is the Medical Director Emeritus at Weill Cornell Center for Human Rights.

Joanne Ahola, MD

Among us are psychiatrists who evaluate people fleeing persecution, including those who are lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ). We have heard their devastating stories, and we know the mental health consequences of the human rights abuses they have suffered.

“Marina” and her young daughter fled their Central American country after years of persecution based on her lesbian sexual orientation and gender-nonconforming behavior. Her daughter was born after a so-called “corrective rape” by a local gang leader. At the US southern border, the 2 were forced to remain in Mexico under Title 42 [see following] and the Migrant Protection Protocols. During months of forced waiting, they experienced robbery, kidnapping, extortion, and sexual molestation.

Title 42 is a Trump Administration policy continued by the Biden Administration that blocks entry of refugees into the United States at the US-Mexico border under the pretext of public health. Part of US health law, Title 42 prohibits entry into the United States when the director of the Centers for Disease Control and Prevention (CDC) believes “there is a serious danger to the introduction of a disease into the United States.”

Protecting the public from SARS-CoV-2 does not require sacrificing the human rights and well-being of legitimate asylum seekers seeking safe haven from torture and other human rights abuses in the United States. Even some of the CDC’s own physicians argued that halting the asylum process was not based on protecting public wellness and safety. Title 42 can be rescinded in a safe way that is not a risk to public health.

Yet for reasons that probably have more to do with politics than public health, the Biden Administration and the CDC have extended this policy indefinitely. While the United States has historically been a beacon of hope for refugees fleeing persecution, the plight of refugees has been increasingly caught up in electoral politics. The American Immigration Council reports that the Biden Administration has banned more than a half million immigrants from entering into the United States and has increased the number of expulsions over the previous administration by 67%.

American law and international human rights treaties require that the United States and other countries offer the right to seek asylum. According to Karen Musalo, JD, professor and founding director of the Center for Gender and Refugee Studies at UC Hastings, “Until Title 42 is rescinded, the US will continue to be in blatant violation of its domestic and international legal obligations.”

Refugees expelled to the areas of Mexico just south of the border face grave danger. Human Rights First has tracked at least 1500 public reports of rape, torture, murder, and other human rights abuses among refugees in Mexico.

 The Marshall Project reports that the migrant death rate has almost doubled under Title 42.

This situation is disheartening for all who value international laws that protect the right of those who have suffered persecution to seek safety. It is life threatening to those expelled—vulnerable human beings, especially those who are LGBTIQ, those who are living with HIV, Black and African migrants, unaccompanied minors, and families with young children. Anti-LGBTIQ and racist violence are well documented at the border.

Marina and her daughter eventually found safety. An attorney investigating cases of asylum seekers expelled to Mexico identified them as especially vulnerable and took on Marina’s case. A volunteer psychiatrist also evaluated the mental health consequences of her trauma. Asylum was granted in US Immigration Court.

We implore President Biden, his administration, and the CDC to reverse a policy that puts LGBTIQ asylum seekers and other refugees in peril and does not keep COVID-19 and its variants out of the United States. The United States should continue its honorable tradition of offering safe haven to those fleeing persecution and continue to uphold international human rights treaties and conventions that it has long championed. Now is the time to make a comprehensive break with the cruel and harmful immigration policies of the previous administration.

42 U.S. Code § 265 - Suspension of Entries and Imports From Designated Places to Prevent Spread of Communicable Diseases

 is medical director emeritus at the Weill Cornell Center for Human Rights and has a private practice in New York City. 

 is director of the Youth Equity Science/YES Project; a senior visiting fellow at Yale Law School; an assistant clinical professor at Columbia University College of Physicians & Surgeons; and a clinical assistant professor at Weill Cornell Medical College. 

 is an associate professor of clinical psychiatry at Icahn School of Medicine at Mount Sinai. 

 is an Episcopal priest at St George’s Church in Newburgh and St Paul’s Church in Poughkeepsie. 

works with the Division of Gender, Sexuality and Health at Columbia University College of Physicians and Surgeons. 

 is a community and public psychiatrist in New York City. 

 is a psychiatrist, LGBTQ+ Specialty Team (Southern Colorado VA) LGBTQ+, and veteran care coordinator senior instructor at University of Colorado Denver. 

 is a clinical professor of psychiatry at Columbia University and an adjunct professor at New York University. 

 is an assistant professor of psychiatry at Columbia University Medical Center and a consulting psychiatrist at the Hetrick-Martin Institute. 

 is a public psychiatry fellow at Columbia University. 

 has a private practice in New York City. 

 is a consultation/liaison telepsychiatry assistant professor of clinical psychiatry at Weill Cornell Medicine, and an adjunct assistant professor of clinical psychiatry at Columbia University. 

is an assistant clinical professor at the Yale Child Study Center. 

 is a clinical assistant professor in the Department of Psychiatry at New York University’s Grossman School of Medicine, and has a private practice in New York City. 

 is a professor emeritus of clinical psychiatry at Weill Cornell Medical College. 

 is vice chair and residency training director at SUNY Downstate Medical Center. 

 is an associate professor in the Department of Psychiatry at the University of Toronto

 is a psychiatry resident (PGY4) in the Department of Psychiatry at Indiana University School of Medicine, and founder and president of OutCare Health

 is on the faculty and supervisor of psychotherapy at the William Alanson White Institute, and has a private practice in New York City. 

 is director of the Division of Substance Abuse and Addiction Medicine, and an associate clinical professor of psychiatry at the University of California, San Francisco School of Medicine

 has a private practice in New York City.

Tracking the Biden agenda on legal immigration in the first 100 days

. April 29, 2021. Accessed December 1, 2021.

. June 28, 2021. Accessed December 1, 2021.

Delivered to danger: U.S. Government sending asylum seekers and migrants to danger.

. February 19, 2021. Accessed December 1, 2021.

Strict border enforcement policies put migrants in harm’s way. Title 42 is no exception

. May 26, 2021. Accessed December 1, 2021.

Articles

The Group for the Advancement of Psychiatry (America’s mental health think tank) calls for an end to the use of Title 42 to expel asylum seekers at the southern border. This policy places LGBTIQ asylum seekers in particular danger.

Psychiatrists Call for End to Cruel and Harmful Immigration Policy

LGBTQ COMMITTEE OF THE GROUP FOR THE ADVANCEMENT OF PSYCHIATRY

As the number of COVID-19 cases in the United States hits 30 million and continues to cause widespread pain in lives lost and economic devastation, sexual and gender minority youth face particular hardships threatening their lives, mental health, and social development.

In particular, social isolation may be especially challenging. These youths may be quarantining with rejecting family-members and losing contact with supportive social networks. The nature of quarantining means these problems are invisible to the public.

“Aiden,” a 16-year-old boy who is transgender, lives in a community particularly hard-hit by COVID-19. Aiden’s parents refuse to accept his gender identity or call him by his male name or use male pronouns. They frequently yell at Aiden to dress and act like a girl, assigning dishwashing and laundry chores to him alone, and not to his brother, to get him “used to doing girl stuff like you are supposed to.”

Serial COVID-19 outbreaks at Aiden’s school forced him into remote learning. His family has only 1 computer, shared by Aiden and his brother for schoolwork and Aiden’s mother for church meetings. Aiden’s parents banned him from using social media or communicating with friends because his parents believe “that’s where she picked up all this nonsense.” Aiden became completely disconnected from his friends. He was also cut off from affirming and supportive teachers. As tensions in Aiden’s family escalated, fighting became the only interaction between him and his parents.

One evening during a fierce argument, Aiden’s mother pushed him, and he pushed her back. As a result, she fell and had a small laceration on her shoulder. Aiden’s father became angry and punched Aiden in the face. Aiden’s brother called 911. The police arrested Aiden and his father. Aiden was released from jail to a Child Protective Services emergency residence. Because of COVID-19, he was required to spend 14 days isolated in his room, including mealtimes, and was unable to receive visitors. He also faced misdemeanor charges for assaulting his mother. His father also faced charges. Aiden was afraid of returning home because he was petrified of what his father might do to him.

Administration for Children’s Services (ACS) attempted to reunify Aiden with his parents, but over a period of several months, each attempt resulted in further physical altercations between Aiden and his father. Aiden moved into a group home where peers bullied him because of his gender identity. ACS was unable to address the problem because several staff members were hospitalized with COVID-19, and no other group homes were available for transfer. After a bully hit him, Aiden ran away from the group home, and the police could not locate him.

Even before COVID-19, lesbian, gay, bisexual, transgender, questioning (LGBTQ) youth were at 

 of depression, suicidality, and tobacco, alcohol, and other drug use.

 These increased risks stem from elevated rates of rejection, discrimination, and victimization. During the pandemic, risks were further compounded by the loss of relationships in schools, clubs, or other community venues where LGBTQ youth found support and affirmation. Laura Erickson-Schroth, MD, a psychiatrist at the Hetrick-Martin Institute, a New York City-based LGBTQ youth organization, reported that youth members of the institute are looking for more frequent counseling sessions. According to her, there were at least one-third more requests for initial psychiatry visits during 2020 than during the same period in 2019.

 found one-third of the city’s youth in foster care identifies as LGBTQ, an order of magnitude greater than the general population.

 Nearly three-quarters of these youth are Black, and one-third identify as Hispanic/Latino. LGBTQ youth are placed in group homes and other campus settings rather than foster families more often than their non-LGBTQ peers, and they are more likely to be dissatisfied with their placement. The study also found these youth experience a greater burden of depression.

According to Dylan Waguespack, director of public policy and external affairs of 

, 20% to 40% of homeless youth identify as LGBTQ. True Colors United is a national organization dedicated to ending LGBTQ youth homelessness. Although family conflict, involvement in the foster care system, and involvement in the criminal justice system are among the factors that contribute to homelessness among these youth, poverty is often the root cause. Not only are these youth at risk for adverse mental health outcomes because of rejection and discriminatory behaviors, they often face traumatic experiences through conflict with their families, involvement in overwhelmed and poorly informed state programs.

Agencies that previously made efforts to address racial, social, gender, or sexuality based inequities before the pandemic have become even more overwhelmed with the increase in housing and food insecurity, increased unemployment, instability in the agency’s own staff, and the need to rapidly implement physical distancing and other public health measures in routine work. Overwhelmed and encumbered agencies are increasingly unable to provide critical services for LGBTQ youth, leaving them powerless in impeding a downward spiral into homelessness and associated negative ramifications.

Even as the pandemic ends, there may be continual struggles and support needs. Fortunately, there are ways psychiatrists and other mental health care professions can help.

Some of these methods include the following:

Financially donate to organizations that support or serve LGBTQ youth.

Advocate for programs that decrease income inequality and promote housing and food security.

Enable rapid interventions to prevent LGBTQ youth from entering the foster care and criminal justice systems.

Use clinical, teaching, institutional, and forensic roles to speak out and advocate for this vulnerable group of young people.

Share resources and references for supportive organizations with patients who are LGBTQ (

LGBTQ youth have long experienced marginalization and significantly increased risk of poor mental health outcomes. The COVID-19 pandemic sharpened the crisis and brought clarity to the precariousness of social service agencies that address those needs. Strengthening the support system for these youth and their allies and making agencies more inclusive of their voices is critical to help these young people achieve a healthy and fulfilling life.

is the director of the Youth Equity Science/YES Project and senior visiting fellow at Yale Law School. He is also an assistant clinical professor at Columbia University and an adjunct clinical assistant professor at Cornell Weill Medical College.

the medical director emeritus at Weill Cornell Center for Human Rights. Dr Barberis the past president and journal editor for the Association of LGBTQ Psychiatrists and is an MDiv candidate at Union Theological Seminary.

is a community and public psychiatrist in New York City.Dr Drescher is a clinical professor of psychiatry at Columbia University and an adjunct professor at New York University. He is also a distinguished life fellow of the American Psychological Association and the past president of the Group for Advancement of Psychiatry

is an assistant professor of psychiatry at Columbia University Medical Center and a consulting psychiatrist at Hetrick-Martin Institute for LGBTQ youth.

. 2020;18(3):268-276. doi:10.1176.appi.focus.20200018
2. Sandfort TGM. Experiences and well-being of sexual and gender diverse youth in foster care in New York City: disproportionality and disparities. November 2020. Accessed January 5, 2020. 

https://www1.nyc.gov/assets/acs/pdf/about/2020/WellBeingStudyLGBTQ.pdf

Overwhelmed and encumbered agencies are increasingly unable to provide critical services for LGBTQ youth, leaving them powerless in impeding a downward spiral into homelessness and associated negative ramifications. There are 5 ways psychiatrists can help.

Helping LGBTQ Youth During the Pandemic

As the number of COVID-19 cases in the United States rockets past 21 million, causing widespread pain in lives lost and economic devastation, lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth face particular hardships threatening their lives, mental health, and social development.

In particular, social isolation may be especially challenging for LGBTQ youth. They may be quarantining with rejecting family-members and losing contact with supportive social networks. The nature of quarantining means these problems are invisible to the public.

Aiden, a 16-year-old transgender boy, lives in a community particularly hard-hit by COVID-19. Aiden’s parents refuse to accept his gender identity, call him by his male name, or use male pronouns. They frequently yell at Aiden to dress and act like a girl, assigning dishwashing and laundry chores to him alone—and not to his brother—to get him “used to doing girl stuff like you are supposed to.” 

Due to serial COVID-19 outbreaks at Aiden’s school, he is forced into learning remotely. His family has only 1 computer, shared by the 2 siblings for schoolwork and Aiden’s mother for church meetings. Aiden is banned from using social media or communicating with friends because his parents believe “that’s where she picked up all this nonsense.” Aiden has become totally disconnected from his friends. He is also cut off from affirming and supportive teachers. As tensions in Aiden’s family escalate, fighting becomes the only interaction between him and his parents.

Even before COVID-19, LGBTQ youth were at higher risk for depression, suicidality, and tobacco, alcohol, and other drug use.

 Moreover, this increased risk stems from increased rates of rejection, discrimination, and victimization. During a pandemic, risk is further compounded by loss of relationships in school, clubs, or other community venues where LGBTQ youth find support and affirmation. Laura Erickson-Schroth, MD, MA at the New York City-based LGBTQ youth organization, Hetrick-Martin Institute, reports youth members are asking for more frequent counseling sessions. They have made at least a third more requests for initial psychiatry visits during 2020 than during the same period in 2019. 

One evening, during a fierce argument, Aiden’s mother pushes him and he pushes her back. She falls, suffering a small laceration on her shoulder. Aiden’s father becomes angry and punches Aiden in the face. Aiden’s brother calls 911. The police arrest Aiden and his father. Aiden is released from jail to a Child Protective Services (CPS) emergency residence. Because of COVID-19, he is required to spend 14 days isolating in his room, including mealtimes, and he is unable to receive visitors. He faces misdemeanor charges for assaulting his mother; and his father may also face charges. Aiden is afraid of returning home, as he is petrified of what his father might do to him. 

A study commissioned by New York City’s Administration for Children’s Services (ACS)

 found one third of the city’s youth in foster care identify as LGBTQ, an order of magnitude greater than the general population. Nearly three quarters of these youth are African American and one-third identify as Latinx. LGBTQ youth are placed in group homes and other campus settings rather than foster family placement more often than their non-LGBTQ peers, and they are more likely to be dissatisfied with their placement. The study also found LGBTQ youth experience a greater burden of depression.

ACS attempts to reunify Aiden with his parents, but each attempt over several months results in further physical altercations between Aiden and his father. Aiden moves into a group home where he is bullied by some peers because of his gender identity. The agency is unable to address the problem because several staff are hospitalized with COVID-19 and no other group homes are available for transfer. After a bully hits him, Aiden runs away from the group home and the police have yet to locate him.

, a national organization dedicated to ending LGBTQ youth homelessness, says 20 to 40 percent of homeless youth identify as LGBTQ. Contributors to LGBTQ youth homelessness include family conflict, involvement in the foster care system, and involvement in the criminal justice system. Poverty is often the root cause. Not only are LGBTQ youth at risk for adverse mental health outcomes because of rejecting and discriminatory behaviors, they often face traumatic experiences through conflict with their families, involvement in overwhelmed and poorly informed state programs, and homelessness. 

COVID-19 exacerbates these problems. Agencies that might have made efforts to address racial, social, gender, or sexuality based inequities before the pandemic have become even more overwhelmed with the increase in housing and food insecurity, increased unemployment, instability in the agency’s own staff, and need to rapidly implement physical distancing and other public health measures in routine work. Overwhelmed and encumbered agencies are increasingly unable to provide critical services for LGBTQ youth, leaving them unable to impede a downward spiral into homelessness and associated negative sequelae. 

- Increase representation in leadership bodies so marginalized youth can help shape successful programs and interventions. 

- Reevaluate policies and practices that harm or further alienate LGBTQ youth. 

- Create resources to hire LGBTQ youth as peer advocates who can help engage others at the front lines of service delivery. 

What Psychiatrists and Other Mental Health Professional Can Do:

- Donate financially to organizations that support or serve LGBTQ youth.

- Advocate for programs that decrease income inequality and promote housing and food security.

- Enable rapid interventions to prevent LGBTQ youth from entering the foster care and criminal justice systems.

- Use clinical, teaching, institutional and forensic roles to speak out and advocate for this most vulnerable group of young people.

- The Trevor Project – A national 24-hour, toll free confidential suicide hotline for LGBTQ youth. 

- The Family Acceptance Project – An initiative which helps ethnically, racially and religiously diverse families learn to support their LGBTQ children. 

- PFLAG – A national organization with local chapters providing support for LGBTQ+ people, their parents and families, and allies. 

- Trans Student Educational Resources (TSER) – A youth-led organization dedicated to transforming the educational environment for trans and gender non-conforming youth. 

- Gay, Lesbian, and Straight Education Network (GLSEN) – An organization that works to Ensure All Students Have a Safe Place to Learn. 

All of the authors are members of the LGBTQ Committee of the Group for the Advancement of Psychiatry.

is the director of the Youth Equity Science/YES Project and Senior Visiting Fellow at Yale Law School. He is also an assistant clinical professor at Columbia University, and an adjunct clinical assistant professor at Cornell Weill Medical College.

is the past president and journal editor for the Association of LGBTQ Psychiatrists, and is a MDiv candidate at Union Theological Seminary.

is a community and public psychiatrist in New York City.

is a clinical professor of psychiatry at Columbia University and an adjunct professor at New York University. He is also a Distinguished Life Fellow of the American Psychological Association and the past president of the Group for Advancement of Psychiatry.

assistant professor of psychiatry at Columbia University Medical Center and a consulting psychiatrist at Hetrick Martin Institute for LGBTQ Youth.

1. Lothwell L, Libby N, Adelson S. Mental health care for LGBT youths. 

2. Sandfort TGM. Experiences and well-being of sexual and gender diverse youth in foster care in New York City: disproportionality and disparities. November 2020. Accessed January 5, 2020. 

The pandemic has exacerbated many existing dangers, and introduced a few new ones.  

Joanne Ahola, MD

Articles

Psychiatrists Call for End to Cruel and Harmful Immigration Policy

Helping LGBTQ Youth During the Pandemic

Impact of COVID-19 Crisis on LGBTQ Youth