Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Young LGBTQ+ patients deserve more 


36% of LGBTQ+ youth are unsure they’ll live until the age of 35. These mental health outcomes are even more severe for LGBTQ+ youth of color. It’s critical that clinicians create a safe space to talk about anxiety, depression, self-harm, and suicidal ideation. 

“I don’t feel Black enough around my friends,” Kevin said to the psychiatry team during his intake appointment. Kevin’s parents had brought him into the clinic for concerns of paranoia, after he told them that he felt classmates were talking about him behind his back. At his school, Kevin struggled to fit in with the other Black children and felt left out. While his parents were protective and loving, they struggled to understand how Kevin’s identity as a minority youth was impacting his mental health. Additionally, he was struggling with other parts of his identity and background. He’d experienced bullying at school from peers and wasn’t sure how he identified in his gender. At times, he’d brought it up with his parents, but amid his other mental health struggles, the topic of his gender identity often fell to the wayside at home. “I don’t really fit in at school, and I don’t want to go. Sometimes, I just want to disappear,” he said, with a dejected affect. His parents expressed feeling of being at a loss of what to do to help. 


This story is sadly not unique. In a recent national survey in the U.S. by The Trevor Project, just over 1 in 3 LGBTQ+ youth (36%) reported feeling unsure they would live to the age of 35. Additionally, youth with lower perceived life expectancy reported higher rates of anxiety, depression, self-harm, and attempted suicide within the past year. These statistics are more pronounced in LGBTQ+ youth of color, with higher percentages of reported suicidal ideation and attempted suicide in Black, Latino, Indigenous, Middle Eastern/North African, and multiracial youth.  


Healthcare professionals can work to eliminate stigmas about race, sexuality, and gender in the clinical setting by creating a safe space to talk about these realities with patients. Here are a few tips:  


1. Ask about minority stress.
Talking about minority stress with patients can help clarify for LGBTQ+ youth what they are experiencing in the world. It also validates their experience.  


2. Avoid making assumptions.
Instead of making generalizations or assumptions about a patient’s identities, approaching patients with cultural humility helps you to understand your patient and gain a sense of how larger social stressors may be impacting them. Specific examples include: 

1) Asking all patients their pronouns and introducing your pronouns. 

2) Asking open-ended questions so patients can talk freely about their identities. 

3) Longitudinally checking in with patients regarding their identities, understanding the fluidity of sexual and gender diversity.


3. Talk about resilience.
Studies have shown that talking about discrimination and prejudice without talking about resilience mechanisms can make it more difficult for youth to work through minority stress. Talking about venues for community building and the strengths of their LGBTQ+ identities can help give agency and a safe space to explore identities.












This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.