The Britannica dictionary defines pride as “a feeling that you respect yourself and deserve to be respected by other people.” There is no doubt that for people to achieve prosperity and prosper, individuals must respect themselves and be respected by others. When someone doesn’t respect themselves or doesn’t feel respected by others, their behavioral health is affected. This Pride Month, I want every lesbian, gay, bisexual, transgender, queer, questioning, and intersex (LGBTQI+) person to know that SAMHSA respects you, honors you, and works every day to ensure that you receive equitable access to high-quality care.
SAMHSA has a multifaceted approach to addressing the behavioral health needs of LGBTQI+ people with, affected by, or at risk for mental health and substance use conditions, which is based on the requirements of the President Executive Order to Promote Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Persons (EO 14075).
EO 14075 called for a whole-of-government approach to address exposure to the harmful practice of so-called “conversion therapy.” At SAMHSA, we refer to this discredited practice as attempts to change sexual orientation and gender identity (SOGI change attempts), because the practice does not change anyone’s sexual orientation or gender identity, nor is it therapeutic in any way. On Trans Day of Visibility this year, SAMHSA issued a report: Moving beyond change efforts: evidence and action to support and affirm LGBTQI+ youth. The report provides an overview of effective and ineffective therapeutic practices for working with LGBTQI+ youth and provides an update to our 2015 publication, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth.
The new report is based on a thorough review of current scientific evidence, guidelines from medical and other professional associations, and a professional consensus from a diverse group of experts. The report offers guidance and resources for health care providers, educators, families, community leaders and others. It finds that SOGI changes efforts:
- They are based on the inaccurate belief that diversity in sexual orientation, gender identity, or gender expression is an illness or deficiency.
- Seek to change (or suppress) a person’s sexual orientation or gender identity — in an effort to align with being heterosexual, express their gender in a stereotypical way, and/or have a gender identity that is the same as gender assigned at birth.
- They are harmful, ineffective, inappropriate and should never be provided to young people.
- They have been rejected by every major medical, psychiatric, psychological and professional mental health organization.
Instead, the report finds that gender-affirming care supports the health and well-being of gender-diverse youth — and should not be hidden or prohibited. Gender-affirming care as described in the report:
- It recognizes that variations in sexual orientation, gender identity and gender expression are normal, healthy aspects of human diversity.
- It supports youth — without seeking predetermined outcomes related to sexual orientation, gender identity or gender expression.
- It’s highly personalized.
- Provides age and developmentally appropriate gender and sexuality education.
- It is appropriate and beneficial for many intersex youth and may involve social transition (eg, changing name, pronouns and/or appearance).
- It addresses the adolescent’s individual needs which may include some form of medically necessary gender-affirming medical care. Any decisions about providing gender-affirming care should be made with the involvement of an adolescent’s parent or legal guardian.
As a clinical psychologist, I would emphasize that affirmation is a professional practice that is not unique to issues of sexual orientation or gender. It’s about caring and meeting people where they are — while honoring all aspects of their identity.
Executive Order 14075 also calls for promoting family counseling and support for LGBTQI+ youth as a United States public health priority. I am pleased that SAMHSA currently has a Notice of Funding Opportunity (NOFO) open until July 3rd called the LGBTQI+ Family Support NOFO. This program will provide grants to prevent health and behavioral risks and promote well-being for LGBTQI+ youth within their families/caregivers, cultures and communities by establishing LGBTQI+ family counseling and support programs and training providers to effectively deliver these documented services. Having even one caring adult can make a significant, even life-saving, difference in the life of an LGBTQI+ youth.
Finally, EO 14075 also requires that we take steps to prevent LGBTQI+ suicide. Last fall, SAMHSA launched a pilot program of specialized services for LGBTQI+ youth in 988 Suicide & Crisis Lifeline ― which offers 24/7 call, text and chat access to trained crisis counselors. Those who contact the 988 Lifeline can press 3 to sign up for this specialist service, which aims to support young people who want to call or text 988 as well as via chat.
SAMHSA is not new to doing work in the LGBTQI+ space. Since 2007, the Sexuality and Gender Minority Interest Group has been SAMHSA’s internal professional development group for educating colleagues about the mental health and substance use disorder needs of the LGBTQI+ population. SGMIG members share best practices, coordinate programs and policies across SAMHSA, design activities to recognize key LGBTQI+ observances, and help develop outward-facing materials such as Moving beyond change efforts report.
From our report to our suicide prevention efforts to our new grant program, SAMHSA continues to make strides in our continued support of LGBTQI+ people. June, as Pride Month, may only be one month a year, but our work and commitment to the LGBTQI+ community is year-round. To learn more about SAMHSA’s work to foster pride for all LGBTQI+ people, visit SAMHSA’s LGBTQI+ webpage.
