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When I was 17, I really didn’t want to be gay. I didn’t want to fall in love with my basketball teammate like I did. I wore heels and skirts to parties, hoping they would disguise my tomboy mannerisms. He truly believed that he would be alone forever.

Fast forward to a few days ago when I celebrated my 37th birthday with a group of friends of diverse race, profession, and sexual orientation, and who were invited by my fiancée, the most brilliant and beautiful woman I know. Moments like this remind me that it gets better, and it got better.

For context, I am a black, queer, masculine cis woman who works as a psychiatrist. I’m living my “dream”, technically. However, I continue to struggle with severe anxiety and depression despite constant treatment with medication and therapy for over a decade. In fact, one of the reasons I decided to become a psychiatrist in the first place was to better understand my anxiety, which first manifested itself in high school in the form of panic attacks.

My reflections come on the heels of the results of The Trevor Project’s Third Annual National Survey on the Mental Health of LGBTQ Youth. For those of you who may not know much about The Trevor Project, it is a non-profit organization focused on suicide prevention for lesbian, gay, bisexual, transgender, queer and questioning youth through crisis service platforms. 24 hours, 7 days a week.

As a psychiatrist, the results of this year’s report are unfortunately not surprising, but they are still deeply disturbing. Of the nearly 35,000 LGBTQ youth surveyed, 42 percent of respondents between the ages of 13 and 24 had seriously considered attempting suicide in the past 12 months, and more than half identified as trans or non-binary youth.

Looking more closely at the data, the values ​​were highest for those ages 13 to 17, the age range we call “adolescence.” When most of us think of adolescence, we probably think of typical teenage angst centered around getting good grades, managing bad acne, or whether your crush likes you.

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For mental health professionals, adolescence represents a period in which people try to solidify who they are, what they believe and what they want. That The Trevor Project report shows is that LGBTQ teens are not only dealing with typical teen concerns, but also relentless bullying at school and, for some, where they’ll find their next meal.

For example, an HRC Foundation analysis of the 2019 CDC Youth Risk Behavior Survey shows that 29 percent of transgender youth have been threatened with a weapon on school property. Data from The Trevor Project suggests that 30 percent of LGBTQ youth experienced food insecurity in the past month and that 1 in 4 will experience housing instability at some point in their life.

These numbers paint a very different picture of adolescence for LGBTQ youth and raise additional concerns, such as whether they want to stay alive.

This is not to say that “typical” teen worries aren’t equally distressing. However, from my own experience and that of patients, I know how difficult it can be to manage both traditional psychosocial dilemmas and intersectional identities.

While my high school panic attacks may have been triggered by exams, college applications, and a perceived lack of time due to extracurricular activities, my chronic anxiety was kept alive by worrying about how I would fit in among my peers as a closeted black lesbian. I spent much of my emotional energy on edge, worried that my actions would reveal my secret to those around me.

At school, classmates questioned my acceptance into Stanford, citing my race rather than intelligence as the main factor for admission. Back home in West Palm Beach, Florida, where religious values ​​were at the forefront, liking girls put my soul in danger of going to hell.

The results of the Trevor Project suggest that concerns like mine are common for LGBTQ youth in general. For example, half of respondents reported discrimination based on their race/ethnicity in the past year, and only 1 in 3 found their households to be LGBTQ-affirming.

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I see similar themes in my work with depressed patients in their 20s and 30s related to mental health problems that began in their youth. They recall stories about not fitting into their racial communities or feeling undesirable as sexist teenagers.

Their experiences correlate with The Trevor Project’s findings that in the two weeks prior to the survey, 72 percent of LGBTQ youth reported symptoms of generalized anxiety and 62 percent reported symptoms of major depressive disorder.

This brings me to the results that are most distressing to me: almost half of LGBTQ youth wanted advice from a mental health professional in the past year, but did not receive it. The heartbreaking truth is that help is hard to find, as there are an average of only 9.75 child psychiatrists per 100,000 children in the United States and 70 percent of counties do not have child psychiatrists.

I think of how many young people continue to live their lives alone in their thoughts, without being able to share with family or friends. This is especially true during the COVID-19 pandemic, when more than 80 percent reported their life situation has become more stressful and 70 percent said their mental health was “poor” most of the time.

It’s not hard to imagine how symptoms like depression and anxiety morph into suicidal thoughts over time without help.

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I honestly have no faith that the workforce will grow to meet demand in the foreseeable future. A few times a month, I get an email from a frantic parent, old classmate, or colleague asking if I treat children or if I can connect them with a child psychiatrist. (I am trained as an adult psychiatrist and see patients over the age of 18).

Every time I read one of these emails, I feel a wave of sadness knowing what an uphill battle these children and their families will face in finding a provider who is unlikely to be accepting new patients, is too expensive, and is out of network. , or don’t. understand their plight as people of color.

I wonder if their children will contribute to the continuing trend in data showing higher rates of suicidal thoughts among youth of color, a group that had historically seen relatively low rates compared to white youth until the 2000s.

What will adulthood be like for these respondents if they don’t get help? Or, more importantly, what could help look like?

Despite the obstacles, I believe that help can come in many forms.

First, we will need more mental health providers if we are to reduce the risk of youth suicide and the preceding symptoms that are a cry for help, such as depression or anxiety. In the meantime, we must ensure that pediatric providers, adolescents, and guidance counselors are trained to identify the special needs of LGBTQ youth with depression, anxiety, or other mental health symptoms and intervene before suicide becomes a One option.

Second, we must continue to elect politicians who protect the rights of LGBTQ people, such as Sarah McBride, the first openly transgender state senator, and other LGBTQ legislators with intersectional identities.

And we must also engage at ground level. Right now, there’s a record amount of anti-trans legislation being approved or proposed throughout the country. Parents, teachers, doctors, and friends of LGBTQ people should hold accountable state politicians who create laws designed to harm young people by kicking them out when the time is right, especially since young people under the age of 18 cannot vote for themselves.

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Third, let’s be brave in sharing our stories about our own mental health struggles to reduce the stigma of asking for help. The more adults normalize talking about mental health and seeking help, the more likely it is that young people will feel comfortable talking and asking for help.

I applaud the transparency of LGBTQ celebrities like Demi Lovato and Ruby Rose who speak publicly about their personal experiences seeking help for mental health issues, and I encourage more of us to do the same.

As difficult as it is to confront the reality painted by the most troubling findings in the new Trevor Project report, does not tell the full story of LGBTQ youth.

The report ends by listing hundreds of ways respondents find joy, from watching anime to viewing rainbow flags in public to spending time with their chosen family. The comments about joy remind me of the many LGBTQ patients I have seen over the years and their resilience in being able to express themselves and find support in unlikely places.

Similarly, I also remember my own high school friends who were excited for me to come out as they suspected I was gay. I hear a song by rapper Lil Nas X on the radio, see a post by trans activist Ashlee Marie Preston on my Instagram feed, or laugh at the antics of the Nigerian queer character Ncuti Gatwa on the TV show “Sex Education” and I am heartened by the candor and courage of these individuals who serve as role models to so many.

I remember my own mentors who took pride in their roles as deans of medical school and also encouraged me to be open about my sexuality when I applied to medical school. And I think of my future genderqueer patients who will be excited to start therapy for the first time because they will have found a psychiatrist who is “just like them.”