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.

Stewart Adelson, MD

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 Medical Director Emeritus at Weill Cornell Center for Human Rights.

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. 

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

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