Mental health and substance abuse (behavioral health) issues are two major obstacles that lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth experiencing homelessness deal with every day. Successfully managing these issues can improve health and well-being, help support resiliency, build coping mechanisms for dealing with trauma, and support recovery from substance abuse. All of these are necessary building blocks for young people aiming to get and keep a job, stay in school, and secure safe and stable housing. Behavioral health is an essential component of sustainable strategies to end homelessness for LGBTQ youth.
In general, half of all lifetime cases of mental illness begin by age 14, and three quarters by age 24. LGBTQ youth are disproportionately likely to experience issues such as depression, post-traumatic stress disorder, anxiety, and suicidality – a particularly salient issue for LGBTQ youth experiencing homelessness. Suicide is the second leading cause of death among young people ages 10-24. Additionally, between 20 and 30 percent of LGBTQ people may abuse substances, as compared to 10.2 percent of the general population. These numbers are likely higher in the homeless population, as homeless youth are at higher risk of having substance use disorders generally, and LGBTQ youth experience unique stressors that contribute to negative behavioral health outcomes.
These issues can be compounded by family rejection, which is one of the primary drivers behind LGBTQ youth homelessness and has also been associated with increased suicide risk . Positive programs that seek to minimize rejecting behaviors and build permanent and supportive connections between youth and adults are an example of the important role that behavioral health care can play in helping support LGBTQ youth experiencing homelessness. Examples of programs whose work is particularly relevant in this area include Eva’s Initiatives Family Reconnect Program in Toronto, the Ruth Ellis Center in Michigan, and the Family Acceptance Project. Likewise, family connectedness, connections with caring adults, school safety, and LGBTQ support networks serve as protective factors against suicide for LGBTQ youth . The Trevor Project is a leading national organization providing crisis intervention and suicide prevention services to LGBTQ youth ages 13-24.
Effective behavioral health care depends on building trusting relationships between providers and patients; something that may be particularly difficult for LGBTQ youth experiencing homelessness to do. Often, they have experienced family rejection, mistreatment and disproportionate discipline in school, and harassment and discrimination in foster care and juvenile justice settings. In sum, nearly every adult relationship that should have been reliable may have violated their trust. Building a relationship with a social worker, therapist, or other professional to address the behavioral health issues that may have arisen as a result of so much trauma may be challenging, but it is a vital piece of efforts to end LGBTQ youth homelessness. Strategies that connect whole systems and include behavioral health concerns from the beginning, like Safe and Supported in Cincinnati, OH, or the NEST Collaborative to Prevent LGBTQ Youth Homelessness in Houston, TX are best situated to have a long-term, permanent, and positive benefit to the health and well-being of LGBTQ homeless youth.
Elliot Kennedy, JD, Special Expert for LGBT Affairs, Substance Abuse and Mental Health Services Administration (SAMHSA)
Ashby Dodge, LCSW, Clinical Director, The Trevor Project
Founded in 1998 by the creators of the 1994 Academy Award®-winning short film TREVOR, The Trevor Project is the leading national organization providing crisis-intervention and suicide-prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13 to 24. Every day, The Trevor Project saves young lives through its free and confidential Lifeline, in-school workshops, educational materials, online resources, and advocacy.
- LGBTQ youth are disproportionately likely to experience issues such as depression, post-traumatic stress disorder, anxiety, and suicidality.
- Suicide is the second leading cause of death among young people ages 10-24.
- Behavioral health care providers can help support LGBTQ youth experiencing homelessness by working to minimize rejecting behaviors and build permanent and supportive connections between youth and adults.
LGBT young adults who reported high levels of family rejection during adolescence were:
Times more likely to report having attempted suicide.
Times more likely to report high levels of depression.