The Loss of a Vital LGBTQ+ Suicide Prevention Resource: In Conversation With AFSP’s Christine Yu Moutier, MD

CLINICAL CONVERSATIONS

The Substance Abuse and Mental Health Services Administration recently announced the termination of the 988 National Suicide & Crisis Lifeline tailored support options for LGBTQ+ youth and young adults.¹ These services will stop on July 17, 2025. In the wake of this decision, Psychiatric Times spoke with Christine Yu Moutier, MD, the chief medical officer of the American Foundation for Suicide Prevention (AFSP), about how this will impact suicide rates of LGBTQ+ youth and what mental health clinicians can do to support them.

Psychiatric Times: What do psychiatrists and mental health clinicians specifically need to know/be aware of in the wake of the loss of 988 LGBTQ+ tailored services?

Christine Yu Moutier, MD: Like all marginalized populations that have experienced historical and present-day discrimination, LGBTQ+ individuals can experience mistrust or harm when interacting with general mental health systems—related to any number of actions like misgendering, making assumptions, or overt discrimination. 988 Press 3’s specialized counselors are trained in the LGBTQ+ experience and include identity-affirming, trauma-informed approaches, which creates a trusting space for these individuals, which affords more authentic connection, more openness, and perhaps receptivity to the counselor’s expressions of support and recommendations.

In the first year alone, 280,000 LGBTQ+ crisis contacts were served through The Trevor Project’s participation in 988,² demonstrating an unmet demand for identity-specific services. Without trusted crisis support, LGBTQ+ youth are more likely to avoid reaching out for help, which may lead to worse mental health outcomes.

PT: How will this decision specifically impact trans youth?

Moutier: Transgender youth face exceptionally high risk. Approximately 26% of trans youth attempted suicide in the past year, compared to 5% to 11% among cisgender youth.³ What’s more, research has linked anti-trans legislation to a 7% to 72% increase in suicide attempts by trans youth,⁴ which is especially concerning given the 988 Press 3 service is ending alongside escalating anti-trans policies and restrictions on gender‑affirming care in 26 states.⁵

PT: Are there any actions mental health clinicians can take?

Moutier: First, increase your radar’s sensitivity to pick up on distress among patients, community members, and even colleagues. If relevant, name the loss of this vital resource. Validating the harmful actions going on in the current climate can help youth process grief, express anger, and restore agency.

Second, help your patients to develop personal crisis plans (or safety plans for those with suicidal ideation) that identify affirming adults, friends, or local organizations—especially in the absence of 988’s LGBTQ+ line, and strengthen referral pathways with organizations like The Trevor Project, Trans Lifeline, local affirming clinics, and peer-support groups. Also remember that 988 is for everyone, so this should remain a recommended resource despite this change.

Make sure to create identity-affirming environments by listening first to the experiences and needs of patients, using correct pronouns and names from the first interaction, and by building specific knowledge about intersectionality with race/disability, and specific cultural beliefs/practices regarding gender and sexual identities. You can build education in LGBTQ+ mental health and cultural competency by familiarizing yourself with clinical best practices for LGBTQ+ clients,⁶ and working with BIPOC and LGBTQ+ experts/clinicians to enhance cultural sensitivity. It is important not to put the burden of education on patients.⁷

Finally, mental health clinicians must acknowledge and address the fact that generic services are not neutral—they often reflect mainstream norms that can alienate marginalized youth since psychiatry and clinical psychology training does not always center LGBTQ+ development, minority stress, and resilience frameworks. We encourage mental health professionals to lobby for dedicated LGBTQ+ mental health funding and tailored services, and join AFSP in pushing policy makers to restore the 988 LGBTQ+ specific crisis service.

PT: Thank you!

Dr Moutier is Chief Medical Officer, American Foundation for Suicide Prevention, New York, NY.

References

1. Kuntz L. Loss of 988 hotline services tailored to LGBTQ+ youth. Psychiatric Times. June 19, 2025. https://www.psychiatrictimes.com/view/loss-of-988-hotline-services-tailored-to-lgbtq-youth

2. The Trevor Project celebrates another year of supporting LGBTQ+ young people through 988’s inclusive crisis services. The Trevor Project. News release. November 16, 2023. Accessed June 20, 2025. https://www.thetrevorproject.org/blog/the-trevor-project-celebrates-another-year-of-supporting-lgbtq-young-people-through-988s-inclusive-crisis-services/

3. Suarez NA, Trujillo L, McKinnon II, et al. Disparities in school connectedness, unstable housing, experiences of violence, mental health, and suicidal thoughts and behaviors among transgender and cisgender high school students — Youth Risk Behavior Survey, United States, 2023. CDC. 2024. Accessed June 20, 2025. https://www.cdc.gov/mmwr/volumes/73/su/su7304a6.htm

4. Lee WY, Hobbs JN, Hobaica S, et al. State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nat Hum Behav. 2024;8(11):2096-2106.

5. Map: attacks on gender affirming care by state. Human Rights Campaign. Accessed June 20, 2025. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map

6. Fadus M, Hung K, Casoy F. Care considerations for LGBTQ patients in acute psychiatric settings. Focus (Am Psychiatr Publ). 2020;18(3):285-288.

7. Zullo L, van Dyk IS, Ollen S, et al. Treatment recommendations and barriers to care for suicidal LGBTQ youth: a quality improvement study. Evid Based Pract Child Adolesc Ment Health. 2021;6(3):393-409.