Before the pandemic, mental health among adolescents was bad. Since the pandemic, it’s only gotten worse—especially for LGBTQ+ youth, who face extensive social and cultural pressures that put them at greater risk of negative mental health conditions.
Lesbian, gay, and bisexual youth are more than twice as likely to experience persistent feelings of sadness or hopelessness than their heterosexual peers, according to the National Alliance on Mental Health. And these concerns are even more present among transgender youth, who are twice as likely to experience depressive symptoms, seriously consider suicide, or actually attempt suicide than cisgender lesbian, gay, bisexual, queer, and questioning youth.
This significant disparity highlights why it’s essential for care providers to develop treatment plans that are specifically positioned to improve the mental well-being of LGBTQ+ youth. It’s also why Lightfully has created a program that can be personalized to address the unique challenges our adolescent clients encounter.
We asked Casey Weitzman, MA, LMFT, a Lightfully Clinical Advisory Board member and leading national specialist working with the LGBTQ+ youth, to explain the unique mental health challenges facing this community and how Lightfully’s approach is helping these patients move from suffering to well-being.
Q1: There’s been a lot of great progress with regard to awareness and acceptance of the LGBTQ+ youth recently. Why isn’t this translating to better mental health within this community?
CW: We still have a long way to go. There’s just so much people still don’t understand. Yes, there’s been more openness, especially on social media, but no one arbitrarily chooses to be transgender or non-binary.
And let’s face it: We’re now living in a fairly hostile and divided cultural and political environment, so these young people struggle with negative emotions and feel a lot of pressure from a lot of different directions. A recent study found that 92% of LGBTQ+ youth regularly hear negative messages about LGBTQ and the top sources are school, family, social media, and their peers.
LGBTQ+ youth know there are going to be more challenges for them, both personally and culturally, and that often translates into consistent mental health conditions within the community.
Q2: What are some of the specific mental health challenges facing these young people?
CW: Studies show that LGBTQ+ youth often face many challenges in school, within communities, with family and friends, and medical services. They often feel misunderstood. They’re two times more likely to be bullied, three times more likely to be sexually assaulted, and four and half times more likely to have considered suicide than their non-LGBTQ friends. As a result, they’re suffering from severe anxiety, depression, eating disorders, and substance abuses.
Lately, I’m seeing more clients starting on puberty blockers or hormone replacement therapy (HRT) to delay physical changes that don’t match their desired identity. I always counsel them that it’s not a silver bullet. It can help, but if you’re depressed or anxious, it isn’t going to go away overnight.
I’m not sure if it’s because the kids are now just coming out of pandemic, but I’m seeing so much more sadness, hopelessness, and tears. I have recommended many people seek medical help such as anti-depressants and treatments on that level. I just think so many of these kids are burned out. They’re reading so much social media and how terrible their lives are or will be.
They’re like, “What now?” A lot of them are now going to go off to college feeling really afraid. I’m referring more LGBTQ+ youth for higher levels of treatment than I ever had before. I suspect we’ll see more adolescents in general—and more LGBTQ+ youth specifically—in our residential programs moving forward.
Q3: You’ve also spoken about the misperceptions the LGBTQ+ community has toward therapy and therapists, which can make treating them a challenge. Can you explain?
CW: For the transgender and non-binary populations, a big one is that we as therapists are gatekeepers. With the recent Roe v. Wade ruling and political discourse against their care, young people will hear what they can and cannot do and what hoops they have to jump through to get any medical intervention. A lot of times when young people enter therapy, we’re sometimes seen as the enemy. For that reason, LGBTQ+ patients struggle to maintain an honest relationship with their clinicians. They want the help but sometimes are fearful of the system. They perceive that the healthcare industry typically doesn’t understand their challenges and needs.
For other LGBTQ+, the stigma is we won’t understand them. Or will this really help? This is caused by the healthcare industry and of course, conversion therapy. At Lightfully, we address this one head on during a free consultation. We meet virtually and discuss any questions or concerns they may have before making any commitments.
If we’re working with a family, we always meet with the parents first. Having parental support is a game changer. Without it, the numbers spike in terms of suicidal ideations and suicide attempts, depression, anxiety, things like that.
Q4: What does parental support look like?
CW: Let me answer with a few stats. A study by HRC of 10,000 LGBTQ+ youth, 13 to 17 years old, found that only 56% are out to their immediate family, and a quarter to extended family. Why? Because of those who are out, more than a third say their family is not accepting of them.
In fact, a study by the Administration for Children Family Services found that 39% of LGBTQ+ youth were eventually forced from their homes due to their sexual orientation or gender identity.
So, naturally, many young LGBTQ+ patients worry their parents and families will not understand and support them. Acceptance of transgender and non-binary is 30 years behind being gay or lesbian. Parents will tell me, “Why can’t my child just be gay?”
The first thing we say is, “Don’t panic and be supportive no matter what.” What’s beautiful is after a short amount of time, sometimes the parents become bigger advocates for their kids than the kids are for themselves.
At the end of the day, all patients deserve the treatment they need and should be accepted for whomever they are—even if they’re still unsure of their identities. It’s the therapist’s job, as the care provider, to help the patient build a support system and gain the skills he or she needs to thrive. With LGBTQ+ patients, that needs to start with family support above all.
Lightfully clinicians work closely with families and, ultimately, help them accept their children’s identities. Families are involved from the start of a patients’ time in our program; they take part in the orientation process, provide their insights through assessments, and participate in family sessions twice a week.
Ultimately, we want to help families understand and prioritize their child’s needs so our clients can easily transition to outpatient care after their time at our treatment center—and have access to a deep-rooted network of family and allies in the long term.
Also, we immediately tell parents to limit access to social media. Though it has some positives—such as the global movement toward more openness and acceptance—it can still be a fairly hostile place for individual youth.
And there are indirect consequences too. For example, we know that youth need about eight or nine hours of sleep a night, but a lot of them are getting only four or five hours. Literally say they can’t get their homework done, but they’re on social media for 20 hours a week.
When they come to a session, I’ll say, “Let’s go take a walk” or “I have a little garden—let’s go put our hands in the dirt.” I think that more residential and outpatient programs should have gardens. This stuff is so foreign for many of this youth who I work with.
Q5: Last question: What makes you hopeful?
CW: A lot of things, actually. I see progress every day. Seemingly little things make a big difference. Like parents using the right pronoun. I’ve actually had to have some parents use a cookie jar. Every time they use the wrong pronoun, I have them put a dollar in the jar. After a week, they’re like, “Oh my God.”
We talk with the kids too. “Listen, your parents are trying, and I know that they’re slipping up. But you just told them you’ve known for a year and they’re just finding out and they’re in shock. So try and be a little more patient with them.”
It’s hard work but it’s so rewarding. Slowly, we’re fixing the fissures and slowly bringing families back together.
And despite what’s happening politically, there are more providers, more surgeons, and more support from families and friends now than I’ve ever seen in the 31 years that I’ve been doing this work. That gives me a lot of hope. They are the most authentic people I’ve ever worked with.