While a rising percentage of young adults in the U.S. identify as LGBTQIA+, they also face an unprecedented level of systemic discrimination that has a real and lasting impact on mental health. For the first time ever, the Human Rights Campaign declared a state of emergency in response to the challenges facing LGBTQIA+ youth, following 75 anti-LGBTQ+ bills signed into law in 2023 alone, more than twice the amount in 2022, the previous worst year on record.
The mental health impact of systemic discrimination on young adults is real and measurable. For instance, The Trevor Project recently found that two thirds of LGBTQ+ youth, and 4 out of 5 trans or nonbinary youth, report that state laws restricting the rights of transgender people have impacted their mental health negatively. And psychologists have long studied the impact of system oppression on mental health.
“The political climate of a country may be traumatic for young adults without a supportive community, especially for those living in certain states,” says Dorm Partner & Chief Clinical Officer Amanda Fialk, PhD, LCSW, LICSW.
What can we as mental health professionals do to address the current political climate with clients?
As a proudly-affirming organization, in which nearly 40% of our clients identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual or another gender or sexual orientation, we’ve covered practical steps for creating an inclusive healthcare environment, but we also understand the importance of consistent self-education about the ever-changing landscape in which our clients live. Considering the fact that rates of substance use, eating disorders, suicidal ideation, and suicide are significantly higher among LGBTQ individuals in the US than their straight, cisgender counterparts, it’s also critical that we do so.
Below, we learn from one of our clinical supervisors on how our team approaches the complexities of the impact of systemic discrimination on youth mental health.
Understanding Discrimination on Multiple Levels
“At The Dorm we sometimes look at discrimination as an ecological model,” explains Clinical Supervisor Amie DiTomasso, LICSW (she/her). “We can zoom closely into someone’s microcosm, and talk about their self acceptance or acceptance within the family, or we can think about our community at large, and then even the nation or world at large. Within each of these spaces you can see some real challenges specific to LGBTQ+ youth.”
Finding Self Acceptance on an Individual Level
In the context of discrimination, ranging from hate crimes to micro-aggressions, therapists find that self acceptance can be particularly challenging for LGBTQIA+ people just launching into adulthood, explains Amie. “Especially if you’ve been raised with a different pronoun or assumed sexuality. For example, you may have grown up always hearing ‘Oh, you’re going to have so many girlfriends when you grow up!’ instead of ‘Oh, so many people are going to like you when you grow up.’”
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The messages you hear over a lifetime, even if they’ve had no malicious intent, are hard to process and align with changing identities, making the shift to understanding your authentic identity is an enormous task.
“Clients may also struggle with identity in young adulthood because it’s hard to know how to invite yourself into a new social sphere, even if you know that’s where you want to be,” adds Therapist Carly Linn, LMSW (she/they). “Sometimes you need others who’ve been there before you to support you in that transition, but that community isn’t always there.”
Navigating Family Life & Personal Relationships
Many young adults in the U.S. face estrangement or ostracism when it comes to coming out to their families. In fact, over two-thirds of LGBTQIA+ adolescents have reported family members making negative comments about their sexuality. This can be particularly damaging to LGBTQIA+ youth who are beginning the process of coming out and fear losing their sense of safety, or even the security of home.
Familial discrimination can lead to devastating outcomes. One study found that young adults experiencing high levels of parental rejections are eight times more likely to report attempting suicide and according to True Colors United LGBTQ+ youth have a 120% higher risk of homelessness. This is most often the result of abuse at home, or being kicked out after coming out to their family.
Finding Community Acceptance
In a recent survey of LGBTQIA+ teenagers, over half reported that they had been bullied at school, and transgender and nonbinary students reported higher rates of bullying compared to cisgender LGBTQIA+ students. Bullying or other peer-based trauma have been shown to lead to higher rates of suicide amongst teens.
Community acceptance and integration, however, can have a profound impact on LGBTQIA+ mental health. LGBTQIA+ youth with at least one accepting adult in their lives saw a 40% decrease in suicide attempts in the past year. These affirming and supportive adults don’t even have to be a parent but a trusted friend, therapist, coach or mentor.
Societal: Facing Discrimination and Systemic Barriers to Care
On a societal level, LGBTQIA+ young adults face immense barriers in every facet of life, to name a few: participating in school sports, running small businesses, expressing their authentic identities and fighting for their right to marriage. Systemic barriers are also particularly frightening for Black LGBTQIA+ youth, who are less likely to receive and access life-saving mental health.
“Considering the current political climate in the United States, we’re in the midst of a step back when it comes to being able to provide and access affirming care,” notes Amie.
Facing discrimination on a societal level takes consistent self-education, activism, and voting. It’s important to stay abreast of policy changes in your area, for starters. This helps us form informed, considered opinions before voting. Organizations like HRC, Them, The Trevor Project, and the ACLU can help you stay knowledgeable about the issues that impact our community. And for trans rights in particular, Track Trans Legislation is a great option.
How does inclusive and affirming mental health treatment make a difference?
LGBTQIA+ individuals have a higher likelihood of seeking mental health services such as psychotherapy, counseling, substance use disorder treatment, and inpatient mental health service. And accessing treatment that is validating, affirming and LGBTQIA+ inclusive can be life-saving.
Clients are more likely to grow, flourish as their full, authentic selves when they feel seen and believe their therapist authentically understands their lived experiences.
Organizations and therapists can take several steps to combat the risks facing LGBTQIA+ youth, including:
- Implementing groups specifically for lesbian, gay, bisexual, transgender, asexual and/or intersex individuals. At The Dorm, we frequently survey our community to continually evolve along with our clients’ needs and offer a trans-nonbinary process and identity group specifically for this population.
- Conduct regular diversity training with vetted professionals. For example, our team participates in diversity training with organizations such as Choice Points Learning and BCG Bridge.
- Hire a diverse team. Representation matters, and while self-disclosure must always be done with care, it’s essential that LGBTQIA+ young adults see themselves in the population they are looking to for care.
Learn additional actions mental health providers can take to provide inclusive care in the following post: Beyond Pronouns: What Inclusive LGBTQIA+ Mental Health Treatment Really Looks Like.