The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not supportive. They kept telling him, “This is just a phase.” They wanted him to delay treatment with hormones, but he knew he could not wait.
I was notified of his suicide attempt when I arrived at work, and my heart broke. After learning that he would be physically OK, my mind flooded with questions. This is a patient I felt connected to — had I asked him if he was feeling depressed? Was he thinking of suicide? What had I missed? What could his community and I have done to prevent this?
Evan’s desperation, which both shocked and devastated his parents, is sadly not unusual among lesbian, gay, bisexual, transgender, and questioning (LGBTQ) teens. A 2001 national study published in the American Journal of Public Health found that LGBT youth are more than twice as likely to have attempted suicide as their peers. Additional research published in the Journal of Youth and Adolescence in 2009 found that the root cause of this is not inherent mental health disorders, but rather chronic exposure to unconscious bias, discrimination, and victimization.
Whether LGBTQ youth experience acceptance or rejection can make all of the difference. A 2014 survey of more than 7,000 LGBTQ youth found that 74.1 percent and 55.2 percent reported verbal harassment at school based on sexual orientation and gender expression, respectively. Sadly, this does not always end at school. The journal Pediatrics reported in 2009 that LGBT youth who faced rejection by their parents were nearly eight times more likely to have attempted suicide. It can be tempting to want to place blame, yet many parents are also isolated, unknowing of where to turn for support, and this blame does not solve the problem. Moreover, the Family Resilience Project shows us that many LGBTQ youth have loving, supportive families, which is very protective.
Evan’s story, while unique in its nuances, is not rare in its truths — we need to be doing more to support our youth and their families. Legislative advances help. This month, Governor Charlie Baker signed a bill into law that will make it illegal to discriminate against transgender people when they are in public spaces like bus terminals, retail stores, and restaurants. Even with the public debate that took place around this bill, conversations regarding gender, sexuality, and mental health continue to be relatively taboo. We are fortunate in the Northeast; we have wonderful organizations such as Youth Pride, TransYouth Family Allies, GLSEN, BAGLEY, Gender Spectrum, and more. What we do not have, though, is consistent, open, supportive dialogue around these issues in our homes, schools, places of worship, or our health care settings.
So who is responsible for this dialogue? Not all young people feel safe disclosing to parents, and not all parents have the ability to explore these topics. Presumably, health care providers should always initiate these conversations. However, not all youth attend annual visits and not all providers will raise these topics. As for our public schools, as of 2015, only 22 states require sex-education, and those that do generally focus on contraception and sexually transmitted infections.
Each of us is connected in some way to the well-being of LGBTQ youth and their families. Our reticence to talk about gender, sexuality, and topics of mental health in the open is triggering grave consequences. It is up to each of us to initiate conversations within families and communities. This is a vital time to engage. We all can feel empowered to raise the issue in our clinics, schools, places of worship, and our homes; it may make all the difference for our youth, their families and our communities.
Not long after Evan’s suicide attempt — and motivated in large part because of it ― I helped create the first Trans Health Conference at the Warren Alpert Medical School of Brown University, in 2015. This multidisciplinary and community conference saw nearly 200 participants the first year, and nearly 400 the second year. I knew we were on the right track when, that Saturday in January 2015, from the corner of my eye, I saw Evan and his father walk in together.
Dr. Alexis Drutchas is a family medicine physician at Fenway Health.