Compared to their non-LGBT peers, LGBT youth experience higher rates of mental health challenges and increased health complications arising from those challenges.¹ Moreover, suicide is the third leading cause of death among youth aged 15 to 24 years, and LGBT youth are more likely to attempt suicide compared with their heterosexual peers.² This does not mean, however, that LGBT identity itself is the cause of these challenges; rather, the influences can be environmental. Higher rates may be a result of bias, discrimination, family rejection, and other stressors associated with how they are treated because of their sexual identity or gender identity/expression,³ which can lead to higher rates of anxiety, depression, and other mental health challenges, as well as suicide and self-harming behavior.

Recent population-based studies suggest the reported rates of suicide attempts for high school students who identify as LGBT are two to seven times higher than rates among high school students who describe themselves as heterosexual.⁴ LGBT youth are also twice as likely to have thoughts about suicide.⁵ Furthermore, the 2009 Youth Risk Behavior Surveillance System found that during the 12 months before the survey was administered, across the eight to nine sites evaluated,

• the percentage of students who reported having felt sad or hopeless ranged from 19.3 percent to 29.0 percent among heterosexual students, from 28.8 percent to 52.8 percent among lesbian and gay students, and from 47.2 percent to 62.9 percent among bisexual students;  
• the percentage of students who seriously considered attempting suicide ranged from 9.9% to 13.2% for heterosexual students, but from 18.8 percent to 43.4 percent among lesbian and gay students; and
• the percentage of students who attempted suicide one or more times ranged from 3.8 percent to 9.6 percent among heterosexual students, but 15.1 percent to 34.3 percent among lesbian and gay students.⁶

While less developed, some recent non-random surveys of self-identified transgender people indicate that up to one third reported attempting suicide at least once, with higher rates for youth and young adults than older adults.⁷

Key steps in primary prevention of self-harming behavior and suicide include

• providing safe and supportive environments; 
• enacting legislation to protect the safety of LGBT youth; 
• re-evaluating institutional practices that undermine positive child and youth development; and
• building community awareness and capacity to understand and address stressors that LGBT youth may experience.⁸

Resources, toolkits, toll-free lines, trainings, and organizations are available to assist LGBT youth, parents, and those who work with LGBT youth with behavioral health challenges. For example, the Trevor Project offers resources about LGBT youth and suicide for youth, families, and educators. They also provide a lifeline (available 24 hours per day, 7 days per week) at 866-4-U-TREVOR (866-488-7386). Further, the Movement Advancement Project (PDF, 4 pages) offers key recommendations for talking about suicide in safe and accurate ways with LGBT youth.⁹ Learn more about how the mental health system can support LGBT youth by reading endever*'s story.

Resources

Centers for Disease Control and Prevention: Lesbian, Gay, Bisexual, and Transgender Health
This website from the CDC contains specific health topics for the LGBT community, with specific resources for gay and bisexual men; youth; lesbian and bisexual women; transgender persons; and health services.

Centers for Disease Control and Prevention: Lesbian, Gay, Bisexual, and Transgender Health: Youth
This website from the CDC focuses on information for LGBT youth. The site highlights the experiences that LGBT youth face and provides information for schools and parents related to responding to violence for LGBT students.

Gay Male and Lesbian Youth Suicide (PDF, 36 pages)
This report from the Secretary of the U.S. Department of Health and Human Services Task Force on Youth Suicide in 1989 highlights the risks associated with gay male and lesbian youth suicide, speaking about many topics such as religion, substance abuse, school, social isolation, and coming out. Further, it provides information for addressing and ending gay and lesbian youth suicide.

Healthy People 2020 Topics & Objectives: Lesbian, Gay, Bisexual, and Transgender Health
The Healthy People 2020 website has a specific focus to improve the health, safety, and well-being of LGBT individuals. It provides resources and sub-topics to address specific health challenges the LGBT community faces. Moreover, a new Healthy People 2020 LGBT Workgroup was formed recently to help advance efforts to identify LGBT healthcare disparities, needs, and potential ways these needs could be addressed.

HIV/AIDS and Substance Use Disorders in Ethnic Minority Men Who Have Sex with Men
This online training curriculum, prepared for the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT), provides extensive background on providing behavioral health services to African Americans, American Indians and Alaska Natives, Hispanic/Latino Americans, and Asian/Pacific Islanders/Native Hawaiians who have substance abuse disorders and are at-risk for HIV. The curriculum can be found here, but you must register to access the actual curriculum.

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
This comprehensive Institute of Medicine report on LGBT people, commissioned by the National Institutes of Health, concludes that future research and data collection must address LGBT people as the lack of research yields an incomplete picture of the health status and needs of LGBT people.

Medline Plus: Gay, Lesbian, and Transgender Health
This website, managed by the U.S. National Library of Medicine, the U.S. Department of Health and Human Services (HHS), and the National Institutes of Health, provides resources and information for the specific health issues related to gay, lesbian, bisexual, and transgender individuals.

Practice Brief 1: Providing Services and Supports for Youth Who Are Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, or Two-Spirit (PDF, 6 pages)
This practice brief, commissioned by the Council on Coordination and Collaboration of the Child, Adolescent and Family Branch, Center for Mental Health Services, SAMHSA, outlines key information for working with, and providing culturally and linguistically competence services to, LGBTQI2-S youth.

A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals
This manual, prepared for the CSAT seeks to inform administrators and clinicians about appropriate diagnosis and treatment approaches that will help ensure the development or enhancement of effective LGBT-sensitive programs. SAMHSA has also funded the development of a 22-module training curriculum to accompany this publication.

Recommended Actions to Improve the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Communities
This statement by the Secretary of the HHS addresses the work HHS has engaged in and future recommended actions to address and improve the health and well-being of the lesbian, gay, bisexual, and transgender communities.

SAMHSA Office of Behavioral Health Equity
SAMHSA website for the Office of Behavioral Health Equity provides a variety of LGBT-focused data and resources on substance abuse and mental health.

Suicide Risk and Prevention for Lesbian, Gay, Bisexual, and Transgender Youth
This report, prepared for the Center for Mental Health Services, SAMHSA, highlights the higher risk of suicidal behavior among LGBT youth and provides recommendations for youth services (e.g., schools, health practices, suicide prevention programs) and funders to promote the health, safety, and inclusion of LGBT youth.

National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families
The Child, Adolescent and Family Branch (CAFB), Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services initiated the National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families to support and enhance services for children and youth who are lesbian, gay, bisexual, transgender, questioning, intersex, or two-spirit (LGBTQI2-S). The workgroup helps to guide CAFB efforts to develop policies, programs, materials, and other products that help address the needs of children and youth who are LGBTQI2-S. The workgroup has developed a system of care toolkit of more than 100 resources from various organizations and has delivered learning events at conferences/meetings and in communities to build capacity to improve services for LGBTQI2-S youth and their families.  

Top Health Issues for LGBT Populations Information and Resource Kit (PDF, 100 pages)
This toolkit, prepared for CSAT, presents an overview of current health issues among LGBT populations. While many challenges exist with regards to the availability of data, this toolkit aims to create awareness among prevention specialists and healthcare providers of the needs, experiences, and health status of LGBT Americans.