LGBTQ Mental Health and Suicide: How Can We Save the Next Generation?

The night David Rabadi walked down the middle of New York's Cross County Parkway hallucinating that reality TV cameras were filming this "moment for gay Arabs everywhere," he had no idea he was having a psychotic episode.

In fact, Rabadi had no idea he had a mental illness at all – not even when he was tackled to the ground by five police officers, handcuffed and hospitalized. But Rabadi's actions that night – a psychotic break that he believes was triggered by Adderall rather than the stress of coming out as gay to his Jordanian family – were not just symptoms of severe bipolar disorder; they were also the kind of behavior experienced by LGBTQ youth who are struggling with mental health and suicide risk.

According to The Trevor Project's second annual national survey on LGBTQ youth mental health, 40 percent of respondents seriously considered attempting suicide in the past twelve months, with more than half of transgender and nonbinary youth having seriously considered it. And 46 percent of LGBTQ youth wanted psychological or emotional counseling from a mental health professional but were unable to receive it in the past year.

The survey, the largest of its kind, drew on the experiences of 40,000 LGBTQ youth and comes at a time when the COVID-19 pandemic and political upheaval are having a devastating psychological impact on queer and trans kids.

The Trevor Project hopes the study will underscore the need for a significant investment in intersectional support services for LGBTQ mental health, especially with the current nationwide upheaval, which has significantly impacted youths with diverse backgrounds.

Rabadi, who has written a memoir about his experiences, told EDGE that he does not conflate his gayness with mental illness. Still, two stressors in his life – the fact that few Arabs ever come out and the stigma of mental illness – contributed to close friends and family advising Rabadi to keep his bipolar diagnosis to himself.

"I shouldn't be scared or ashamed of having bipolar disorder. It's a mood disorder that either makes you feel depressed or overjoyed. There is medication that can control my mood swings," says Rabadi. For the most part, the LGBTQ community has supported him in living his truth, and he hopes his memoir helps young people now. "These are scary times for all of us as a human race, not just for those with mental illness," says Rabadi.

Awareness around diverse sexual and gender identities has improved since Rabadi's first episode, as has public awareness of mental health, which has led to the perception that there's been a major advancement of LGBTQ rights and acceptance in the past few years. But there is more to be done based on the Trevor Project's most recent study, which projects figures that are similar if not worse than earlier studies of suicide risk among LGBTQ youth.

The National Survey on LGBTQ Youth Mental Health 2020 found that 68 percent of LGBTQ youth reported suffering from anxiety in the past two weeks, one in three had been physically threatened or harmed, 10 percent had undergone conversion therapy (with a majority under the age of 18), and a staggering 86 percent said today's political climate negatively impacted their well-being.

What type of world can LGBTQ youth look forward to rejoining as we emerge from the coronavirus pandemic – especially when the epidemic of bullying based on students' sexuality or gender identity is still a leading cause of suicide and the Trump administration continues to advance anti-LGBTQ student agendas?

Does it "get better"? It depends on who you ask.

SURVIVING REJECTION

According to Dr. Caitlin Ryan, Director of the Family Acceptance Project, when it comes to the kinds of challenges LGBTQ youth have faced over the decades, not much has changed: "It's almost as if we have been repeating the same data collection and we haven't had the impact that we needed to have."

The Family Acceptance Project (FAP) believes families are the most important resource to reduce risk and promote well-being for their LGBTQ children. Historically, families were seen as an adversary or even as an "enemy." Unlike other children and adolescents, LGBTQ youth were served alone and not in the context of their families, says Dr. Ryan. For many years the narratives around coming out were about rejection.

"Many of us come from families where we struggled, we were wounded, our feelings about our families are very complex, those issues got carried over into services for LGBTQ youth and into the lack of services to help diverse families learn to support their LGBTQ children," says Dr. Ryan. "But I saw that families were critical to the well-being of young LGBTQ people, and not all families reacted in the same way – including families of color."

FAP shows how parent and caregiver behaviors contribute to risk – or well-being – for their LGBTQ children and helps diverse parents, families, and caregivers learn to change behaviors that increase health risks and increase behaviors that promote well-being.

While not all mental illness is caused or exacerbated by societal stigma – David Rabadi's bipolar disorder, for example, is the result of a chemical imbalance in the brain – the role of caregivers is essential in making sure young people survive long enough to seek and receive the right treatment.

FINDING CONNECTION

While the nuclear family's role is a key to societal acceptance, in the absence of that, LGBTQ people are adept at finding or creating chosen families. When Bree Pear hit rock bottom after escaping a toxic relationship, losing her job and her home, her salvation came in the form of creating the kind of help she needed.

"I traveled with my dog, Mika, across the country for almost a year, just connecting with humans, sharing my story and listening to theirs."

The result was Only Human, an LGBTQ-owned cause campaign collective. "Advocating for love and LGBTQ+ rights alongside our mental health efforts is the core," says Pear.

September's National Suicide Prevention Month is close to Pear's heart. Around the time she founded Only Human, a friend committed suicide, sending shockwaves through her circle.

"Close to 80,000 humans die by suicide each year. It's really hard to just stay silent about that when you're an organization all about human connection," says Pear, who made September her "Stay" campaign, aimed at Suicide Awareness.

"The more humans we can encourage to 'Stay,' and provide with free resources, the more positive impact we can make together," says Pear.

Three such advocates spoke to EDGE about the intersection of advocacy and need. Kay Kira Jacobs, 27, signed on three years ago while struggling with depression over their identity (they now identify as gender nonbinary).

"I was having those thoughts of, 'I want to give up, I just can't take it anymore,'" says Jacobs, who is based in Atlanta. "I was uncomfortable with my sexuality for a really long time. I was trying to figure out if I was trans or who I am now. It felt normal to have the thoughts I was having, but it was abnormal at the same time because I just didn't understand who I was." Jacobs has lost two friends to suicide in the past month, saying, "I think that there needs to be some support for people who know other people who are suicidal and who come to them for advice.

Danielle Shepherd, 32, grew up in a conservative background, which suppressed her sexuality. "It was very hard to come out and tell people who I had known for 20-plus years, 'By the way, I identify as a lesbian' and not know whether or not they were going to be okay with that or if I was going to lose my friends and family."

Shepherd was invited to Only Human by a friend. "I discovered a group of people who want to spread love and kindness and create a sense of community no matter what our differences are. I was able to learn about and understand the lived experience of transgender people of color. It has helped me grow as an individual as well, and allowed me to develop friendships with people that I may not have otherwise ever encountered."

Carly Campbell, 26, is a pediatric nurse at Boston Children's Hospital and was drawn to Only Human at Boston Pride. "Like most people, I struggle mentally sometimes. I see a therapist, and I'm really thankful for that," says Campbell, who identifies as bisexual. "From a nursing standpoint, I see kids having a mental break, anxiety attacks, even suicide attempts. I think my youngest patient with a suicide attempt was 10. They don't know where to go, they don't think their parents understand them, and I think that carries into young adulthood. Young people need to feel seen and understood, and to know that even when your problems feel too big, there is always someone who can understand you."

IN A PANDEMIC, WHERE DO LGBTQ YOUTH TURN?

The average coming out age has dropped dramatically in the past few decades, a fact that Dr. Ryan partially attributes to young people growing up online with LGBTQ-affirming virtual spaces and images just a click away.

"It's not unusual for me to get a call from a parent saying, 'My daughter's eight, she said that she's gay, she said, 'Mom, where are all the playgroups with other kids and families like us?'," says Dr. Ryan. "Children express gender diversity at very early ages and are identifying as gay in childhood. Parents want to help these children, but our communities don't have services and guidance to support diverse families with LGBTQ children."

While young queers might connect virtually, places, spaces and resources where diverse families can support their LGBTQ child are limited. For LGBTQ youth, peers, the arts and other activities and supportive adults outside the home are primary support sources. But in the middle of a pandemic, those resources are not available. In the future – and as soon as possible – they will need to be reinstated and increased.

"The family is connected to the child's social world, the cultural world outside the home," says Dr. Ryan. In FAP's family support model, the family becomes the vector for social change that learns to advocates for their LGBTQ children in the extended family, school settings, cultural community and congregation, shows the child how to advocate for themselves and teaches others how to affirm LGBTQ young people. "There's an urgent need to increase these services, but they aren't widely in place."

For Jacobs, the pandemic pressures have been alleviated by Only Human's Social Sundays via Zoom, which offers "that human contact that we miss. Even though we're more divided, now I feel there is also more connection, even if it is only online."

"The isolation that we were feeling at the beginning of COVID – stop your life, stop your social life, you can't go anywhere, you can't see anyone, and now you have to wear a mask – that is very similar to what it feels like when you're coming out," says Shepherd.

Many LGBTQ kids are stuck at home with families who either don't accept or understand them. Confinement in a hostile family significantly increases risk. FAP's research shows that conversion efforts occur at home – parents and families try to change their child's LGBTQ identity through the more than 50 family-rejecting behaviors that FAP identified and studied in their research. These rejecting behaviors increase the risk for suicide, drug use, depression and HIV infection. One of these behaviors includes taking their child to a therapist or religious leader for conversion "therapy." All of these behaviors, which include using religion to condemn or change a child's LGBTQ identity, focus on making the child repress or minimize their identity as the cost of connection to their family.

"Even ambivalence – a mix of accepting and rejecting behaviors – confers risk," says Dr. Ryan. "The lifeline for LGBTQ young people is typically not their families; it's their peers. That lifeline is cut now. There are also multiple impacts of what's happening to their families. It's not just job insecurity, housing or food insecurity, or losing their external sources of support. Those young people also face losing family members and cultural leaders to COVID-19, a three to five times greater likelihood for African American, Latino, or Native Americans. This is generating traumatic loss that as a society we are not prepared to deal with."

FINDING HOPE

LGBTQ mental health is not a single issue. Our cultural backgrounds and social environments are intersectional.
"LGBTQ and gender non-binary children don't have a textbook definition of what it means to be them," says Dr. Ryan. "Many of these children's identities are mixed, they're intersectional, they lack access to LGBTQ services and positive adult role models, and they need a safe space so they can survive into finding out who they are and learn how to live as an LGBTQ person in their cultural worlds."

When David Rabadi came out in 2009 and was hospitalized three days later, he had already spent years living as a fledgling fashion designer and aspiring journalist in New York City, with a tumultuous love life and a pill dependence. He had suppressed his shame at being a little Arab boy who loved Wonder Woman, played with dolls, and was molested by a neighbor. He could not recognize how desperately he needed mental health intervention that addressed the different facets of his identity.

Rabadi's mental health journey had a happy ending: Diagnosis, treatment, acceptance and a book that aims to educate. But not every outcome is so positive – suicide is the second leading cause of death among young LGBTQ youth ages 10 to 24.

Rabadi found hope and help and offers words of wisdom for LGBTQ youth struggling with mental health issues:

"Speak to someone you can confide in because there is local support in most communities. Don't fear who you are – we are all special, and we all have a purpose. Don't let anyone dim your light because you deserve to shine bright."