Article Published: 9/20/2023
Experts agree that there is a mental health crisis in the United States, and particularly among children and adolescents. However, this does not affect all populations equally. The LGBTQ population is at an increased risk for mental health problems and for suicidality specifically. This is true throughout the life span.
“Professional counselors need to be aware of the risk factors with these populations, so they can appropriately assess and support clients initially and throughout treatment,” says Clark Ausloos, PhD, NCC, LPCC, LPSC, Chair of the NBCC Minority Fellowship Program Mental Health Counseling Advisory Panel.
A 2021 study led by researchers from the National Institute of Mental Health found that suicide risk was three to six times greater for lesbian, gay, and bisexual adults than for heterosexual adults. (The survey used did not assess gender identity.) This year, researchers from the Williams Institute at the UCLA School of Law found that transgender adults were seven times more likely to consider suicide and four times more likely to attempt it than cisgender adults.
The Centers for Disease Control’s Youth Risk Behavior Survey found an increase in mental health problems and suicidal thoughts and behaviors among adolescents between the years 2011 and 2021. It also found that these feelings and behaviors were more common among LGBTQ youth. The youth mental health crisis is a concern for everyone, but LGBTQ youth undeniably experience an outsized burden.
“Counselors should be aware of supportive mental health resources within the client’s communities, such as crisis hotlines/text lines, crisis response teams, and outpatient services,” says Dr. Ausloos. “Counselors working with LGBTQ+ clients should also be able to create robust safety plans, highlighting client strengths, social supports, and resources. These statistics highlight the importance of counselors’ advocacy for and with LGBTQ+ clients in schools and communities.”
The Trevor Project is the leading nonprofit organization combating LGBTQ youth suicide. This year, the organization released the results of its 2022 National Survey on LGBTQ Youth Mental Health, and the data reinforces the stark picture that has emerged. The organization’s surveys found an increase in suicidal thoughts among LGBTQ youth over the preceding 3 years.
Based on self-reported survey results, 73% of LGTBQ youth experienced symptoms of anxiety and 58% experienced symptoms of depression. Nearly half of LGBTQ youth seriously considered suicide within the preceding year, while 14% attempted suicide during that time.
The Trevor Project’s work provides a detailed look at the mental health crisis facing this vulnerable population and underscores the need for quality mental health services by counselors and other providers competent to treat LGBTQ youth.
In fact, the 2022 National Survey on LGBTQ Youth Mental Health asked respondents specifically about mental health care. It found that, overall, 82% of LGBTQ youth wanted mental health care, while only 18% did not. However, only 40% of respondents who wanted mental health care within the preceding year actually received it. Those who did not receive care cited numerous reasons, including concerns about parental permission, fear of being outed, fear of their identity being misunderstood, lack of affordability, and a fear of discussing their mental health concerns.
Counselors should take steps to make care more accessible for LGBTQ youth, says Dr. Ausloos.
“Knowing the barriers to accessing mental health services for LGBTQ+ youth is important for professional counselors. Counselors must carefully navigate confidentiality and parental rights while respecting client privacy and autonomy. Counselors must know how to deal with guardians who are not affirming or validating, provide psychoeducation and resources, and—ultimately—assure the safety and wellness of minor LGBTQ+ clients.”
This also means raising awareness and providing education about counseling, so that LGBTQ youth feel comfortable and empowered to seek treatment, explains Dr. Ausloos.
“Counselors—particularly LGBTQ-identifying counselors—should work to increase their visibility within schools and communities and educate others on the roles of professional counselors. Broadly, professional counselors are highly needed in a variety of spaces—in schools, homes, communities, prisons, etc.”
Why are suicidality and other mental health problems more prevalent among LGBTQ youth and adults? Experts believe it is largely due to the stigma, discrimination, and harassment that this population endures. The Trevor Project’s findings support this consensus.
The survey found that 73% of LGBTQ youth have experienced discrimination based on their gender identity or sexual orientation. Those who did experience such discrimination reported a suicide attempt within the past year at a rate three times higher than those who did not report experiencing discrimination.
LGBTQ youth face unique threats, such as the unscientific and harmful practice of so-called conversion therapy. The Trevor Project’s national survey found that youth who were subjected to or threatened with conversion therapy were approximately 2.5 times as likely to report a suicide attempt in the preceding year.
The current political climate provides another stressor. Transgender and nonbinary respondents to the Trevor Project’s survey overwhelmingly expressed worry about the ability of transgender people to play sports, use public restrooms, and access medical care due to state or local laws.
These recent findings highlight the need for culturally competent and accessible mental health care for LGBTQ people of all ages. Counselors can take steps to improve their personal competency to work with this population, explains Dr. Ausloos.
“Professional counselors must continue to stay informed of harmful legislation, both proposed and passed, that impacts LGBTQ+ clients within their states,” says Dr. Ausloos. “Counselors should continue to engage in trainings and professional development, as language, topics, and issues within LGBTQ+ populations often change.”
In addition to pursuing training and continuing education opportunities to enhance their skills for working with this population, counselors can make a difference by advocating in their communities. LGBTQ youth who reported their home or school was an affirming space were less likely to consider or attempt suicide, in the Trevor Project’s survey. And the more accepting a respondent rated their community, the less likely they were to attempt suicide.
“An important part of a counselor’s role is the need for consistent and rigorous self-reflection and introspection, to become aware of our own deeply held beliefs and biases,” says Dr. Ausloos. “As multicultural counselors, this is an essential part of our work with nondominant populations, particularly LGBTQ+ clients. A more nuanced detail of working with LGBTQ+ clients is really listening to clients and focusing on their presenting issues, which may or may not have to do with their LGBTQ+ identities.”
It is possible to make a difference, both in these stark statistics and in individual lives. In an open-ended question, the Trevor Project’s survey also asked about sources of joy. Among many fulfilling activities, hobbies, and life experiences, respondents reported therapy as one such source of joy and strength.
Dr. Clark D. Ausloos is a National Certified Counselor, a Licensed Professional Clinical Counselor, and a Licensed School Counselor. Dr. Ausloos has worked in elementary, intermediate, and junior high school settings, as well as private practice, and in higher education. Dr. Ausloos has worked with students at the College of William and Mary, as well as Palo Alto University and is now serving as Clinical Assistant Professor in the SchoolCounseling@Denver program at the University of Denver. Dr. Ausloos centers his clinical, school, and scholarly work on supporting and advocating for marginalized, nondominant populations, specifically queer and trans youth, and their families. Dr. Ausloos has authored over 17 peer-reviewed manuscripts and has several book chapters and encyclopedia terms in press, in addition to presenting over 40 conference presentations. Dr. Ausloos serves on numerous professional counseling organizations and counseling divisions, including ACA, AARC, SAIGE, ACAC, and ACSSW.
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