s the LGBTQ+ community at U of U Health expands, we’ve seen many younger patients embracing their true identities. LGBTQ+ youth don’t just have this desire to know themselves – they want to show others who they are, too.

This resilient generation inspires us with their acceptance of themselves and one another. They've put in so much work and effort into finding their own beautiful identity, and by the time we get to meet them, they have really blossomed.

While we’re encouraged by this growth in our youth, there are still many challenges to overcome. People often fear what they don’t connect with or understand, especially when it comes to individuals who aren’t exactly like them. As a result, LGBTQ+ youth have experienced a culture that teaches them that certain parts of their identities are wrong.

When people act out of fear, the resulting psychological damage to patients can be devastating. Many young LGBTQ+ youth have been bullied and disrespected in terrible ways, not only by their peers, but by adults too. According to The Trevor Project, 42% of LGBTQ+ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth.

We also see a lot of scared parents of transgender youth overwhelmed by the transitioning process and associated safety risks. They want to know how to support their child, but don’t have resources to help them reach the next step.

We must help people understand how to find compassion and connect with our LGBTQ+ youth. Let’s empower these families and individuals with the specific resources and support systems they need for success.

Create a supportive environment for LGBTQ+ youth 

Normalize asking questions. Start your interactions in a non-judgmental way by asking their name, pronouns, and a simple, “Tell me about you.” If we assume that the patient goes by the name or sex marker in the chart, then we may unintentionally cut them off without giving them the space to share their authentic selves with us.

As a community, we’re working on the nuances. For example, we don't say “preferred pronouns” anymore, because we’re shifting away from terms that unconsciously imply patients are ‘making a choice.’

Names and pronouns really do make a difference. For trans youth, regularly using their names and pronouns at home, in school, at work and with friends reduces the risk of suicide dramatically. Even if an adolescent can comfortably use their name in one of those four places, the incidence of suicidal ideation decreases by nearly 30%. Simply having a place where you feel accepted, where you can be yourself, and where you can acknowledge those parts of your identity is incredibly important for anybody, especially youth.

Recognize the systemic barriers LGBTQ+ youth face. Sometimes, when we only see patients in the office, we don’t recognize all the systemic barriers they face in their life. Many youth struggle with safety at school, home and work. LGBTQ+ adolescents make up a significant proportion of homeless youth. The justice system also presents barriers for LGBTQ+ people through bias and discrimination.

Additional advocacy, by health care providers and parents, is needed to eliminate some of these barriers and create safer environments. Until we fully understand the whole experience our patients bring us, we can’t provide them with the whole-body care they deserve.

When a patient or child is suicidal

Look for the signs: Our first line of defense against youth suicide is prevention. It’s helpful to know some potential warning signs:

• Withdrawing or taking space from friends or family
• Not interested or engaged in activities they typically enjoy
• Increased anger or frustration
• Significant changes in schoolwork or grades
• A shift in demeanor or presence
• Self-injurious behavior

Start a conversation: Begin your conversation in a safe place and try not to ask questions in front of their peers or even around other family members. While you might assume someone is safe, the child might not have the same relationship with that person.

Offer one-on-one support: Gently offer them support one-on-one. You can say, “Something seems different. Is there anything going on that you want to talk to me about?" Present yourself as somebody who cares and listens without jumping to judgment or offering an immediate fix.

Acknowledge their feelings: Try to create an environment where you can acknowledge feelings without the stigma of ‘good’ or ‘bad.’ Assure them that it’s okay to be sad or frustrated. If you’re telling a child, “Don’t cry,” they’re going to think there’s something wrong with being sad or crying.

Ask questions and don’t be afraid of the answers: Even though it’s heartbreaking when a child tells you they’re suicidal, try to stay calm and just listen. If you overreact they might shut down, because now they’re more worried about how you’re feeling. Let them know, "That must be really scary. Is there anything I can do to help? Can we connect you with somebody that can help?"

Offer privacy in a health care setting: Often, youth don’t feel comfortable speaking openly to their provider when their parent is in the room. We need to normalize asking parents to step out to help us create space for our patients. Assure parents that, “If there's a safety issue, we'll let you know. But your child needs some space to talk with their providers independently."

During these discussions, remember to have a plan in place for suicidal patients. It’s dangerous to ask the question and ignore the answer—intentional ignorance triggers hopelessness, which is one of the greatest contributors to suicide.

Also, patients struggle to access LGBTQ-competent care and support systems in health care. They're coming in for severe mental health problems and typically leaving without getting as much help as they needed. Developing these affirmative spaces specifically within our outpatient and mental health services has become increasingly critical.

Coping strategies: Coping looks different for everyone, so don’t assume that what works for one person will work for somebody else. Some examples of coping strategies include:

• Make sure they have someone to talk toA common mistake parents make when punishing youth is to take social support away like phones or social plans. This leads to social isolation and is detrimental to their child's mental health., like a friend, teacher, or coach.
• Introduce mindfulness exercises like deep breathing, meditation or guided relaxation.
• Establish safe spaces for when things get overwhelming, like a warm bath.

Simply put, if you’re seeing patients, you’re seeing diverse patients. It’s vital to have the resources and knowledge to best serve them.

Build an affirming health care community

Building affirming health care spaces and preventing suicide isn't just the task of psychologists – awareness is something we must cultivate throughout all our systems. Here are some ways to build an affirming health care community:

• Ask questions, not for your own benefit, but to help you serve the patient.
• When you make a mistake, fix it and move on. The intention is to support your patients, not make yourself feel better.
• Stay curious. Pursue continuing education and keep yourself updated on new resources.
• Support parents. It's okay for parents to have feelings of grief or failure, but they need to be able to process them with someone other than their child. Recommend parents see their own therapist or find other support systems. This step ensures youth won’t have to carry their parents' feelings or internalize being transgender as something to feel guilty for because it upsets their parents. 

We must create a society that is open and understanding, and that intentionally recognizes the beauty in everybody.

*Originally published January 2022