A new report by the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) provides a comprehensive overview of the scientific research and consensus that LGBTQI+ youth are resilient and can thrive when they are supported and affirmed, but that pervasive discrimination, rejection, and bullying of LGBTQI+ youth has led to a nationwide mental health crisis. The report finds that this crisis is most acute for transgender youth, whose mental health and wellbeing is put at risk by policies that seek to restrict their access to appropriate health care and inclusion at school. HHS is releasing this report today, on Transgender Day of Visibility, to uplift transgender youth and the parents, teachers, and providers who support them.
The report, Moving Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth, strengthens previous findings that it is normal and healthy for children to identify as LGBTQI+ and that all children should have their sexual orientation or gender identity affirmed and supported. The report also strengthens previous findings that sexual orientation and gender identity (SOGI) change efforts, commonly known as so-called “conversion therapy,” are never appropriate for youth, are ineffective, and can cause significant harm.
"On Transgender Day of Visibility, and every day, we celebrate the courage and resilience of transgender people across this country in the face of violence, hatred, and bigotry,” said HHS Secretary Xavier Becerra. “Everyone should be able to be who they are and access the care they need – but, too often, that is sadly and shamefully not the case for transgender people, including transgender youth. The Biden-Harris Administration remains deeply committed to providing transgender people with the care and support they need. That’s why we have helped to stand up the 988 Suicide & Crisis Lifeline and have staffed the lifeline with counselors trained to support LGBTQ youth and young adults, invested in crisis health centers, and worked to get mental health support into schools. The message is clear: we see you. We hear you. And we stand with you, every single day.”
Just as evidence shows that SOGI change efforts are harmful, the report includes evidence that withholding timely gender-affirming care can also be harmful and can exacerbate distress and suicidality among transgender youth. For gender-diverse youth, gender-affirming care supports health and well-being — and should not be withheld or legally prohibited. Gender-affirming care is a highly specialized model of care that uses evidence-based practices to address distress arising from gender dysphoria. It is highly individualized and focuses on the needs of each person, appropriate to age and developmental level. Any decisions about providing gender-affirming care are reached with the involvement of an adolescent’s parent or legal guardian.
According to the report, effective therapeutic approaches support youth without seeking predetermined outcomes related to their sexual orientation, gender identity, or gender expression.
Evidence-based affirming care for LGBTQI+ youth:
- provides accurate information on sexual orientation, gender identity, and gender expression;
- affirms that diversity in sexual orientation and gender identity is normal and healthy;
- identifies sources of distress for youth and families — and works in partnership with youth and their parents to reduce it;
- supports adaptive coping, to improve well-being;
- seeks to protect youth from the negative effects of stigma, rejection, and discrimination;
- increases family, school, and community support; and
- responds to youth and families’ identities.
“The increased risks to LGBTQI+ youth are not a function of their identity -- but are related to the stress of stigma and discrimination,” said HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D., and the leader of SAMHSA. “By helping to raise awareness of and address these inequities, we can help LGBTQI+ youth achieve optimal health and well-being.”
Supportive families and caregivers, peers, schools, and community environments are all associated with improved mental health and well-being, according to the report. Having even just one caring adult can make a significant, and even lifesaving, difference in the life of an LGBTQI+ youth.
Because of stigma and discrimination, LGBTQI+ teenagers continue to face extremely high levels of violence and mental health challenges, according to new data reported by the Centers for Disease Control and Prevention (CDC). The report also found that more than half (52%) of LGBTQI+ students had recently experienced poor mental health and that more than 1 in 5 (22%) attempted suicide in the past year.
The 988 Suicide & Crisis Lifeline began operating a federally-funded pilot program for LGBTQI+ youth last fall, as part of the department’s strategy to expand access to affirming support for LGBTQI+ youth who are struggling with a mental health crisis. The LGBTQI+ youth pilot program provides the “press 3” option and is designed for anyone under 25 who wants to connect with a counselor specifically focused on meeting the needs of LGBTQI+ youth and young adults. Since the pilot was launched in September 2022, the demand for this service (calls, chats, texts) has accounted for about 6% of calls routed in the network and 11% of routed chats and texts.
Moving Beyond Change Efforts is based on a rigorous review of the scientific evidence and a professional consensus from a panel of experts who are practitioners and researchers in child and adolescent development and mental health; researchers in gender development, gender identity, and sexual orientation; and experts in related fields. It builds on the 2015 SAMHSA report Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth.
The 2023 revision includes additional research on harms associated with SOGI change efforts; latest developments and research in the field of sexual orientation and gender identity; development in youth; updated guidance for behavioral health providers, families, caregivers and school-based professionals; and a new section on public policy considerations.
The report explores policy levers and future research areas that support the health and well-being of LGBTQI+ youth and their families. However, the report doesn’t mandate requirements or set policies for states or localities. HHS policy priorities for improving the mental health of, and reducing substance use by, LGBTQI+ youth are based on efforts to ensure LGBTQI+ civil rights and to increase access to, affordability of, and equity in health care.