Improving LGBTQIA+ Youth Mental Health Care and Access

By Tracy Mullare, Medical Director of Outpatient Services, Iris Telehealth
Twitter: @IrisTelehealth

In October, the American Academy of Pediatrics, the American Hospital Association, and the American Academy of Child Adolescent Psychiatry declared a mental health emergency for youth. Now more than ever, providers and organizations need to learn how to accommodate the mental health needs of LGBTQIA+ youth.

More than 80% of LGBTQIA+ youth reported that COVID-19 made their living situation more stressful.

For many LGBTQIA youth, access to mental health care is difficult due to:

• Inadequate mental health care
• Lack of access to mental health services and workers
• Fear of discussing mental health concerns, their identity being misunderstood, or not being taken seriously
• Concerns with obtaining parent/caregiver permission to receive care
• Lack of available transportation options
• Insufficient information about LGBTQIA+ mental health needs for providers.

Along with these barriers, there is also hesitancy to receive care exacerbated by a history of discrimination and lack of acceptance – which make it harder for LGBTQIA+ youth to receive the care and support they need. For example, as of 2022, 60% of LGBTQIA+ youth report they have wanted to receive mental health care but did not. This statistic represents nearly 3 in 5 transgender and non-binary youth as well as 3 in 5 cisgender youth.

Fortunately, there are steps your organization and your provider can take to ensure LGBTQIA+ youth can feel safe and heard.

Best practices for providing effective care to LGBTQIA+ youth

Here are some best practices for effectively supporting and communicating with your LGBTQIA patients:

1. Be mindful of pronouns and names: You can limit the burden for LGBTQIA+ youth by asking directly about what pronouns they use and what their preferred name is. It’s important to correct your staff members if they incorrectly address the patient to foster inclusion and affirm the patient’s identity.
2. Avoid assumptions: In addition to using the patients’ preferred pronouns and names, your care team should utilize inclusive language. By avoiding assumptions about a patient’s identity, it is easier for patients to reveal information at their own pace about their romantic or sexual relationships. Instead of assuming, ask questions like “Do you have a partner?”
3. Honor patient confidentiality: Sometimes LGBTQIA+ youth don’t come from supportive households. It is essential to build rapport with your young patients and reiterate that your conversations during your appointments are confidential — unless they are thinking about harming themselves or someone else.
4. Continue to educate yourself and your providers on LGBTQIA+ matters: Many resources are available for providers and organizations to learn more about LGBTQIA+ mental health care and youth. By paying attention to current issues and statistics around LGBTQIA+ youth, you can further change the type of care you provide by accommodating those needs.

Telehealth specific best practices for providing effective care to LGBTQIA+ youth

There are multiple ways to make your appointments with LGBTQIA+ youth inclusive and accommodating using telehealth.

1. Take steps to ensure patient privacy above all else: Some patients might not feel comfortable speaking openly during their telehealth appointment if they don’t feel like they have adequate privacy in their home (or any other location where they might be receiving virtual care). By asking in the beginning if they are in a space that is private where they are willing to be open and honest with you, you can increase the quality of care. If they don’t have a space that’s safe and private, suggest other ways to communicate with your patient: taking a walk outside and continuing your telehealth appointment there, utilizing text for information that they are too worried to say out loud, or even come up with codewords or aliases for certain things and people to maintain privacy.
2. Offer services in their area: Some patients might not have access to LGBTQIA-friendly providers or physicians. Offer to help them find one in their own area if they need to see an in-person provider for prescriptions, counseling and therapy, or HIV/AIDs management and treatment. LGBTQIA+ youth need to know they have options and access to care that is LGBTQIA-friendly.

How organizations help provide effective care to LGBTQIA+ youth

Creating a welcoming environment for LGBTQIA+ patients is essential. Many LGBTQIA+ people avoid seeking care as a result of bad experiences with providers or because they are discouraged by a lack of services that cater to the LGBTQIA+ community.

To combat that hesitation, make it clear that your organization is LGBTQIA+ friendly by clearly stating it on your websites and other branded materials. Normalizing and validating their experiences can increase the likelihood of seeking out care. Many LGBTQIA+ people look for clues whether an organization is LGBTQIA+ friendly by taking into account how they are greeted by staff and whether non-discrimination policies are posted on their websites or any other public-facing material.

Another way to make your practice more inclusive as an organization is by employing gender-inclusive medical forms. By giving your patients an opportunity to indicate their sex, gender, and sexuality, your organization can increase the quality of care your providers can deliver.

As an organization, make LGBTQIA+ specific training accessible to your providers and your care team. Sometimes, providers will have their own biases about gender and sexual orientation that they might bring to work without even realizing. Training providers on specific LGBTQIA+ topics and making sure they are asking for consent before providing care can erase discomfort in a healthcare setting.

Resources and education opportunities about LGBTQIA+ youth for providers

Many resources are available for providers and organizations to learn more about LGBTQIA+ mental health care for children and adolescents. By paying attention to current issues and statistics around LGBTQIA+ youth, you can further improve the care you provide by accommodating those needs. Here are a few resources that can help you provide quality care to LGBTQIA+ youth:

• The Trevor Project: The Trevor Project is a national organization that specializes in suicide prevention and crisis intervention for LGBTQIA+ youth. They are constantly working to provide updated research and statistics on LGBTQIA+ youth and the challenges they’re facing. In the past, they’ve conducted a recurring National Survey on LGBTQIA+ mental health that gives context to the state of mental health in the U.S. for LGBTQIA+ youth.
• The American Academy of Child and Adolescent Psychiatry: The American Academy of Child and Adolescent Psychiatry is a non-profit organization that focuses on topics related to youth and adolescent psychiatric care. Their gender and sexuality resource page has evidence-based guidelines for providers, including various tips to improve care with LGBTQIA+ youth during the pandemic, clinical guidelines and training for providers, and LGBTQIA+ specific topics frequently encountered while treating LGBTQIA+ youth.
• The National LGBT Health Education Center: The National LGBT Health Education Center is part of The Fenway Institute. Their mission is to ensure access to quality and culturally competent mental health and medical care for the LGBTQIA+ community. They have a guide for providers on how to provide inclusive services for the LGBTQIA+ community. In addition, they have various continuing medical education (CME) and continuing education units (CEU) opportunities like webinars, learning modules, and training credits for providers looking to further their understanding of how to provide quality care for LGBTQIA+ communities.

How telehealth can help

LGBTQIA+ youth have many barriers at an individual level, provider level, and systemic level. By utilizing telepsychiatry, LGBTQIA+ can overcome some of these barriers.

Between 2.9 million to 3.8 million LGBTQIA+ people live in rural areas. Telehealth can make mental health care more accessible to LGBTQIA+ patients, especially in rural and underserved areas where there might not be access to non-discriminatory mental health care. By having the option of telehealth available, LGBTQIA+ youth can see their providers from the comfort of their own homes.

And remember, harassment in a medical setting is common –especially in areas where LGBTQIA+ populations face discrimination and larger barriers to access. For patients who’ve been a victim of harassment in the medical setting in the past, having providers who are trained to build rapport and provide comfort can dispel distrust that the LGBTQIA+ community has against some providers.

This article was originally published on the Iris Telehealth blog and is republished here with permission.