatives that promote and support LGBTQI+ behavioral health.

*The Trevor Project is a leading national nonprofit organization focused on suicide prevention efforts among the LGBTQ+ population, and its widely known national survey provides critical data and insight into mental health trends among LGBTQ+ youth.