LGBTQ youth say cost, parental permission pose major barriers to mental health care

The Covid-19 pandemic stands to exacerbate the existing mental health crisis among LGBTQ youth, who are at far higher risk of suicide than their peers. But it might also yield lessons in how to surmount the barriers to counseling they so often encounter.

A large new survey finds that while the majority of LGBTQ young people want access to mental health treatment, many don’t receive that care. Young people often said that barriers such as cost, parental permission, and stigma stand in the way. The research, published Tuesday, was conducted by the Trevor Project, a national organization focused on suicide prevention among LBGTQ teenagers and young adults.

“[LGBTQ youth are] experiencing high rates of discrimination and victimization, which impacts their mental health,” said Amy Green, director of research at the Trevor Project. “They also have incredibly high rates of saying they want mental health care, and then they can’t get it. And so it really shows where the problems exist — that it’s not within the youth, it’s within the system.”

The Trevor Project surveyed more than 40,000 young LGBT people ages 13 to 24, 84% of whom said they would like to access mental health care. Among the 84% who wanted care but couldn’t access it, more than half said that cost was a prohibitive factor.

One-third said that they didn’t want to ask permission from their parents — which many states require to provide medical care to a person under 18. The report suggested that for some youth, getting their parents involved would mean having to disclose their sexuality or gender identity. Nearly a quarter also said they were afraid of being outed.

“In a number of states in the country, youth would need parents’ permission to get therapy. Now imagine an LGBTQ youth who is experiencing depression and anxiety because they are terrified that their parent will reject them and put them at risk,” Green said.

The survey concluded in March, before Covid-19 led to widespread lockdowns and physical distancing guidelines in the U.S. Green said the pandemic has introduced even more barriers to care for LGBTQ youth. School closures specifically may prevent high school and college students from being able to access counseling and care on campus.

At the same time, the crisis has only escalated the need for psychological support for many people.

“Being physically isolated [and] potentially being in a home where your identity is rejected can be very harmful,” Green said.

But Covid-19 — and the widespread expansion of telemedicine it precipitated — might also hold the key for some of the doors barring access to care. The survey found that 20% of young people with an unmet mental health care need don’t have a way to get to an appointment. Another 10% who have no mental health services in their area, while 11% who don’t have providers who are themselves LGBTQ in their community.

“This is a survey of youth who spend a good portion of their life in an online environment. And so by meeting them where they’re at, we’ll be able to provide services,” Green said. She cautioned, however, that easier access to virtual care won’t remove obstacles to care for everyone.

In their paper, Green and her colleagues also advocate for all states to permit mental health providers to take on patients under 18 for whom parental consent may be a barrier to care.They also called for the mental health workforce to shore up its cultural competency and strive to look like the people it serves.

“I’m thinking particularly about our LGBTQ youth of color,” Green reflected. “Providers in this country tend to be white, and may not really understand their compounded experiences with discrimination — including things like racism — and how that impacts their mental health.”

“There are so many barriers,” she said. “We just need to start dismantling them one by one.”