Author(s): The Trevor Project
- Amy Green, PhD – Director of Research
- Samuel Dorison, LLM, MSc – Chief Strategy & Innovation Officer
- Myeshia Price-Feeney, PhD – Research Scientist
Published: Aug. 18, 2020
Report Intro/Brief:
“Not all youth currently have access to high-quality and culturally appropriate mental health care.
Unfortunately, youth who experience the greatest mental health disparities, including youth living in poverty, youth of color, and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, are more likely to have unmet mental health care needs. Higher rates of mental health challenges and lower rates of access to care among youth with the most need reflect the impact of discrimination, victimization, and oppression at the interpersonal, community, and structural levels.
COVID-19 has highlighted vast disparities that exist within the U.S. mental health care system.
For marginalized communities, COVID-19 exacerbates structural inequalities that already exist, particularly among those at the intersection of multiple marginalized identities. COVID-19 has negative impacts on not only physical health, but also mental health through increased isolation, economic strain, and anxiety which are expected to be experienced at greater levels among marginalized youth. However, widespread recognition of a broken system can serve as an entry point towards improving the ways care is provided.
A greater understanding of barriers to mental health care can help shape policies and practices that produce a system of care capable of meeting the needs of all youth.
Using data from a large, diverse national sample of LGBTQ youth between the ages of 13–24 in the United States, this paper highlights disparities in receipt of desired mental health care as well as LGBTQ youth perceptions of barriers to receiving mental health care, including how these barriers operate within and across social identities. Drawing on this data and examples of healthcare transformations that have occurred during the COVID-19 pandemic, we offer recommendations for ways to address barriers to quality mental health care for LGBTQ youth
Overall, more than half (54%) of LGBTQ youth who reported wanting mental health care in the past year did not receive it.
Statistically significant within-group differences were found, with Black (62%), Latinx (62%), and Asian American (60%) LGBTQ youth reporting higher levels of not receiving desired mental health care compared to LGBTQ youth who were White (53%), American Indian/Alaskan Native (53%), or multiple race/ethnicities (55%). Cisgender LGBQ youth had greater reports of unmet mental health care needs (57%) compared to transgender and nonbinary youth (50%). LGBTQ youth who lived in the South reported the highest levels of unmet mental health care needs (58%), while LGBTQ youth in the Northeast reported the lowest levels (47%).
LGBTQ youth endorsed a variety of barriers related to the reasons they were unable to receive the mental health care they wanted in the past year.
Inability to afford care was the most frequently endorsed barrier (53%) to not receiving desired mental health care among all LGBTQ youth. Over one-third of LGBTQ youth reported concerns due to not wanting to get parental permission needed to receive care, including half of Asian American/Pacific Islander LGBTQ youth. American Indian/Alaskan Native LGBTQ youth were more concerned that a provider would only focus on their sexual orientation or gender identity (29%) compared to LGBTQ youth overall (16%). One in three transgender and nonbinary youth stated that they didn’t receive desired mental health care because they didn’t feel a provider would understand their sexual orientation or gender identity.
Over 3,500 LGBTQ youth provided written descriptions detailing additional reasons they were not able to receive the mental health care they desired.
LGBTQ youth of color highlighted concerns related to mental health stigma within their culture as well as a mental health care system that wasn’t equipped to understand their racial and ethnic identities. Youth frequently described stigma using words like “embarrassed,” “ashamed,” and “weakness” for why they didn’t get mental health care despite wanting it. LGBTQ youth reported concerns about the ability to trust therapists, particularly related to conversion efforts and disclosing information to family members.
During the COVID-19 pandemic, there have been increased national conversations focused on mental health, making now a crucial time to implement needed changes.
For example, COVID-19 has highlighted that mental health care can be effectively provided via telephone or video conferencing when necessary. The mental health care system in the U.S. must adapt to the needs of those who are unable to find appropriate mental health care locally by expanding tele-mental health. Further, during COVID-19, policy changes on parity in reimbursement rates for tele-mental health care and allowing for the provision of out-of-state care through tele-mental health have expanded the ability for those in need to receive care. Such changes should be instantiated and expanded on in the future. There is also a need for public health campaigns that raise awareness of ways to reduce mental health stigma and assist in helping youth find ways to ask for help. Additionally, the mental health workforce needs to engage in ongoing professional development around anti-racism as well as addressing LGBTQ-stigma and the impact both have on mental health. Addressing barriers will require an approach that relies on policy and funding changes as well as changes to the ways mental health care providers serve those who are in need of care. We hope others will join us in finding solutions that provide LGBTQ youth with the support they need to thrive.”
>>> CLICK HERE to see all of Youth Today’s REPORT LIBRARY
