Lesbian, gay, bisexual, transgender, and queer-identifying (LGBTQ) youth face myriad social factors that increase their risk of experiencing mental health problems. Discrimination, harassment, rejection, bullying, and hate violence all put LGBTQ youth at greater risk for depression, anxiety, substance abuse disorders, thoughts or attempts of suicide, and feelings of worthlessness and hopelessness about the future (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). LGBTQ youth additionally experience the same syndemic factors (e.g., disruptions to school, social life, and extracurricular activities) that have contributed to increased mental health concerns across all American youth. Furthermore, along with the life-disrupting pandemic, the past few years have brought an onslaught of antiqueer school and state legislation across the nation. Most of these bills target transgender and gender-nonconforming (GNC) individuals and focus on queer youth themselves (e.g., banning gender-affirming care; the use of preferred name, pronouns, and bathrooms). Bills that do not pass into law may still have a negative impact on LGBTQ youth, sending a strong message from people in power to the queer community that they are not wanted, not understood, not safe, and even villainized. These messages can be internalized as ultimate rejection by society, contributing to bleak feelings about self-worth and the future. 

As Certified Family Life Educators (CFLEs), we can address the social factors contributing to the mental health crisis of LGBTQ youth through education about human sexuality, gender, and the risks associated with family and community discrimination based on sexual orientation and gender identity. As we work with LGBTQ youth and their families, it is vital that we remember that being LGBTQ does not automatically or inherently put a person at increased risk for experiencing adversity and undesirable outcomes. Instead, it is societal prejudice, marginalization, and discrimination that LGBTQ youth experience that puts them at greater risk for mental health problems such as suicide attempts, depression, and substance abuse. Stuart Roe (2017) summed his research findings on the topic in a helpful way: It is not being “other than,” it is being othered that is associated with increased risk for adverse experiences and outcomes in LGBTQ individuals. In fact, his research has shown that LGBTQ individuals who come from accepting families and communities do not experience the mental health crises that LGBTQ individuals who experience rejection, harassment, and violence for their queerness. CFLEs can alleviate the mental health risks LGBTQ youth face by increasing family acceptance and community safety through advocacy and educational efforts. 

The Family Acceptance Project (FAP; n.d.) from San Francisco State University is a research, intervention, education, and policy initiative to decrease mental health risks and promote well-being for LGBTQ youth. In addition to offering trainings and consultations for program development, FAP has developed many resources CFLEs can use to support LGBTQ youth in the context of their families, cultures, and faith communities. Their Family Education Booklet is included on SAMHSA’s Best Practices Registry for Suicide Prevention and is printed in English, Spanish, and Chinese. FAP has also developed Healthy Futures posters that can be downloaded for free from its website (https://familyproject.sfsu.edu/posters). The posters are designed like bingo cards with blocks of actions. The Family Acceptance poster gives examples of supportive actions families can take to protect their child and promote their well-being (e.g., “believe that your child can be a happy LGBTQ adult—and tell them they will have a good life”). The Family Rejection poster provides examples of actions that harm children and put them at greater risk for mental health crises (e.g., “pressure your child to be more masculine or feminine”). There is a third poster designed for conservative audiences with actions that may be more accessible for more conservative families (e.g., “tell your LGBTQ/gender diverse child that you love them”). Cultural competence is a priority for FAP and they have developed these three posters and made them available in 11 languages (English, Spanish, American Indian, Chinese [Traditional], Chinese [Simplified], Hindi, Japanese, Korean, Punjabi, Tagalog, and Vietnamese).   

The resources FAP has developed are based on the research conducted by the project on the impact of family acceptance and rejection on LGBTQ youth and adult mental health and well-being. Families can be a risk factor or a protective factor for LGBTQ youth mental health and life outcomes. Family rejection can be severe, such as physical or psychological abuse and total rejection of the child from the home and family. However, rejecting behaviors can be more subtle as well, such as preventing the child from having friends who are LGBTQ, learning about LGBTQ community and resources, or being involved with support groups for LGBTQ youth. Examples of accepting behaviors include learning about the child’s LGBTQ identity, advocating for the child, and welcoming the child’s partners and LGBTQ friends into the home and at family gatherings. Most families are a mixture of both accepting and rejecting behaviors. Example of this are a family welcoming a child’s partner in their home but telling the child not to bring the partner to larger family gatherings or a family telling a child that their gender nonconformity is just a phase but going to the school to demand the child be able to use their preferred pronouns when being discriminated against by school policies. 

The negative outcomes of family rejection cannot be underestimated. LGBTQ young adults who reported higher levels of family rejection during adolescence were 8.4 time more likely to have attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to have engaged in unsafe sex compared with peers from families that reported no or low levels of family rejection (Ryan et al., 2009). Family acceptance, however, predicts greater self-esteem, social support, and general health status; it also actively protects against depression, substance abuse, and suicidal ideation and behaviors (Ryan et al., 2010). Family acceptance can also serve as an important source of support for LGBTQ youth as they face discrimination outside the family. 

Fortunately, family acceptance levels and behaviors can change and improve over time, especially with support. As CFLEs, we can educate families about how their behaviors, attitudes, and messages about queerness impact their child’s mental health and safety. We can provide parents with a more accurate understanding of sexual orientation and gender identity; many people believe that queerness is a phase that will go away, but it is not. Further, many believe that transgenderism and gender nonconformity are “new fads,” but nonbinary people and third genders have been observed in cultures around the world for centuries. Many parents want what is best for their child but may not understand what is best for their child, especially if they do not understand sexual orientation or gender identity. Learning that rejecting behaviors put their child at more than 8 times the risk of attempting suicide and 5 times more likely to be depressed can be a strong motivating factor for parents to learn about how they can support and protect their child. As can be demonstrated in the following testimonial from the FAP website, family attitudes, understandings of LGBT identity, and behaviors can change: 

When my daughter was little, I spent so much time fussing over how she looked. I should have been concerned about how she felt. We didn’t know about transgender—but I know how sad and depressed she got right before middle school. The school helped us find a counselor and that’s when we found out how hopeless she felt. I wanted to make sure she wasn’t rejected by others, but instead, I was the one who was rejecting her. I’m so grateful I could change things before it was too late. —Brianna, mother of 12-year-old transgender youth 

Another important way CFLEs can support LGBTQ youth is by emotionally supporting family members in the complex feelings they may experience over a child’s LGBTQ identity. Some parents may experience significant conflict between their religious or cultural beliefs and their desire to love and support their child unconditionally. Some caregivers may experience fear over their child’s safety and future as they may be subjugated to discrimination. It is also common for parents to experience ambiguous loss over the future they had envisioned for their child before their child came out (Wahlig, 2015). CFLEs can normalize and validate family members’ complex feelings around youth’s queer identity and direct parents to resources for support and, when appropriate, individual or family therapy. 

In conclusion, LGBTQ youth face societal factors that put them at greater risk for several mental health issues. CFLEs can address this mental health crisis by educating families about human sexuality and gender identity, and the consequences of rejecting and accepting behaviors on the mental health and long-term outcomes for their LGBTQ children. FAP has numerous research-based resources to aid CFLEs in educating families in a multitude of contexts, cultures, and communities. 

References 

Family Acceptance Project. (n.d.). LGBTQ youth & family resources. https://lgbtqfamilyacceptance.org/ 

Roe, S. (2017). “Family support would have been like amazing”: LGBTQ youth experiences with parental and family support. The Family Journal: Counseling and Therapy for Couples and Families, 25(1), 55–62. https://doi.org/10.1177/1066480716679651   

Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. https://doi.org/10.1542/peds.2007-3524   

Ryan, C., Russel, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205–213. https://doi.org/10.1111/j.1744-6171.2010.00246.x  

Substance Abuse and Mental Health Services Administration. (2012). Top health issues for LGBT populations information & resource kit (HHS Publication no. 12-4684). 

Wahlig, J. L. (2015). Losing the child they thought they had: Therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child. Journal of GLBT Family Studies, 11(4), 305–326. https://doi.org/10.1080/1550428X.2014.945676

Emily Grubbs (she/her/hers), M.S., CFLE-P, lives in Little Rock, AR, and is a doctoral candidate in Human Development and Family Science at Mississippi State University. You can email her at [email protected]. 

Alisha M. Hardman, Ph.D., CFLE, is an Associate Professor in the School of Human Sciences at Mississippi State University where she teaches Human Development and Family Science courses. She is also a state Extension Family Life and Evaluation specialist.