Pediatricians have a significant role in gender-affirming care for LGBTQ youth, who may not have access to LGBTQ-specific services in mental health facilities.

“In my years of work as a nurse, I’ve seen a disproportionate number of LGBTQ youth among patient who attempt suicide,” Kristen Choi, PhD, RN, MS, says. “On any given day, one-third to half of our patients, and sometimes more than that, identify as a sexual or gender minority. Even though we’ve made progress in how we think about sexual and gender minorities and health disparities, there are still many healthcare interactions that include a lot of stigma and negative judgments.”

In a research letter published in JAMA Pediatrics, Dr. Choi and colleagues report the findings of a survey study they conducted to assess state-level variations in the availability of LGBTQ mental health services in US-based pediatric mental health facilities in 2020. They also compared patterns in service availability from 2014 to 2020.

Physician’s Weekly spoke with Dr. Choi to learn more about the study and the implications for pediatricians.

PW: What prompted this research?

Dr. Choi: Every year, the Substance Abuse and Mental Health Services Administration conducts a census of all known mental health facilities in the US. It’s the most comprehensive data source that I know of that can characterize the mental health services available in the US. They have one survey item that asks about whether the facility offers specific services for LGBTQ populations. We used this to look at the landscape of LGBTQ-specific mental health services available in the US, as we know that, in general, access to mental health services is limited for this patient population.

What were the primary findings?

There was a slight increase in the facilities offering services for LGBTQ youth, from 25% in 2014 to 28% in 2020, but it wasn’t as large of an increase as we would have hoped, given known disparities in mental healthcare for LGBTQ youth.

We found a lot of differences from state to state. In some states, as many as half of mental health facilities might offer LGBTQ-specific services, while others had quite a lot fewer such facilities.

Even in some states, such as California, that have quite a few mental health facilities offering services for LGBTQ youth, there are sometimes few of those facilities per capita, making services less accessible than we would hope. Access challenges can also be seen in rural states where mental health is concentrated in urban centers; they may not be accessible for those who live far away from these urban centers.

What are the implications for pediatricians?

Access to mental healthcare is a huge problem for all kids in the US, and the evidence shows that many children access mental healthcare in primary care—through their pediatricians. In some ways, our findings have more implications for pediatric primary care providers, because we know that’s where so many kids are going for mental health services.

There are several things for pediatricians to keep in mind. First, it’s important for clinicians to think about what it means to provide affirmative care in the context of mental health. There’s a lot that goes into affirming people’s identity, being sensitive, and assessing their needs through the lens of sexual identity and gender that we all can do regardless of setting.

Further, when pediatricians do make referrals to mental healthcare, they should ask whether a facility offers services for LGBTQ patients. Of course, they are not going to be available in all situations, but if there is an option to send kids to a facility or a provider with that sensitivity, prioritize that.

There are several basic things that we can do in practice to offer affirmative care, such as asking patients: What do you want to be called? How do you identify, and how does this affect your health? Basic, open-ended questions can help to broach that conversation and create space for people to talk about it.

There are several existing resources to utilize, including guidelines from the American Academy of Pediatrics on gender-affirmative care.

It’s important for pediatricians to serve as advocates. There are many policies being put in place about affirming, or un-affirming, care in the US. Pediatricians are in such a strong position to advocate for policies that are evidence-based, compassionate, and humane—policies that let kids get the care they need and deserve.

Finally, pediatricians can do a lot just by serving as a safe space for kids who don’t have anywhere else to go. It’s a big deal to have providers who respect you, listen to you, and validate your experience.