For-Profit Healthcare Shortchanges Us All, but It's Failing Black Queer Youth En Masse

POPSUGAR: Reading this study, I feel like it spurs a necessary conversation around mental health in Black youth — and Black queer youth specifically — in relation to police brutality, which comes up in the study itself. But I want to ask you, what are the key risk factors here for poor mental health?

Myeshia Price-Feeney: When we're looking specifically at Black LGBTQ youth, we see some of the same things we see with all LGBTQ youth in terms of: not getting support, conversion therapy, attempts to convince them to change their sexual identity or gender identity.

You see housing instability disproportionately in Black LGBTQ youth; you see food insecurities. These are in many senses the impact of poverty that is largely brought on by societal conditions that Black people in general have to endure, and it's being experienced by Black LGBTQ youth as well.

Then we have discrimination and victimization, and so we have Black LGBTQ youth who are experiencing that for both their sexual and gender identity, as well as race or ethnic background. And so, there's a compounding impact to some of these things that may be experienced by Black LGBTQ youth more compared to other youth.

PS: One of the key findings I found interesting is that Black queer youth are just as diverse in their sexual identities and gender expression as non-Black queer youth. Was that known quantitatively before this study?

MPF: It's interesting — it was there, and I think a lot of people haven't dug deeper into that. But there have been studies that have come out that have found that Black youth are more likely, even, sometimes — compared to non-Black youth or white youth — to identify as LGBTQ.

And so I think it's oftentimes overlooked. I wouldn't say it hasn't been out there before, though; I've personally seen news articles about this topic. But I do think it's important to point out, because we often think of identities as sort of monolithic. Once we say, "Okay, now we're talking about Black LGBTQ youth," it's easy to just say, "We've gone deep enough." But it's important to continue to go deeper and look at this as continuing to be an array of identities, even within this smaller subset of the population.

PS: I would imagine reading these findings, it might be very affirming for some folks — just to understand that the diversity is there in terms of sexual identity and gender identity.

MPF: Absolutely. It gives a voice to youth who may feel that, "I can't identity that way because it's not something my community is, I haven't heard that in my community." You do have a larger representation, too. I think people like Janelle Monae identifying as pansexual, [who] I believe recently has sort of said, "I'm not necessarily cisgender, either," gives a voice to these youth to say, "I can have these more complex identities and also be Black."

PS: Does a study like this have the potential to shape interface with Black LGBTQ youth who are coming to The Trevor Project in a moment of need?

MPF: We're devoted to the mental health of Black LGBTQ youth. That ranges from having put out papers discussing how to support Black LGBTQ youth's mental health [to having] conversations of race and the intersection of LGBTQ identity. Our crisis services team wants to make sure that everything we're doing is culturally grounded in terms of having a diverse team of counselors that are aligning with the demographics of youth. And so, I think while we [do] these things internally, continuing to put things out there lets youth — particularly Black youth — know that at Trevor, we're here for them. We're here to help them. And if they need us, we're equipped to assist them in any of their crisis services needs, or support them in anything that may come up for them.

I think there is a bit of hesitancy — not necessarily directed at Trevor, but overall — based on a history of mistrust. Based on a history of having been mistreated in mental healthcare environments, or in medical places, or [by] researchers. Society doesn't have a good track record when it comes to the treatment of Black individuals.

PS: No, it doesn't.

MPF: And so, I think Trevor is doing all that we can to build that trust, and I hope that the support can continue to let Black youth know that we're here for them.

PS: Talking about Black LGBTQ youth and access to care, it's a deeply systemic issue: that Black people have so much less access to healthcare, that Latinos have so much less access to healthcare. And then when they do have that access, it's often marred for queer people by homophobia. You're exposing yourself to situations that can be traumatic. This study is a great way, I think, to reframe for healthcare providers an understanding of, who am I serving? And, how do I serve them better?

MPF: Yes, absolutely. And it's something that we talk about in the report: the need for youth-serving organizations to be inclusive of Black LGBTQ youth. They have to adopt LGBTQ inclusion and also the antiracism policies and programs. And that goes for mental health care providers as well. It's a sort of dual identity for Black LGBTQ youth. Feeling supported in their LGBTQ identity and their Black identity is going to be first and foremost important for them when they're going to seek mental healthcare, [and] it's often a barrier for them.

PS: Something the study also mentions is why youth who can access mental healthcare, don't. Citing, "I don't trust people easily, not even therapists," or "I was too afraid to set up an appointment," or "Because I thought it was pointless," which is really disparaging and hard to read. How do we fix that? Part of the work is talking about it, is having this conversation, is pushing people in the right direction. But, what needs to change?

MPF: Yeah, that's a big question: so big that we have a report in and of itself on just this topic, on breaking barriers. But I think part of it is when we start to talk about issues of trust, we talk about issues of fear, and I think some of that does speak to overall concern with anyone seeking care. But there are very specific issues when it comes to both Black and LGBTQ individuals when seeking this care.

One of the most important things we can do is increase representation of individuals in these areas that they can go to. So if you already feel as though, "OK, well, what I wanna do is find someone who is Black to start this journey off with," and that perhaps my assumption [is] that I wouldn't have to cross as many cultural barriers because this individual is Black — just like me. That starts way in the beginning when we talk about education in terms of allowing more Black individuals to go into psychiatry, and psychology, and mental healthcare in the first place.

MPF: How we increase the representation is there, [but] there's also affordability. So, 60 percent of Black LGBTQ youth who wanted mental healthcare in the past year couldn't afford to get it. That's an important aspect to this as well. How do we make mental healthcare more affordable for Black LGBTQ youth so that they can get access to this care?

The reality is that there are so many Black LGBTQ youth who want and need mental healthcare, but can't receive it because it's just unaffordable for them. And, really, that's beyond us. It should force us all to question the systems that allow all of these disparities to persist in the first place.

PS: Absolutely. I think this report is especially pertinent to conversations of universal healthcare that are happening right now around the election — that neither party has accepted fully. But to have these findings, to know that 40 percent of people are open and willing to avail themselves of resources that are not available to them, is heartbreaking. Services can only be so inclusive, but if there's no access, that's a very difficult thing to overcome.

MPF: Yes, absolutely.

PS: I've looked into other studies of yours, and I was impressed by the breadth of your work. What was the most surprising thing for you to come out of this study?

MPF: I admittedly come from more of a sexual health and sexuality [background]: looking at sexual orientation, and gender identity, and all the theoretical. I had less of the suicide background, so coming into Trevor, I had to adapt to seeing these numbers — and I still haven't, is the short answer to that. I hope I never adjust to seeing some of these numbers. And so it was really striking to see some of these, and when I share this with people, I sort of give them that warning. I see something like, 61 percent of Black trans and nonbinary youth reported self-harm. You know, the number that really stood out to me was that 59 percent of Black trans and nonbinary youth who seriously considered attempting suicide in the past 12 months.

PS: Sure.

MPF: And that's a lot. Every single one of them is a young Black trans nonbinary person who's considering suicide. And so I think for me it was just sort of experiencing and sitting with these numbers and thinking okay, now that we have this, what is the next step? What can we do? What are some things that we can recommend to address some of these issues that we're seeing with these youth?

PS: It's just such a staggering number, and I feel like some of the most startling numbers to come out of here are in the intersections of — and the same with the Latinx study — being Black, and being trans, and being nonbinary. As it pertains to suicide, those intersections are quite grim.

MPF: I will say, while that was the downside of everything, the most uplifting part was seeing what support can do for these youth: just sort of seeing the numbers change. When you see the one in four compared to one in 10 in terms of suicide attempts, and that protective nature of support for these youth — particularly Black trans and nonbinary youth — that was amazing for me. And that's one of the messages I would like to send with this report: that support can go a very long way for these youth.

PS: And, it was amazing to see that having just one supportive adult in your life could completely change those numbers for the better. So many people are having conversations around allyship, and what that looks like, and what it means right now. But, if somebody reads this — maybe you're an adult who wants to be a better ally to queer people in your life, especially queer youth. How do you take these findings into consideration?

MPF: I love that question, and I think it speaks to one of the goals of putting this research out there. I think part of it depends on the role that you have in these youth's lives. If you're someone who works at a youth-serving organization, being sure to take in some of these recommendations in terms of ensuring that your policies are inclusive: LGBTQ inclusive and antiracism. And not assuming that suicide prevention efforts can be one size fits all.

If we're looking less in a youth-serving organization and more in the personal, I would hope that people look at this and say, "I can make a difference," you know? "I can be that one supportive adult in these youth's lives, in whatever forms that takes." I just imagine that if everyone's goal is to be that one supportive adult, it can mean the world for the numbers that we're seeing.

MPF: I say this being that it would put me out of a job, right? But, organizations like Trevor wouldn't have to exist if these youth had the support that they needed. There's a lot in this report, and so you can often feel like, "Well, I can't change all these systems: I'm only one person, and I can't dismantle all of these systemic issues going on and impacting Black people, impacting LGBTQ people." But what you can do is be there for the people in your life.

PS: I think that's a great takeaway: that on a singular level it's [rare] we have a massive impact on a macro level, but in our communities we can have a massive impact on a specific person, or in the spaces that we occupy.

MPF: Absolutely.

If you are a young person in crisis, feeling suicidal, or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386. Or click here for TrevorChat, TrevorText, TrevorSpace, and more.

If you or a loved one are experiencing suicidal ideation or are at risk, the National Suicide Prevention Lifeline has several resources and a 24/7 lifeline at 1-800-273-8255.