LGBTQ-Specific Youth Mental Healthcare Access Still Elusive

Only about a quarter of youth mental health providers offer specialized mental healthcare for young members of the LGBTQ community, according to a research letter in JAMA Pediatrics.

This was particularly a problem in public mental health facilities, which are instrumental in ensuring equitable access to mental healthcare, the researchers said.

These findings come as the nation stares down a looming youth mental health crisis. Per CDC figures, mental health concerns are more prevalent among teens now than ever before. The February 2023 CDC report showed that this issue is especially common among young members of the LGBTQ community, 52 percent of whom reported poor mental health and 22 percent of whom reported prior suicide attempts.

This latest data from the University of California Los Angeles found that mental health concerns among LGBTQ kids are exacerbated by a lack of mental healthcare access.

“Fifty-four percent of LGBTQ youth reported wanting mental health care but not receiving any, partly due to adverse experiences with clinicians and perceptions that clinicians do not understand sexual or gender identity–related mental health needs,” the researchers wrote in the study.

The team, which hailed from the UCLA schools for nursing, public health, and medicine, combed through the National Mental Health Services Survey, which contains information about different mental health facilities nationwide. Notably, the survey includes information about whether the facility provides dedicated mental health treatment for members of the LGBTQ community.

In 2020, only 28 percent of facilities that offered services to children or teens also offered LGBTQ-specific services. That’s a small increase from 25 percent of facilities offering the same specific services in 2014, the team said.

And even though some states had a lot of resources for LGBTQ-specific mental healthcare, those services were seldom dedicated to kids. The researchers said that all 50 states had fewer than 10 child-service facilities with LGBTQ services per 100,000 children.

Of course, there were geographic disparities present. Mental health facilities located in coastal areas were more likely to offer LGBTQ-specific healthcare compared to those in rural areas, the researchers reported.

Moreover, there was a difference between public and private mental healthcare providers, with public mental healthcare providers being less likely to offer this specific type of care. For-profit facilities were more likely to offer LGBTQ-specific healthcare to youths compared to nonprofit facilities, as were accredited mental health facilities.

These findings mirror those of other researchers. In 2022, the Trevor Project, an LGBTQ youth advocacy organization, showed that more than half of LGBTQ kids said they wanted or needed mental healthcare access but could not access it.

The reasons for limited LGBTQ mental healthcare access are nuanced. While the JAMA Pediatrics study outlined the dearth of providers available to provide this specialized mental healthcare, the Trevor Project report added that this is more than a workforce problem.

For one thing, pediatric mental healthcare has the barrier of parental consent. Around half (48 percent) of kids told the Trevor Project they were afraid of discussing their mental health needs, while 45 percent of LGBTQ kids said they were concerned they wouldn’t get permission from their parents or guardians to access care.

Around one in five kids said they were completely denied that permission, while about a quarter (23 percent) said they were worried about using telehealth to access care at home.

There’s also the matter of the patient-provider relationship. Just over a quarter of respondents told the Trevor Project they were worried their identity might be misunderstood, 29 percent feared being outed, and 43 percent were worried they would not be taken seriously. Thirty-four percent of LGBTQ kids said they were worried mental healthcare would not work to address their mental health needs.

With youth mental health—and particularly the mental health of LGBTQ kids—reaching a boiling point, it will be essential for the US to not only ensure it can hit a workforce quota but also to train mental healthcare providers in how to deliver culturally competent care to this population.