As Dr. Rosenthal highlighted, this is all amplified in the era of social media where people can post anonymously. This is amplified in our current political environment in the US nationwide.

So, I think those factors just really amplify the stressors for young people today who are identifying as part of the LGBT community.

Rob: 4:36
And discrimination can occur on several levels at once, Dr. Rosenthal added.

Dr. Rosenthal: 4:41           
One of the pieces that we see is something that’s discussed as – it’s called intersectionality where we really see multiple different sub-populations that are coming together. So, we, for example, see people that identify with, let’s say, Latino/African American/gay boy that is having more challenges because of the intersectionality of discrimination and challenges upon them as a minority stressed population. 

Rob: 5:07
And data supports the idea that simply being aware and supportive can have a huge impact.

Dr. Roderick: 5:12
The resiliency literature for decades always talks about like one person. You just need one person to have your back. So, I think that’s so important for our LGBTQ young people is that they have an ally and if it’s not at home, then, in the school setting, in their friend group, wherever it might, a coach, whomever it might be. Just really looking for those allies.

Of course, we encourage parents to listen to their children’s voices and try to help them feel proud of whoever their authentic self is and perhaps support them as they grow with helping – if they’re trans perhaps, maybe helping their outside align better with how they see themselves inside and so on.

A lot of parents talk about the success of driving and having a conversation when that young person is next to them because somehow, having just that ability to look out that windshield rather than stare into each other’s eyes really does help promote a good dialogue. So, I put that out there in inviting parents to try to find ways to open the doors to communication.

But if not a parent, then, someone else in their network to just say, “I see you, I provide that unconditional support.”

Rob: 6:24
The 2023 Trevor Project survey further supports Dr. Roderick’s point.  It found that having at least one accepting adult can reduce the risk of a suicide attempt among LGBTQ young people by 40 percent… Yet, fewer than 40% of respondents found their home to be affirming to their identity and a majority reported being verbally harassed at school because people thought they were LGBTQ.

Dr. Roderick: 6:49           
It’s a heavy, heavy burden. Young people are obviously connected to media at their fingertips many, many hours a day. They are bombarded with this information and they are sponges; they are taking this in. So, it’s shaping how they view themselves, how they view the world around them, how they feel about the future.

So, the effects are super profound and the effects kind of snowball over time… There’s a lot of self-esteem issues that can develop as you’re receiving these negative messages. You may then kind of be one of these isolated young people that you just don’t know who’s safe to turn to. 

So, we’re seeing that a lot; that young people are withdrawing into themselves, not trusting the world around them to be safe and responsive. If you have a young person who is all of a sudden isolating themselves, but you can also think about a student who all of a sudden has a dramatically different performance in school where their grades are declining without any real obvious reason for why that might be.

Certainly, if a parent is seeing a young person who’s crying often, who’s even making statements or threats around self-harm, I really do encourage that they connect with mental health professionals and get an evaluation, get some answers, and see if there could be solutions for that young person.

Dr. Rosenthal: 8:11
And I think there are other warning signs that we need to look at, as well. One of the things that we know is that adolescents often will want to be able to create their own identities and create their own perceptions and be able to have their own friends and figure out their own way in the world. And that’s all part of normal development.

But what we really do want to make sure we’re having is that if we do see a lot more of isolation, if we do see a lot more people only living in virtual worlds rather than in real worlds, if we do see people not interacting with peers or society or being able to kind of be able to go to school or being able to have those social interactions; those are really a critical part of childhood development and being able to develop who we are.

So, really making sure that we can create spaces that we understand those things that are going on. Self harm is another significant concern and so, obviously, if a child is considering self-harm or something like that, that's something that we need to do. So all of these things are other issues that we need to address and make sure that, when we see them as parents, as family members, as teachers, as trusted adults in these kids' lives, that we're able to help them get the mental health support that they need.

Rob: 10:40
And that burden is amplified for LGBTQ kids living in states where these laws are proposed or in effect.

Dr. Roderick: 10:46
We know of families that are picking up and moving. They’re relocating where Mom and Dad – or Mom and Mom, for that matter, Dad and Dad, whatever – where they don’t have all the answers but they just know they need to find appropriate health care and have that access for that young person. There are families where they’re just terrified of punitive measures that will be taken against them.

So, these are very, very real concerns. It is an enormous burden. We’re doing what we can in terms of Northwell telehealth and reaching who we can here in New York State. But yes, I think it’s a huge concern nationwide.

Rob: 11:27
So how do you create these safe spaces? On an individual level, simply knowing more about certain topics related to these communities and experiences can help, according to those surveyed for the 2023 Trevor Project report, which we talked about earlier. Over 70% of respondents cited gender identity, sexual orientations and pronouns as topics they wish people around them knew more about.

• 67% said the gender binary
• 58% said Microaggressions
• 52% said Racism
• And 45% said Intersectionality

And Dr. Rosenthal said you can show that you understand these topics in creative ways. For him and Dr. Roderick, that includes wearing colorful pins on their name tag and lanyard.

Dr. Rosenthal: 12:05
I think one thing that’s really important is that I have a pronoun pin that lets people know that my pronouns are he and him because it really makes an enormous difference. Because regardless of what pronouns someone else uses, the fact that I'm telling other people that I know what a pronoun is and how it’s critically important to an identity for some people makes an enormous difference.

I have rainbow pins for LBGT patients, I have trans flag pins for my trans patients. You walk into our office and you see a rainbow flag. You see a big sign that says that, “Trans rights equal human rights.” … These are going to let these young people be seen and feel that they can find other people like themselves and create those kinds of environments.

I think patients love it. I think parents are like, “Oh, my gosh, you get my kid.” … I think that’s one of the key messages that I’d really like to have come out of today. We started the story really talking about the staggering statistics that are coming out of the CDC and all the challenges that we have there. But the real question is; what can we do and how can we really change this so that we can make people feel they have safe spaces and to have things that they can do that can make a difference for them and that can really make them feel comfortable in different environments?

Rob: 13:09
Beyond these non-verbal cues, Dr. Roderick had this advice for parents to help their children feel more supported at home.

Dr. Roderick: 13:16
Yes. I just want parents to think about it not as a black-and-white issue but think about all the different degrees of acceptance that they can communicate. I think it can be a little overwhelming for parents to kind of envision their own journey sometimes. But if they can think about one small step of perhaps using a different pronoun for their child, a different name for their child, and just starting small like that if their child is trans and kind of looking to be seen in a different way. That’s just one example.

Dr. Rosenthal: 13:44
I think those changes in the home are really important. But changes in the school are also really important. And one thing that I was fortunate to participate with it was the change that occurred within – it was a committee that was formed by the New York State Department of Education Board of Regents over the past year. And in June of this year, the New York State Department of Education Board of Regents released new guidance for schools within all the public schools within New York State called “Creating a Safe and Supporting and Affirming School Environment for Transgender and Gender-Expansive Students.” It’s a 2023 legal update and best practices. One of the things that we did is at least we brought together resources that were from LGBT agencies from school psychologists, from school boards, from other organizations that represent the community and the legal community. Really, to be able to represent the medical community on behalf of Northwell Health was quite an honor.

Rob: 14:34
This 42-page document highlights existing protections within New York law to help public schools better cultivate a safe environment for all students, regardless of sex, gender identity, or expression. Importantly, it also included comments from the same students it’s looking to support.

Dr. Rosenthal: 14:52
Really, what we heard was the voices of the students. And one student actually told us, “Just be polite to everyone. Treat someone like a person and not like they’re strange or they’re out of place. Small things like that will go a long way.” It's those words that make a huge difference.

So, there are opportunities now to make sure that you can grab that document and be able to have those resources to understand what you can do to help your child navigate the school waters about how you’re able to create safe spaces in schools. What bathroom are your kids going to use? How are they going to make sure there is no bullying? What are we going to do to make sure that your child’s preferred name appears on the school roll when they’re calling the kid’s name in class? How do we make sure that your kid’s pronouns are addressed? How do we make sure that there are clubs that provide other supportive environments and safe spaces where you can have an opportunity to talk to other kids that are interested in the same thing as you are about LGBT identities?

I think that different people want different things. Kids don’t necessarily all want the same thing. Some things are going to say, “I want to read a book,” some kids are going to say, “I want to talk to someone,” and some kids are going to just see a flag and feel like they’ve got a safe classroom that they can walk into.

I think that the key thing is creating these safe spaces at schools. And the same truly applies to, I think, other places where young people congregate. If that’s going to be congregations of prayer, mosques, synagogues, churches, if that’s going to be youth centers or community centers; all these places need to create an opportunity for the young people to be themselves and to let them be able to explore themselves.

Rob: 16:22
The new guidance also facilitates compliance with state and federal laws concerning bullying, harassment, discrimination, and student privacy.

You can find a link to the document in the show notes.

While Centers dedicated to treating these communities, like the one at Northwell Health, are growing in number, access to care remains a major pain point for many LGBTQ kids.

Dr. Rosenthal: 16:42
…Mental health is still a scary word to some people. There’s still stigma associated with it. There’s still challenges associated with it.

…Over half of the patients that wanted to see a mental health provider from the LGBT community didn’t see a mental health provider… The youth sometimes feel that they’re afraid to talk to mental health concerns about someone else but they also feel that they need to get their parent’s permission in order to talk to someone else. And they also feel that they wouldn’t be taken seriously or that it wouldn’t work.

Rob: 17:13
One way to bridge that gap, Dr. Rosenthal says, is better collaboration between schools and health systems.

Dr. Rosenthal: 17:17
What we need to realize is that our schools have school psychologists and school social workers that can be a gateway for helping to make sure that your mental health needs can be met. It’s really essential that you can get that as a starting point to be able to kind of make sure you can have those resources to be able to have the opportunity to talk to someone and to be able to get that support so that you can go through adolescence and have the additional resources available. Creating programs that partner with schools, that work with schools, is really essential.

Certainly, there’s a lot of crisis resources out there. So, we’ve mentioned all sorts of research by the Trevor Project but, also, there’s a hotline for young people. There’s a social media space that is very supportive so, that comes through the Trevor Project and is definitely very specialized for LGBTQ young people.

So, I want families to know there are resources out there. There’s PFLAG support groups for families where they can meet others who are perhaps going along their journey, as well, trying to figure it out. So we encourage families to access supports that are out there, to gather information from trusted, reliable resources, so if you're doing an online search, be mindful of what those resources are that you're drawing from.

Rob: 20:25
To learn more about the warning signs and find helpful resources, listeners can visit Northwell.edu/mentalhealth. If you think a child has harmed themselves or is in immediate danger of harming themselves, call 911 or get them immediate care.

That does it for this episode on child suicidality in the LGBTQ community. On behalf of Sandra Lindsay and our 20-Minute Health Talk team, thank you for listening. I’m Rob Hoell, have a great day and stay safe.