The lesbian, gay, bisexual, transgender, queer/questioning, and intersex (LGBTQI+) community faces unique challenges related to mental health conditions and substance use disorders, yet is often underrepresented in behavioral health conversations. The LGBTQI+ Behavioral Health Summit held June 24-25, 2024, in Rockville, MD, was a groundbreaking event for the Substance Abuse and Mental Health Services Administration (SAMHSA). Over the course of two days, members of the LGBTQI+ community and other experts came together to address the mental health and substance use conditions facing the community today.
Attendees included representatives from national and local LGBTQI+ organizations and project managers from SAMHSA’s LGBTQI+ Family Support Grant Program, along with various federal partners. The goal of the event was to build supportive communities and partnerships, optimize health and wellness across the lifespan, and eliminate health behavior disparities and achieve health equity. Throughout the Summit, participants engaged in sessions focused on identifying existing gaps and developing innovative solutions to address the unique behavioral health needs of LGBTQI+ individuals. Topics included lived experience, research and data, preventive care, evidence-based practices and interventions, crisis care and services, innovations in care, and youth mental health. It is worth noting that several key themes and action items emerged.
Elevate and integrate expert voices into federal programming: Attendees emphasized that experts in the fields of research, clinical work, mental health and substance use treatment and prevention, peer support, and lived experience should be at the federal table. These experts offer a unique and complex understanding of the needs of LGBTQI+ people across states, territories and tribal territories – and are eager to share their knowledge, skills and expertise to enhance SAMHSA programming for the LGBTQI+ community . For this reason, it was suggested that SAMHSA use expert and community voices when creating service programs.
Support and retain the LGBTQI+ and LGBTQI+ serving workforce: Many people who work with the LGBTQI+ community in behavioral health settings also identify as members of this community. The workforce is limited and the burden of providing behavioral health services is heavy on these providers. Since many who work with the LGBTQI+ community have lived experience similar to that of those they care for, they put their heart and soul into the work. Labor shortages, coupled with compassion fatigue, can lead to exhaustion (PDF | 8.7 MB). It is important that staff are offered appropriate mental health breaks and days, leave and mental health screening. Knowing that staff burnout is a problem for the LGBTQI+ workforce, participants suggested the idea that service organizations may want to consider preparing and changing organizational policies to support these staff members so that they can, in turn, continue to help others.
Protecting and promoting the mental health of LGBTQI+ youth: The call to action to help and protect LGBTQI+ youth was loud and clear. Participants shared their concerns throughout the Summit regarding the safety and well-being of LGBTQI+ youth. In fact, discussions focused on adult services tended to circle back to youth and young adults. LGBTQI+ youth and young adults struggle deeply with concerns about their behavior, exacerbated by environmental factors that reinforce discrimination and harassment, including state laws that restrict medical care, bans on books containing LGBTQI+ representation, and the dissemination hate on the internet and social media platforms.
One of the most important ways to support LGBTQI+ youth is through family acceptance. Strong evidence shows that family acceptance helps protect against depression, suicidal behavior, and substance use, and promotes self-esteem, social support, and the overall health experience for LGBTQI+ youth. The Trevor Project 2022 National Survey on LGBTQ Youth Mental Health* found that LGBTQ youth who felt high social support from their family reported a suicide attempt at less than half the rate of those who felt low or moderate social support.
During the Summit, one of the presenters emphasized the critical need to help families accept their LGBTQI+ children by training clinicians in evidence-based family therapy approaches that work toward acceptance. Another presenter discussed the need for increased positive LGBTQI+ representation in media, television and film. This representation can help show young people that there is a future for themselves, even if, in their community, they don’t see others like themselves. Positive representation also provides an opportunity for those who may not be accepting of LGBTQI+ people to see these people as everyday people rather than ‘other’.
What SAMHSA does
These action items and lessons learned will help improve SAMHSA’s existing LGBTQI+-focused programs and initiatives, as well as inform future efforts. Current efforts include the recent launch of the LGBTQI+ Family Support grant program, the 2023 release of a data report (PDF | 682 KB) examining LGBTQ behavioral health, and encouraging states to address the needs of LGBTQI+ youth through guidance (PDF | 115 KB) which provides examples of how states, tribes, and communities are using SAMHSA funding for this purpose. In addition, 988 Suicide & Crisis Lifeline now has a specialist service for LGBTQI+ youth and young adults offering Call, text and chat access 24/7 to LGBTI+ trained crisis counselors. And, as of 2020, SAMHSA is funding a Center of Excellence for LGBTQ+ Behavioral Health Equitywhich provides training, mentoring and technical assistance to behavioral health professionals to implement change strategies to address disparities affecting the LGBTQI+ community.
SAMHSA also has a website dedicated to the LGBTQI+ population, which includes national reports, agency and federal agency initiatives, and other resources such as a SAMHSA report (PDF | 5.2 MB) with evidence and action to support and affirm LGBTQI+ youth.
Following the Summit, a SAMHSA grantee shared that he was moved by the visibility and representation of LGBTQI+ individuals and allies committed to addressing LGBTQI+ behavioral health through federal public service. LGBTQI+ federal employees work in programs and agencies to ensure equitable services in all areas of health care. The LGBTQI+ Behavioral Health Summit provided an opportunity for these officials and experts in the field to connect meaningfully and purposefully, strengthening the network of behavioral health services and supports for the LGBTQI+ community. As we recognize LGBT History Month this October, SAMHSA remains steadfast in its commitment to advancing these efforts and addressing the unique behavioral health needs of the LGBTQI+ community.
Additional SAMHSA Resources
Visit the resources below for more information about SAMHSA’s grant programs and initiatives that promote and support LGBTQI+ behavioral health.
*The Trevor Project is a leading national nonprofit focused on suicide prevention efforts among the LGBTQ+ population, and its well-known national research provides critical data and information on mental health trends among LGBTQ+ youth.
