Healthequity4LGBTQ+ Newsletter, Issue 1: Mental Health

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ABOUT HEALTHEQUITY4LGBTQ+ aims to create cross-disciplinary conversations around LGBTQ+ health by leveraging expertise across many domains. Through bridging research and policy with lived experience, HEALTHEQUITY4LGBTQ+ hopes to raise awareness of the breadth of the health disparities facing the LGBTQ+ community and increase understanding of why these inequities are happening and how we can address them.

The mission of this organization and newsletter is to advance health equity for the LGBTQ+ community by increasing education, building policy awareness, and sharing resources.

Education is critical to understanding the extent of the health inequities facing the LGBTQ+ community. The goal of this newsletter is to raise awareness around the various health inequities facing this community and pose solutions for policymakers, organizations, and individuals to enact.

Everyday, policies affecting LGBTQ+ health are enacted, proposed, or struck down. We must advocate for beneficial and against harmful policies. Another goal of this newsletter is to spotlight policies and mobilize advocacy efforts.

This organization and newsletter are only a piece of the larger infrastructure that is tackling the issue of LGBTQ+ health inequities. Countless, hard-working organizations and individuals are at the front of the fight for equity. This newsletter hopes to highlight these resources, which are essential for moving the work forward.

Above all, we hope to center LGBTQ+ voices in this work and through each of these goals. If you have interest in sharing your experiences in the healthcare system, highlighting the work you do, or collaborating in any way, please contact us at healthequity4lgbtq@gmail.com.

DECEMBER 2023

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HEALTHEQUITY4LGBTQ+ LGBTQ+ MENTAL HEALTH

INTRODUCTION

IN THIS ISSUE

The NIH recognizes sexual and gender minorities as a health disparity population; improving the health and well-being of LGBTQ people is a key priority of the Healthy People 2030 initiative. Yet,

SUICIDE AND MENTAL HEALTH IN LGBTQ+ YOUTH

inequities remain. In the United States today, LGBTQ+ individuals face significant health

BUILDING ONLINE

inequities in regard to disease prevalence,

COMMUNITY FOR LGBTQ+

healthcare access, and exposure to social

YOUTH

determinants of health. Understanding of these inequities by LGBTQ+ people, health care providers, policymakers, non-profit leaders, and

RESOURCE SPOTLIGHT:

the general public is crucial for addressing them.

YOU:FLOURISH

The health inequities facing LGBTQ+ people are broad in scope. They encompass sexual and reproductive health, mental health, cancer screenings, health insurance access, substance

THE INTERSECTION OF POLICY AND MENTAL HEALTH

use disorder, homelessness, and so much more. In this issue, we will focus on key disparities related to LGBTQ mental health.

MENTAL HEALTH RESOURCES

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Inequity Awareness: Suicide & Mental Health in LGBTQ Youth Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth experience higher rates of anxiety, depression, suicidal ideations, and other mental health

45%

conditions not because of their sexual identity, but often because of the treatment they receive as a result. LGBTQ+ youth experience stigmatization, discrimination,

of LGBTQ+ youth experience thoughts of suicide

isolation, and mistreatment among their family, peers, and society at large. These feelings of mistreatment compound to increase these youths' risk for mental health struggles.

The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that 41% of LGBTQ+ youth experienced serious thoughts of suicide in the last year, and 14% attempted. Rates of attempt are extremely disproportionate among youth of color, with Native/Indigenous, Black, and Middle Eastern youth experiencing much higher rates than their white counterparts. Additionally, 67% of LGBTQ youth reported symptoms of anxiety, and 54% reported symptoms of depression.

Rates of mental health issue prevalence vary greatly depending on the access to support youth have.

Increasing access to supportive, protective, and culturallycompetent resources has the potential to address these alarming mental health disparities facing LGBTQ+ youth.

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LGBTQ+ YOUTH WITH SUPPORTIVE ENVIRONMENTS EXPERIENCE LOWER RATES OF SUICIDAL IDEATIONS, ANXIETY, AND DEPRESSION The Trevor Project’s survey found that LGBTQ youth who reported having an affirming home attempted suicide at a lower rate than their peers who do not have affirming homes.

Specifically, 10% of youth with a supportive home reported attempting suicide in the past year, while 15% of youth without a supportive home attempted. Additionally, a study from the University of Texas at Austin supports these findings, adding insights that LGBTQ+ youth with supportive home environments experienced fewer depressive episodes.

Beyond the family space, affirming environments reported on in the Trevor Project survey include schools, community events, and online spaces.

Affirming experiences and spaces for transgender and non-binary youth display similar trends.

These findings show hope for supporting LGBTQ+ youth mental health, however, current trends indicate that not enough LGBTQ+ youth have access to affirming spaces. Only 38% of LGB and 35% of transgender and non-binary survey respondents reported having an affirming home. However, these rates were higher among other environments such as school (54%, 52%) and online spaces (68%, 70%). This high percentage of youth who found support in online spaces shows promise for building virtual environments to foster LGBTQ+ connections and may present an area of further exploration for addressing mental health and suicidality in this community.

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Building Online Community for LGBTQ+ People: 68% of LGBTQ+ and 70% of transgender and non-binary youth reported that they had affirming environments in online spaces. This presents promise as a space to address LGBTQ+ mental health.

The Trevor Project survey also found that 81% of respondents reported wanting mental health care, but of those who wanted it, PHOTO BY MARTIN R. SMITH

only 44% received it.

A number of challenges and barriers prevent LGBTQ+ desiring mental health care from actually accessing it, including: being afraid to talk about their mental health, not feeling affirmed in care, being unable to afford it, or being prohibited by a parent/caregiver. Online spaces may be an option for circumventing these barriers and promoting positive outcomes for LGBTQ+ youth.

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Research published in the International Journal of Transgender Health found that the internet provided transgender and gender-diverse young adults with affirming spaces where they felt safe to be their authentic self. These spaces provided these young people with feelings of belonging, confidence, and hope, as well as an escape from the stigma or discrimination they face offline. A transgender male in this study said that when he first discovered other transgender youth on YouTube it was like his

“FIRST BREATH OF FRESH AIR IN OVER A DECADE” PHOTO BY MARTIN R. SMITH

from Austin et al. (2020)

Another key finding of this study was that many respondents likened their online experiences to be

“LIFE-SAVING” from Austin et al. (2020)

This is a profoundly important finding in light of the prevalence of mental health disorders and suicidality among LGBTQ+ youth.

Another particular area of promise is that studies have found online spaces to be of particular importance for LGBTQ+ youth of color, with Tik-Tok in particular being a reported safe space for 53% of LGBTQ+ youth of color, in comparison to 45% of white respondents.

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ONLINE SAFETY Although online spaces can provide a supportive environment for LGBTQ+ youth, it can also be a space of cyberbullying, harassment, and other unsafe feelings. It is important to practice and promote safe online behaviors to ensure the privacy and protection of LGBTQ+ youth.

Leading cybersecurity and LGBTQ advocacy groups have named a number of helpful tips to ensure online PHOTO BY MARTIN R. SMITH

safety, including: 1. Adjust privacy settings - control who can see what you share 2. Be cautious in sharing personal information 3. Use strong, unique passwords 4. Enable dual-authentication softwares 5. Update your apps - they often include new security features 6. Record evidence and report harassment to the platforms 7. Control what you see - cater your content to what you want to engage with & block negative users

8. Trust your instincts - if you feel uncomfortable, “trust your gut and disengage” (The Trevor Project)

RESOURCES The Trevor Project. Online Safety for LGBTQ Young People LGBT Tech. Online Safety National Cybersecurity Alliance. What LGBTQ+ Communities Should Know About Online Safety Glaad. We Keep Us Safe: LGBTQ Digital Safety Guide

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RESOURCE SPOTLIGHT:

You:Flourish is a Colorado-based organization creating a digital wellness app uniquely designed to meet the mental health needs of the LGBTQ+ community.

You:Flourish grew out of Envision:You, a Colorado-based organization focused on behavioral health advocacy. After conducting a “State of the State” survey with nearly 600 LGBTQ+ Coloradans, Envision:You discovered that LGBTQ+ young people, in particular, were increasingly turning to digital spaces for mental health support and for building community. They also learned that 99% of LGBTQ+ Coloradans surveyed want and would use a vetted directory to find culturallycompetent mental health providers. From here, You:Flourish emerged and has since been working to develop a platform that will be equipped to address and respond to all of these needs heard directly from LGBTQ+ people.

Sitting down with Megan Cliff (she/her), Program Coordinator, and Liz Attaway (she/they), MSW Intern, I learned more about the goals and development of the You:Flourish app.

THE APP Through three main content areas, the You:Flourish app is designed to support LGBTQ+ people in accessing mental health care, finding supportive communities of people with like-identities, and building critical wellness skills. Megan and Liz shared more detail about each of these areas.

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Resource Directory In partnership with the GLMA LGBTQ+ Healthcare Directory, You:Flourish will provide LGBTQ+ people with access to a vetted directory of health care providers who are trained and dedicated to provide affirming, culturally relevant care. Providers with a dedicated commitment to delivering affirming care for LGBTQ+ individuals are listed in the directory along with details such as, their accreditations and certifications, therapeutic approaches, and overall experience working with the LGBTQ+ community. Users of You:Flourish are able to navigate this directory to find mental health practitioners that meet their unique needs.

However, the supply of mental health providers is limited, leaving wait times to be connected with a provider to be an ongoing challenge in the mental health sector. You:Flourish seeks to serve as a stop-gap by providing access to other mental health resources and wellness skills that can act as an intermediary while waiting for a provider or, to lessen the need for an immediate crisis intervention. This goal largely drives the creation of the other two content areas of the app.

Peer Support Network You:Flourish recognizes the value of online spaces for LGBTQ+ people and aims to bridge these online communities with wellness skills in order to promote personal growth and positive behavioral changes. Through a peer-support network, app users can be connected to one another based on the social determinants of health (SDOH) model, shared experiences, and common goals.

Through these connections, users can motivate and support one another along their wellness journey.

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Wellness Content Hub Through a range of outlets, You:Flourish will provide users with wellness content that aims to build resilience, teach coping skills, and support overall well-being. Resources range from organizations, videos, guiding practices, apps, and more. While users will be recommended resources based on key social determinants of health and their overall wellness goals, the app is motivated by personal choice allowing users to access any resources and content that is of interest.

You:Flourish is set to launch its beta model in April of 2024.

Though this initial model will be geared toward Coloradans, the app will be accessible to people across the nation. In the coming months while the app is in development, the team at You:Flourish is engaging in a number of activities to ensure that the app is most aligned to meet the needs of the LGBTQ+ community.

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Created for the LGBTQ+ Community, by the LGBTQ+ Community You:Flourish is committed to engaging with members of the LGBTQ+ community and leveraging their experience and expertise in order to develop the most effective app.

Liz and Megan are both working on the development of peer advisory groups.

Through these groups they will hear from the LGBTQ community - the potential users of the app - on what they would most like to see. The groups will be exposed to elements of the app, such as the types of resources included in the Wellness Content Hub. The goal of these groups is to get feedback from the LGBTQ+ community to hear if the app is something that they would use and/or how it can be improved to better serve their needs.

The team at You:Flourish is also working on building a robust resource bank for the wellness content hub. A critical component of this is to collaborate with queer content creators and queer-run organizations, as leveraging their expertise ensures that the resources are useful and community-driven.

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You:Flourish Provides Hope for the Present and Future of LGBTQ Mental Health With intentional efforts to target such a pressing issue that faces the LGBTQ+ community, You:Flourish presents an opportunity to both address mental health struggles for LGBTQ+ people today and to change the future of mental health for LGBTQ+ people to come. Megan and Liz each shared their excitement for the approaching launch of the You:Flourish app and their appreciation for all of the teams and stakeholders who have been involved in the development. Megan shared that You:Flourish is the type of app she wishes were around when she was younger and she looks forward to, as a social worker, being able to refer her future clients to the app as a resource.

Liz shared that they are excited that an app is being designed for a community that continuously does not get the support that it deserves. She hopes that this app serves as a way to mitigate the communal grief felt by the LGBTQ+ community as a result of all that happens to queer people across the nation, everyday.

ENGAGE WITH YOU:FLOURISH! While the You:Flourish app concludes its app development and prepares to launch, you can connect with them to hear important app updates and learn about mental health resources and organizations.

Join the monthly newsletter to hear updates, well-being tips, and find ways to partner with You:Flourish, including by providing content and resources.

Connect on Linkedin, Instagram, and Facebook!

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The Intersection of Policy and Mental Health The Trevor Project 2023 survey also found that LGBTQ+ related laws and policies have a profound impact on LGBTQ+ youth’s mental health. LGBTQ+ youth felt that their mental health was worse due to anti-LGBTQ policies, such as hearing about laws banning LGBTQ+ topics in schools. However, policies such as those that ban conversion therapy, made 79% of youth surveyed feel a little, or a lot better.

Conversion therapy refers to practices that aim to alter an individual’s sexuality or gender identity. There is both medical consensus around the immutability of sexual and gender identities, as well as the ineffective and harmfulness of conversion therapy practices. Despite this, only 22 U.S. states and territories ban conversion therapy for minors - which encompasses only 47% of LGBTQ+ youth.

53% of LGBTQ+ youth reside in states with partial protections against conversion therapy, no protections at all, or explicit prohibition of conversion therapy bans.

THERAPEUTIC FRAUD PROTECTION ACT: This bill, first introduced by Representative Ted Lieu (D-CA) in 2015, and most recently reintroduced in June 2023, would place a federal ban on conversion therapy. Specifically, the Therapeutic Fraud Protection Act would classify the provision and advertising of conversion therapy in exchange for monetary compensation as fraudulent practice. This bill has been introduced but has not yet passed committee.

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Conversion Therapy Laws by U.S. State and Territory

Source: Movement Advancement Project. "Equality Maps: Conversion Therapy Laws." https://www.lgbtmap.org/equality-maps/conversion_therapy

Further Reading Movement Advancement Project, LGBTQ Youth: Conversion “Therapy” Laws (last updated, November 2023) https://www.lgbtmap.org/img/maps/citations-conversion-therapy.pdf Movement Advancement Project (2017), LGBT Policy Spotlight: Conversion Therapy Bans https://www.lgbtmap.org/file/policy-spotlight-conversion-therapy-bans.pdf

The Significance When considering the health inequities facing the LGBTQ+ community, it is integral to also understand the broad policy landscape in which they are situated.

These unique social factors impacting the lives of LGBTQ+ people must be considered when designing solutions to address the mental health needs of this population.

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LGBTQ+ MENTAL HEALTH CRISIS RESOURCES

Trans Lifeline 877-565-8860 LGBT National Youth Talkline 1-800-246-7743 TrevorLifeline 1-866-488-7386 TrevorText TEXT START TO 678-678 The Steve Fund Crisis Textline TEXT STEVE TO 741741 LGBT National Hotline 1-888-843-4564

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OTHER RESOURCES

The Trevor Project Mental Health Resources Center of Excellence on LGBTQ+ Behavioral Health Equity Resource Repository & Learning Opportunities for Practitioners

EVENTS MOVING BEYOND CHANGE: EVIDENCE AND ACTION TO SUPPORT & AFFIRM LGBTQI+ YOUTH DECEMBER 11, 2023 FROM 1:00-2:30PM Hosted by GLMA: Health Professionals Advancing LGBTQ Equality in collaboration with SAMHSA, this event brings together speakers who bring expertise in clinical psychology, substance use, and policy with an LGBTQ+ lens.

LEARN MORE AND REGISTER HERE

Sources Austin, A., Craig, S. L., Navega, N., & McInroy, L. B. (2020). It's my safe space: The lifesaving role of the internet in the lives of transgender and gender diverse youth.

International Journal of Transgender Health, 21(1), 33–44. https://doi.org/10.1080/15532739.2019.1700202 Govtrack, ​H.R. 4340: Therapeutic Fraud Prevention Act of 2023. https://www.govtrack.us/congress/bills/118/hr4340 Human Rights Campaign (n.d.) Policy and Position Statements on Conversion Therapy. https://www.hrc.org/resources/policy-and-position-statements-on-conversiontherapy Human Rights Campaign (July 2023). Therapeutic Fraud Prevention Act. https://www.hrc.org/resources/therapeutic-fraud-prevention-act McCurdy, A. L., & Russell, S. T. (2023). Perceived parental social support and psychological control predict depressive symptoms for lesbian, gay, bisexual, transgender, queer, or questioning youth in the United States. Child Development, 94(3), 691–705. https://doi.org/10.1111/cdev.13894 Migdon, B. (2023). Democrats introduce federal conversion therapy ban. The Hill. https://thehill.com/homenews/lgbtq/4068444-democrats-introduce-federalconversion-therapy-ban/ Movement Advancement Project. "Equality Maps: Conversion Therapy Laws." https://www.lgbtmap.org/equality-maps/conversion_therapy Soto, J. (2021). Online Communities: Ensuring Positive Digital Spaces For LGBTQ+ Youth.

Equality Magazine. https://www.hrc.org/magazine/2021-early-fall/onlinecommunities-early-fall-2021 The Trevor Project (July 2023). LGBTQ Young People of Color in Online Spaces. https://www.thetrevorproject.org/research-briefs/lgbtq-young-people-of-color-inonline-spaces-jul-2023/ The Trevor Project (2023). 2023 U.S. National Survey on the Mental Health of LGBTQ Young People. [PDF]. https://www.thetrevorproject.org/survey2023/assets/static/05_TREVOR05_2023survey.pdf

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