Dismantling Barriers to LGBTQ+ Mental Healthcare

It's no secret that the pandemic has upended the lives and mental wellness of everyone around the world. Even those of us who've been able to safely quarantine, work remotely, and live with others who affirm us have faced depression, anxiety, and dread. Imagine, then, the additional challenges that LGBTQ+ youth face as they move through an already difficult phase of life.

Barriers to mental healthcare for LGBTQ+ youth aren't new, as our country-wide healthcare system isn't in any way set up to cater to the needs of this demographic. But the pandemic has made healthcare access even more troublesome for LGBTQ+ youth in an assortment of ways, and few programs have been put in place to offset the negative impact of the hardships the last two years have caused.

Ahead, learn why mental healthcare access is a life or death situation for this community, how the pandemic has exacerbated the barriers to needed care for them, and what's being done to ensure that young LGBTQ+ youth are able to get the care they need.

Why Is Mental Healthcare Access So Important For LGBTQ+ Youth?

It's not hyperbolic to say that mental healthcare access marks the difference between life and death. Muneer Panjwani, vice president of foundation, government, and corporate partnerships for The Trevor Project, tells Verywell Mind that suicide is the second leading cause of death among young people aged 10 to 34 and that LGBTQ youth are more than four times as likely to attempt suicide than their peers.

In addition to being life-saving, affirming healthcare leads to better mental health outcomes for LGBTQ+ youth. Cathren Cohen, staff attorney for the National Health Law Program, says that specifically, "access to gender-affirming care has a large influence on mental health outcomes for transgender youth." She notes that one study links gender-affirming healthcare to reduced rates of depression.

The pandemic has only amplified the already-present challenges of life, which also holds true for LGBTQ+ youth. Panjwani notes that LGBTQ+ youth face higher rates of stigma and discrimination and the added pressure of bullying and familial rejection, all of which can lead to an increased need for mental healthcare.

Abbi Coursolle, senior attorney for NHELP, notes that LGBTQ+ youth usually have fewer resources to address these issues than their adult counterparts do.

Barriers That LGBTQ+ Youth Face

Traversing the panoply of providers on an insurance website isn't a delight for anyone, and it's on the smaller side of issues that queer youth face when it comes to finding mental healthcare. Read on to learn the largest barriers that LGBTQ+ youth must contend with to receive needed care.

Parental Control

Youth seeking care may need permission from their parents. Coursolle tells us that "in many states, minors, or minors under a certain age (often 14 or 16) cannot access care without parental consent" and that some states are currently attempting to increase consent needed from one parent to two.

This can be a significant barrier to accessing care for kids and teens who have parents who aren't supportive of their identity. She notes that because privacy laws don't keep youth health information from being shared with their parents, accessing care without their involvement is an even larger challenge.

Cost of Care

Accessing care outside of their parents' health insurance can be a costly feat that may not be an option for most LGBTQ+ youth. Coursolle says that "over the last several years, some physician groups have developed practices with a specific focus on the LGBTQ+ community (e.g., FOLX Health)," but that specialty healthcare groups often don't accept insurance or Medicaid.

Many adults cannot afford out-of-pocket healthcare, so it's a given that very few, if any, young people would be able to.

Substandard Care

Even if a young person can get parental consent and the care costs are affordable, receiving healthcare of a reasonable caliber could be questionable. Cohen informs us that "it is well-documented that LGBTQ people, in general, face high rates of discrimination by providers and being denied services, which in turn results in LGBTQ people being afraid or unwilling to seek care because they do not want to face such discrimination."

For example, providers may willingly offer services to LGBTQ youth, but create an unintentionally unsafe environment by using the wrong pronouns.

Inasmuch as affirming healthcare improves wellness outcomes, discriminatory care can't guarantee those same outcomes. And since LGBTQ+ youth have less experience than adults in advocating for themselves, they may not know what to do when a healthcare provider discriminates against them.

The Impact of COVID-19

For most people, isolation, illness, and instability have led to worse mental health than we all had prior—including LGBTQ+ youth. Panjwani offered us sobering statistics, stating that "our research has found that 70% of all LGBTQ youth stated their mental health was 'poor' most of the time or always during COVID-19" and that "only 1 in 3 LGBTQ youth found their home to be LGBTQ-affirming."

Beyond these already large issues, Panjwani notes that many LGBTQ+ youths "were forced to stay in unaccepting home environments and didn't have access to other support systems like school, extracurricular activities, and friend groups."

He adds that being a multiple minority compounds and amplifies challenges. For example, among Black LGBTQ youth, 66% reported depressed mood in the past 12 months, 35% reported seriously considering suicide in the past 12 months, and 19% reported a past year suicide attempt. These rates are comparable to those reported in the overall sample of LGBTQ youth.

In terms of the providers who can offer mental healthcare, Coursells tells us that the pandemic has led to fewer providers available for non-COVID-related care. In turn, that may make it more difficult for a young person to find an appropriate and affirming healthcare provider that suits their needs.

Changes to Healthcare Access

While you might expect new healthcare modalities to have been put in place to offset the hardships of the pandemic, for this topic, there is only one that has had an impact: the rise of telehealth.

Courselle says that the increase in accessibility of telehealth and of providers who offer their services through telehealth has made it easier for some LGBTQ+ youth whose parents wouldn't consent to this care.

Because mental healthcare is particularly easy to receive over video conferencing or phone calls, compared to physical healthcare, this has led to an increase in the ability to find a provider to work with remotely.

"Telehealth can definitely be helpful in enabling youth to connect to services virtually, which may be easier than in-person, particularly for younger youth who can't yet drive," says Courselle.

The main downside to telehealth for young people is that generally, they live with their families and might not have the privacy needed to be forthright with a provider. Courselle stresses that some youth may be unable to safely speak aloud about their identity at home, which becomes even more troublesome when you consider that there has been an increased likelihood of family members present at home throughout this time.

Lastly, she notes that individuals of low income may also not have access to a phone or laptop to use to conduct sessions.

The Future of LGBTQ+ Youth Healthcare Access

Access to mental healthcare is vital for the health and safety of LGBTQ+ youth, although they face numerous challenges to receiving it.

As we move forward as a society working on those issues, there is the chance that cultural progress will improve those areas. While there are no further programs in place, or on the table, to improve access to mental healthcare for LGBTQ+ youth, there are actions we can all take to ensure the wellness of our younger population.

Affirming behavior can come from anywhere. Cohen tells us that "one study from a few years ago found that each area of a trans youth's life in which they are affirmed (such as by family, schools, friends, or faith groups) increases their mental health outcomes."

Affirming adults save the lives of LGBTQ+ youth. Panjwani says that "having at least one accepting adult can reduce the risk of a suicide attempt among LGBTQ young people by 40 percent," and that social support from family and friends directly leads to reduced suicide attempts. Schools also play a huge role here, with LGBTQ+ affirming schools leading to a 35% reduction in suicide attempts.

"It is extremely important that high-quality, culturally competent mental health care is available for all people who need it–including LGBTQ youth of all backgrounds and intersecting identities," says Panjwani.

A Word From Verywell

Clearly, we aren't yet where we need to be with LGBTQ+ youth access to mental healthcare. While advocates continue to fight progress, we can all do our parts to be a positive part of the lives of young people. Their lives, quite literally, depend on our support.

The Trevor Project has been able to expand its services to help LGBTQ children through a health equity grant from Bristol Myers Squibb.