Being able to safely affirm one’s gender identity and sexual orientation is crucial to mental and physical well-being. Yet many LGBTQIA+ people face enormous challenges in owning their true identities. This is all the more so if they are also People of Color. Dr. Kia Darling-Hammond talks about the importance of and challenges associated with having a true sense of belonging.

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Photo editing by Stephen Kelly; Rushay Booysen/Getty Images

On March 11, 2021, The Trevor Project — a not-for-profit organization that provides crisis intervention and suicide prevention services to LGBTQIA+ youth — published its estimates of how often LGBTQIA+ young people in the United States attempt suicide.

Its conclusion was dire. “At least one LGBTQ youth between the ages of 13–24 attempts suicide every 45 seconds in the U.S.”

Suicide ideation and other mental health impacts are most likely explained by the discrimination, inappropriate formal support, and threats to personal safety that LGBTQIA+ people frequently face.

Last year, The Trevor Project surveyed over 40,000 LGBTQIA+ U.S. individuals aged 13–24 years, asking them questions about their mental health and day-to-day experiences in their communities.

The survey indicated that 48% of respondents had engaged in self-harming behaviors during the previous year. Over 60% of transgender or nonbinary respondents reported the same.

The same survey indicated that a significant number of respondents had experienced housing instability, received physical threats, or experienced other forms of harm because they belonged to the LGBTQIA+ community.

At the same time, the survey summary stated that “transgender and nonbinary youth[s] who report having their pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.”

Being able to inhabit one’s identity and express one’s orientation safely is crucial to having a good quality of life. Medical News Today spoke with Dr. Kia Darling-Hammond to find out more about the challenges that LGBTQIA+ people face in living safely and with dignity and why they are at such high risk of mental health issues compared with other groups.

Dr. Darling-Hammond is the director of education programs and research at The National Black Justice Coalition (NBJC). She has developed a Bridge to Thriving Framework to help activists, educators, and young people understand and promote universal thriving.

She was also a working group member on “Ring the Alarm: The Crisis of Black Youth Suicide in America,” a 2020 report that looked at mental health trends among young Black people in the U.S. and recommended new policies to address existing issues.

We have lightly edited the interview transcript for clarity.

MNT: What are some of the unique challenges that queer, trans, and nonbinary People of Color in particular face, mental health-wise?

Dr. Kia Darling-Hammond: Belonging, like air, is a fundamental human need. Without it, we are susceptible to profound despair. To be othered is to be deprived of belonging — to community, to humanity, and even to oneself.

Foremost, to protect people’s mental health, we must affirm their inherent humanity, dignity, value, and potential. A thriving human has strong community and selfhood, abundance, pleasure, relief, and wholeness.

Intersectionality goes beyond the idea that identities are additive (i.e., Latinx and nonbinary). It acknowledges that being a nonbinary Latinx person is its own unique phenomenon and is shaped by sociopolitical forces like cultural norms related to gender and ethnic identity, xenophobia, racism, misogyny, and so on.

Add being young to this list, and the magnitude of possible disempowerment grows. With this in mind, the numerous humans who are both “of color” and gender- and/or sexuality-expansive are bombarded by powerful oppression while attempting to build lives atop historical legacies of complex, brutal, and deliberate abuse.

While it is inappropriate to claim that every queer, trans, or nonbinary youth of color experiences life or the world in the same way, there are some trends that deserve attention.

[One such trend is that] Indigenous, Black, and Latinx People of Color are disproportionately surveilled, harassed, arrested, and incarcerated. They are historically economically exploited (see buying homes, buying cars, wage inequality, environmental racism, [and] sovereignty struggles).

Even when they can afford it, community members receive substandard, often abusive healthcare and are more likely to be harmed or even killed when receiving “care.” With growing awareness of the workings of society comes a concurrent, devastating awareness of how disposable most people think that you, your family, and your community are.

This is rarely accompanied by education about how to change society or reduce the pain that such bigotry causes. It does not come with a side of healing.

‘I work with Black and Latinx trans and nonbinary youth — they know these statistics, and they are exhausted and scared’

Queer, nonbinary, and trans people are also disproportionately subjected to systemic and institutional harm (see anti-trans bills right now). Trans people experience the highest rates of every kind of violence we see — from intimate partner violence to violence inflicted by strangers to police brutality.

It is increasingly well-known that a trans person’s life expectancy is 30–35 years of age, and 2020 was a deadly year (the deadliest on record, but being outstripped in 2021 already). I work with Black and Latinx trans and nonbinary youth — they know these statistics, and they are exhausted and scared.

LGBTQIA+/SGL [same-gender-loving] communities are more likely to face housing instability, job insecurity, and homelessness. In fact, while only about 10% of the youth population identify as LGBTQIA+/SGL, they make up 40–50% of the unhoused youth population, depending on geography and identity disclosure.

The top reasons for their displacement are family rejection (and being kicked out) and fleeing family abuse. Once again, and perhaps earlier in the lifespan, queer, nonbinary, and trans communities become acutely aware of how disposable society believes that they (and people like them) are.

People who are both LGBTQIA+/SGL and “of color” experience many of these challenges at a disproportionately higher rate. Compounded identity can result in compounded hardship. While Black LGBTQIA+/SGL youths experience comparable rates of depression and suicidality with non-Black LGBTQIA+/SGL peers, they are less likely to receive help.

The impact of the former U.S. administration

We, QTPOC+ [queer, trans People of Color, and other identities], entered this pandemic reeling from years of targeting, and then the Trump administration sought to undermine housing and healthcare for trans people during a pandemic.

We voted during a pandemic, and youths shy of voting age had to watch as far too much of the nation voted against their safety, lives, and futures.

Under pandemic conditions, several things happened. Some youths who relied on their peers and having a space away from home — [such as] school, extracurriculars, other spaces — lost key sites of identity affirmation and healing, having to be in a state of hyper-vigilance, and being unable to be one’s authentic self is emotionally exhausting and can become debilitating. Many youths have been unsafe at home.

People who already understood that they would be last on the list for priority care had to contend with the fear of becoming ill with a poorly understood virus. This compounded existing atmospheric existential threats, [such as] never [feeling] safe — from the police, strangers, peers, policymakers, advertisements, media, even oneself — and now add [to that] a virus that’s leaving people gasping for breath and dying alone.

Schools and workplaces insisted on continued engagement without attending to basic human needs for reassurance and relief, and online school sometimes reduced student/family privacy and invited additional surveillance.

People, including young people, with the least economic privilege continued to work and risk exposure to the virus because they had to survive.

People all over the country lost income, employment, homes, and other fundamental resources. The stress of loss, or impending loss, of stability is a critical mental health risk factor. People of Color, LGBTQIA+ people, and especially LGBTQIA+/SGL People of Color are already disadvantaged in this inequitable and exploitative society.

Every aspect of life is likely to be harder:

  • institutionally, [threats to] employment, housing, education, public space, and healthcare, etc.
  • psychological stressors, [such as] rejection and abuse, etc.
  • physical stressors, [including risks associated with] air, water, nutrition, inflammation, disease, early mortality, and violence
  • holistic consequences, [such as] mind, body, and spirit breakdowns
  • gaslighting

QTNB-POC [queer, trans, nonbinary People of Color] youths are forced to participate in institutions and systems that are not designed for their thriving (which they tend to realize over time, often before they have the language to describe this).

They are simultaneously told to value and appreciate these systems and institutions and to pour their energy into participating in them in compliance with destructive norms.

For example, school attendance is compulsory with state and local oversight that can include financial and carceral risks. In schools, students are subjected to adultism, cisgenderism, heterosexism, racism, xenophobia, ableism, ranking, sorting, and a host of other systems of practice and belief that reinforce a hierarchy of bodies and minds.

They are told to work hard to be valued within a context that inherently renders their whole selves impossible, disposable, and/or abject. When they do not participate effectively, they are punished emotionally, physically, spiritually, and financially, with effects that can last a lifetime.

‘Popular representations of gender, sexual orientation, and intimacy still privilege cisheteronormativity’

The persistent othering and abuse of LGBTQIA+/SGL People of Color are important to note.

Popular representations of gender, sexual orientation, and intimacy still privilege cisheteronormativity and largely treat nonhegemonic identities as tragic (and disposable) or comedic.

Teachers, doctors, and other professionals who are members of LGBTQIA+/SGL communities still risk their jobs when they disclose their identities, especially when they are of color (where job security is already more tenuous).

In online environments, racist, xenophobic, transphobic, and homophobic rejection and trolling are abundant. It seems it would be impossible to feel safe in the world after “reading the comments,” and as young people’s lives are increasingly visible across social media platforms, so is their exposure to abuse.

In day-to-day environments, these same threats are present in the form of casual comments, insults, or microaggressions, policies that police gender expression, and school pushout that disproportionately impacts children of color, QTNB children, and QTNBPOC, etc.

Stigma and fear around talking about mental health can get in the way of accessing help. In some communities, people look to the church and think that prayer can resolve issues. Many communities seek to avoid the loss of safety and autonomy that can accompany the admission of mental health challenges. There is a long history of having to prioritize survival over well-being in communities of color.

And [it is also important to take into consideration] the appropriate mistrust of medical and other service providers:

  • social/caseworkers who filter people into [the] carceral system and foster care
  • foster and other care systems that are dangerous and dysfunctional at worst and severely under-resourced at best
  • medical abuse

‘Finding a therapist takes effort, perseverance, and resources’

Even when Indigenous, Black, and Latinx LGBTQIA+/SGL people do manage to access mental healthcare, they have to contend with a predominantly white, cishetero, and affluent provider corps that is not only a product of a bigoted society but has also received little to no corrective training and usually cannot provide responsive support.

Even some identity affinity, like having a Black therapist, does not mean that a Black LGBTQIA+/SGL client will receive the empathy and guidance they need.

Finding a therapist takes effort, perseverance, and resources, [including] time and money. The first therapist a person tries may not be a good fit, nor the second, etc.

The field expects clients to be willing to test out several practitioners to find responsive care. QTPOC are less likely to have the time and finances to undertake such a project and may already be too emotionally exhausted to rehash their pain over and over again to each new prospective therapist.

The American Psychiatric Association recently released statements related to race, gender, and sexual orientation that affirmed a lack of attention and preparation in the field. The association admitted its complicity in sustaining and reproducing racism.

There are at least three critical dimensions of building up responsive care. [The first is] cultivating — recruiting, training, mentoring, subsidizing — a pipeline of representative practitioners with intersectional identities who can be better able to fully see and support clients who experience complex marginalization.

[The second is] advancing meaningful, targeted, community-driven, and accessible research related to the mental health and well-being of people who experience complex marginalization, and [the third is] retraining — and, perhaps, re-credentialing — existing practitioners to ensure that their practice is inclusive, competent, dynamic, and appropriate to client needs.

MNT: What are some intersectional policy solutions to these problems that you would like to see implemented?

Dr. Kia Darling-Hammond: Relief may be the most critical starting point, because eliminating existential stressors like housing and food insecurity can free up significant psychological and physical energy, which is part of what is needed to build a more empathetic society.

To that end, federally enforced wealth redistribution will be key. The nation needs to be one in which safe, stable, and healthy — lead-free, sustainable — housing is guaranteed for all, where food deserts are a thing of the past, and where green space is always within immediate reach.

In other words, every human must be able to achieve a high quality of life. If this were the organizing principle, we could see decarceration, the ouster of polluting commerce, profound advances in accessibility, and more.

In education, we have seen advances toward inclusive curriculums from California (ethnic studies) to Illinois (LGBTQIA+), so there is hope. Representative and responsive public education will reflect the powerful histories, contributions, cultures, and innovations of all communities, which, in truth, would profoundly transform how we educate our children and the structures of schooling.

We absolutely need LGBTQIA+/SGL-informed, respectful sex education as well.

Federal legislation like the Equality Act could anchor efforts toward both advancement and repair, as it would instate some long-needed civil rights protections while modernizing others.

There is a bill moving through Congress, the Pursuing Equity in Mental Health Act, that authorizes an $805 million investment in research, provider pipeline development and training, and stigma reduction programs. Its focus is on Black children and youth, with some attention to Black LGBTQIA+/SGL young people. This kind of legislation is essential and establishes a firm foundation for additional policy infrastructure.

Ultimately, I would love to see legislation that supports universal holistic well-being and is grounded in prioritizing dynamic human needs. I always think of Alexis Pauline Gumbs’ short story “Evidence” when I dream about humane policy.

MNT: What can individuals do to support the mental health of LGBTQIA+ youth more broadly, and that of trans, queer, and nonbinary People of Color in particular?

Dr. Kia Darling-Hammond: Affirm, affirm, affirm. Be vocal and unapologetic about your support for QTNB-POC community members as whole people who are experts on their (developing) selfhood and needs.

Seek, follow, and amplify the guidance of community leaders, teachers, and healers (including young ones) and support community efforts, including businesses and organizations.

Respect and use pronouns and preferred names. This indicates respect for people’s humanity and authority over their own identities. It affirms to young people that they are seen, and it also helps them develop a strong sense of self-awareness, self-love, and self-trust.

Help young people find affinity communities and representations that show them positive possibilities for themselves in the present and future (including QTPOC peers and elders).

Support young people in finding, creating, and sustaining safe, affirming, expansive, and joyful spaces (virtual and physical) where they can explore and work toward their identities, passions, dreams, and goals.

Educate yourself about QTPOC histories and cultures. We have always been here. Work on your biases: Embrace the lifelong challenge of unlearning beliefs that oppress and disadvantage others and act to eliminate structural and interpersonal bias, stigma, and discrimination.

Positive youth development (PYD) includes strong, caring relationships, opportunities to develop meaningful skills and knowledge, opportunities to explore and solidify personal values, and opportunities to develop confidence and make a larger contribution to the world.

Through an intersectionally grounded lens, PYD requires critical consciousness — an awareness of how power is distributed and leveraged in society.

It also requires study of social justice, including strategies and tactics for social and political change, as well as for effective interactions that allow young people to survive their encounters with oppression. It also requires explicit and sustained relief/healing practices to offset the constant, atmospheric threats to safety and selfhood.

MNT: Is there anything else you would like our readers to know?

Dr. Kia Darling-Hammond: The invitation of this moment of upheaval and pain is actually dreaming (and redesign). We have an opportunity to design our futures in a way that casts beyond resilience and survival toward true thriving. If we look at QTPOC history, philosophy, art, and culture, we see models for this.

The communities have been imagining visionary, vibrant futures for a very long time. So, readers should know that blueprints exist. They should know that a better future is possible, but only if they accept that their humanity is intricately interwoven with the humanity of everyone else and refuse the status quo.

It is time to divest from the idea that scarcity, poverty, and hardship are inevitable. They are not. They are designed. People need to know that this is a life-and-death, high stakes, urgent moment — and that our young people are watching us closely to see whether we will choose their futures over our comfort.

Pay attention to [the following resources and causes]: