During the COVID-19 pandemic, while schools turned to remote instruction and extracurricular activities were shut down for safety, students dealt with an unprecedented loss of community.
For many LGBTQ+ students, this meant losing a vital source of support, connection and empowerment while facing mental health challenges unique to the pandemic.
Stay-at-home orders meant some had to spend time with family members who were not supportive of their identity. For others, remote instruction restricted communication with peers, whether in casual interactions or in organized groups such as Gay/Straight Alliances (GSAs).
In a recent survey conducted by The Trevor Project, a national LGBTQ+ advocacy nonprofit focused on youth suicide prevention, 80% of LGBTQ+ youth ages 13 to 17 reported that COVID-19 negatively affected their mental health.
"Big negative events tend to hit the most vulnerable populations the hardest," Dr. Ito says. "You can imagine how the lack of access to education, health care and stable housing was already a huge issue for this population and how that became even more difficult during the pandemic."
For trans and nonbinary youth, he says, COVID-19 posed specific roadblocks in seeking health care, as some procedures considered non-essential were temporarily put on hold.
"Early in the pandemic, while we were trying to understand what is safe in terms of delivering health care, procedures or surgeries were stopped or delayed," Dr. Ito says. "For some of the trans youth that I saw, this equated to delays in gender-affirming procedures."
Gender-affirming care is an expansive range of treatment that can include supportive primary care, surgery, hormone therapy and psychotherapy. Some patients already had been waiting years to have surgical procedures completed. At outpatient clinics, which can handle services such as hormone therapy and counseling, reduced access to providers caused further delays in treatment.
National and state-level politics over the past year also had serious mental health consequences for LGBTQ+ youth. The same Trevor Project survey found that 94% of LGBTQ+ youth reported recent politics had adverse effects on their mental health.
Natalia Ramos, MD, is a psychiatrist and medical director at UCLA's EMPWR program, which offers comprehensive mental health care for LGBTQ+ patients. She says the current sociopolitical environment can be harmful to LGBTQ+ youth.
Recent state-level legislation across the country has targeted trans youth by, among other things, moving to restrict or criminalize gender-affirming care. So far in 2021, 33 states have introduced anti-trans legislation.
"While we're lucky overall that California has generally protected their LGBTQ+ youth, the prevalence of all this discussion sends a potentially hurtful and detrimental message to our youth," Dr. Ramos says.
Because students are so socially aware and engaged, she says, even legislation from the other side of the country can have a very negative impact.
Dr. Ito notes the "separate and parallel stressors" faced by some students, particularly LBGTQ youth of color.
"For a lot of youth of color, they had to deal with a lot of stressors over the past 18 months — so the stressors of the pandemic and their sexual and gender minority status, but also their racial minority identities," Dr. Ito says. "There are a lot of different factors that can overlap to create challenges for individual students."
Returning to in-person instruction
It is important to help youth gradually transition back to socializing in advance of returning to school, Dr. Ramos says.
"A lot of us have been so socially isolated for a year and a half now that it may take practice to get back into social spaces. It can be helpful to incrementally practice talking to people in person, getting out into the world, so there isn't a sudden jump back to in-person school full time," she says.
Some students will celebrate reuniting with peers, but for others, returning may not feel so safe.
At school, LGBTQ+ students can face a variety of challenges, from bullying and harassment to suffering from a lack of LGBTQ+ mentors. Dr. Ito says more than half of LGBTQ+ youth report feeling unsafe at school.
But schools with a supportive infrastructure do make a difference.
"We know that schools that have GSAs, non-discrimination policies, LGBTQ+ curriculum and staff development — those environments have lower rates of suicidal thoughts in LGBTQ+ students," Dr. Ito says. "If school is a warming, affirming and safe environment, then it can definitely be a resource."
According to The Trevor Project, 42% of LGBTQ+ youth struggled with thoughts of suicide in the past year.
Students returning to in-person instruction can seek out support systems, such as GSAs, mentors and peers.
"Identifying and reestablishing those areas of support is one of the most important things that youth can do," Dr. Ito says. "Also, acknowledging that it's going to be tough, that everybody is going to struggle, in some way or another, with the transition back to in-person learning. I think acknowledging that, and having some self-compassion, can remove some of the feelings of isolation."
What can loved ones do?
There are many ways to support LGBTQ+ students.
"For parents of LGBTQ+ youth who have come out, I think it's important to recognize the particular stressors that are going on, and to be supportive and validating of their experience," Dr. Ito says. For youth in clinical care, he says, it is also vital to help them stick to treatment goals.
Daniela Delgado, MD, a primary care physician who works with the Gender Health Program, says one of the most important steps to take is asking loved ones what they need.
"Parents can ask, 'How can I best support you?'" Dr. Delgado says. "Being able to say, 'I love you, I'm here to support you, how can I do that?' and letting them tell you is a really good step."
In cases where youth have not come out to their parents, affirmation is still important.
"Parents can have positive conversations about LGBTQ+ individuals, conversations about sexual health, about things like sexual orientation and gender identity," Dr. Ito says. "Maybe their youth is somewhere on the LGBTQ+ spectrum. It provides an opening to say, 'I'm here, and I support you, and I'm ready to listen.'"
He says parents of trans and nonbinary youth are "critical advocates" when it comes to school.
Dr. Ramos notes that support from school teachers and administrators is key, particularly when it comes to using a student's correct name and pronouns in a classroom setting.
"For youth that have socially transitioned during the pandemic, now is a good time for caregivers to meet with the schools and make sure names and pronouns and all the supportive logistics are up to date," she says.
There are plenty of resources available for families needing more support. The EMPWR program holds Resilience Groups for teens and caregivers, incorporating stress management and skill-building; UCLA’s Gender Health Program provides comprehensive gender-affirming care.
"We're lucky in L.A. that we have no dearth of resources for families that are looking for support," Dr. Ramos says.
Sophie Govert is the author of this article.