While most LGBTQ+ (lesbian, gay, bisexual, transgender, and queer/questioning) young people successfully navigate adolescence, they tend to report poorer mental health than their peers, due in part to increased exposure to risk factors like rejection and discrimination.
Research suggests that LGBTQ+ students who identify as Black, Hispanic, or Multiracial are at higher risk for mental health challenges due to their potential to be exposed to multiple forms of discrimination. For example, youth report seeing hate-related graffiti at school, experiencing verbal and physical harassment related to their race and sexual orientation and/or gender identity, and being unfairly targeted for discipline, among other forms of mistreatment that occur in their communities. Additionally, research suggests that Black and Hispanic LGBTQ+ youth are less likely to have their mental health care needs met than their White peers.
Schools can play an important role in supporting the mental health of LGBTQ+ students. However, while some research is available to help guide schools’ efforts, relatively few studies have focused on the experiences of LGBTQ+ youth who identify as Black, Hispanic, or Multiracial. To help schools better understand what these students want in terms of school mental health supports, our team analyzed Black, Hispanic, and Multiracial LGBTQ+ students’ open-ended responses (see “How we conducted our analyses” box for more information on the sample) to the following questions:
- How could your school better support the mental/behavioral health needs of all students?
- How could your school better support students with mental/behavioral health needs or challenges?
- What is one thing that you like about how your school supports the mental/behavioral health of students?
- What could make students feel more comfortable talking to a counselor or therapist at school when they have a mental/behavioral health challenge?
Influences on youth mental health
Mental health is foundational to adolescent well-being: It is a resource on which young people draw to help them solve problems, connect with others, and achieve their goals. When thinking about how to support adolescents’ mental health, it is important to keep in mind that mental health is impacted by a range of individual, family, school, community, and societal factors.
Factors that can influence adolescent mental health
Individual: Age; genetics; mental health knowledge and attitudes; coping skills
Family: Relationships with parents, caregivers, and siblings; family mental health; family financial stability; safe and stable housing
School: Relationships with peers and teachers; feelings of safety and belonging; instruction on mental health and coping skills; access to mental health treatment
Community: Safe neighborhood free from environmental toxins; access to green spaces; access to healthy food; access to high-quality, affordable health care
Society: Social acceptance; government policies that promote health and safety; poverty; discrimination
Adapted from: U.S. Department of Health and Human Services. (2021). Protecting youth mental health: The US Surgeon General’s advisory. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
Challenges to mental health—like stress or sadness—are a normal part of life. However, mental health challenges that are intense or that last for a long time can become a barrier to thriving in school and achieving other goals. The percentage of adolescents experiencing mental health challenges in the United States is alarmingly high. Data from the Centers for Disease Control and Prevention (CDC) indicate that, among high school students, one in four males, half of females, two thirds of LGB students, and nearly three in four transgender students felt sad or hopeless for two or more weeks in a row in 2023. Minority stress theory helps to explain some of the reasons for the greater prevalence of sadness and hopelessness among LGBTQ+ students, including experiences of identity-based discrimination, stigma, and rejection.
Attitudes on School Mental Health Among Black, Hispanic, and Multiracial LGBTQ+ Youth
To understand more about mental health needs among LGBTQ+ students who identify as Black, Hispanic, or Multiracial, we reviewed more than 5,000 survey responses from these students (see “How we conducted our analyses” box) about how schools can better support student mental health. Here is some of what they told us:
Not every challenge these students face is related to their sexual orientation or gender identity.
They want school staff to engage them in ways that promote a sense of belonging.
They want schools to proactively offer supports while allowing students to select the options that work best for them.
They want assurances that their privacy will be respected.
They want schools to affirm LGBTQ+ identities and to address discrimination.
How we conducted our analyses
We used topic modeling as a method to interpret and analyze open-ended responses from LGBTQ+ youth who identified as Black, Hispanic/Latino, or Multiracial. These responses came from an annual school survey of students attending public urban schools on the East Coast across four years starting in the 2020-2021 school year. Combining the results from the four open-ended questions about how schools can support student mental health, we analyzed a total of 5,824 student responses. Slightly more than 50 percent of the responses were from high school students, with one third coming from middle school students and slightly more than 10 percent from elementary school students. To identify the themes shared below, we used neural topic modeling with contextualized document embeddings. This method identifies groups of responses that share similar themes (called topics), as well as keywords associated with each topic; please see the Methods Appendix for more information on this approach.
Not every challenge is related to LGBTQ+ students’ sexual orientation or gender identity.
Many students’ responses about what schools could do to support their mental health mentioned universal stressors—especially academic pressures. The quote below emphasizes that LGBTQ+ students also grapple with stressors that are unrelated to their sexual orientation or gender identity.
“But the real reason why kids might feel like they need a therapist because [we’re] stressed—like very, very stressed out and … it’s dumb how much work we get in [a] day and teachers and staff think we’re able to get all this done, like me I have anxiety so when I feel stressed out my body shuts down and I don't feel like doing anything; me, I feel like if any staff or teacher look at this I just want them to know half of the challenges we face in life is from school and how stressful it is…”
This theme serves as a reminder that experiences of mental health vary among LGBTQ+ youth, just as they vary among their peers. Additionally, while some risk factors for mental health challenges may be uniquely linked to sexual orientation or gender identity, such as family rejection or harassment based on their LGBTQ+ identity, other risk factors—like academic pressures—may be perceived as unrelated.
When it comes to links between sexual orientation or gender identity and mental health, it is helpful to remember that sexual identity formation among LGBTQ+ youth varies over time, both between individuals and within an individual: Youth who share some characteristics (e.g., age, gender, race/ethnicity) may still have a different identity formation process, and that process may be different across their lifespan. LGBTQ+ youth also differ in how central their sexual orientation and gender identity is to how they see themselves (a concept known as identity centrality), with some finding it consistently important and others seeing it as more/less significant based on the situation. One recent study of Black and Hispanic/Latino adults found that perceiving both racial/ethnic and sexual orientation identities as central to who they are (as opposed to one or the other being less important than the other) was protective against mental health challenges.
Students want school staff to engage them in ways that promote a sense of belonging.
Among LGBTQ+ students in our survey who identify as Black, Hispanic, or Multiracial, students in all age groups emphasized the importance of staff who build positive, supportive relationships with students.
Elementary school students focused on kindness and being heard.
“… that [school staff] always try to find a calm way to talk with the students …”
“… being more open and nice and support [students].”
“… not be so hard and yelling at them when they do something wrong.”
Middle school students expressed a desire for staff to be nonjudgmental.
“They [school staff] treat and respect them, and make sure they learn.”
“By treating people with respect.”
High school students highlighted the importance of ensuring that staff—especially mental health staff—have the knowledge and skills necessary to provide support to all students.
"By being aware of the various mental/behavioral health needs and having the proper training of how to help [students] when or if they have a challenge with it."
“My school could better support those with mental/behavioral health needs by truly being there and supporting them; with this they need some type of training or class for level of community work to better understand the people of the community.”
Research confirms that a strong sense of school belonging is linked to a number of positive outcomes. Among LGBTQ+ youth, a strong sense of belonging can also buffer the mental health effects of experiencing harassment and victimization. A review of 94 research articles identified several aspects of the school environment found to be linked to LGBTQ+ students’ well-being. Many of the studies found that high levels of perceived support from school staff were linked to lower levels of victimization and mental health symptoms among LGBTQ+ students. While some studies found that teachers often feel unprepared to support LGBTQ+ youth, studies that focused on the impacts of supportive teachers found that these teachers had the power to foster a safe classroom climate and implement LGBTQ+-inclusive school/classroom procedures that positively impacted LGBTQ+ youths’ safety and feelings of acceptance in school.
Unfortunately, few studies examining school supports have focused on the experiences of LGBTQ+ students who identify as Black, Hispanic, or Multiracial. However, a recent study that examined the experiences of Black LGBTQ+ students attending predominantly Black high schools found that these students felt less safe at school and that they were less valued at school than their heterosexual Black peers—an impression linked with lower levels of school belonging. Further, one of the few studies to focus on LGBTQ+ Latinx youth found that schools with staff who were openly LGBTQ+ and/or who were perceived as welcoming of LGBTQ+ students provided these students a place where they felt that they belonged, a feeling particularly important for youth who had experienced fears of rejection or actual rejection from family.
Many students want schools to proactively offer support while promoting students’ agency to select the options that work best for them.
In our survey, LGBTQ+ youth who identify as Black, Hispanic, or Multiracial called on schools to normalize seeking mental health support by proactively checking in with students about their mental health.
Elementary students focused on access to physical spaces, objects, and activities to help them manage their emotions when they are feeling overwhelmed.
“I like when [school staff] let us play with toys to calm us down or do yoga.”
"I think that what would make the students [who] aren't comfortable talking to a counselor at the school [feel comfortable] would be to do it in a calm environment with a bunch of pillows and snacks."
Middle school students often focused on having time alone to engage in activities that they find soothing. While middle school students desired autonomy to take breaks, they also wanted adults to check in with them and offer them opportunities to receive supports.
“Ask students if they are okay, have small talks with the students about mental problems, allow all students to talk to an adult or teacher about a problem …”
“When a kid is not in a good mood, let them have space and leave them alone, at least for me.”
High school students wanted school staff to check in on a regular basis and make it easier for them to access help when needed. These students also highlighted the need for school staff to normalize seeking help and reduce stigma related to mental health.
“Checkups. We need checkups every now and then. Probably often.”
“Accepting that mental/behavioral health is indeed an acceptable excuse for missing class, work, and school.”
“Getting rid of the stigma that mental health isn’t really a thing that impacts every single human regardless of age or acting as though it is a bad thing.”
When youth feel empowered to make decisions about their mental health care, they are more likely to engage with the supports being offered. However, young people often overestimate their ability to overcome mental health challenges on their own. This balance can be especially important for Black, Hispanic, and Multiracial LGBTQ+ youth, who may hesitate to seek help because stigmatized messages that frame LGBTQ+ identities as a mental health problem may lead them to feel shame about both their mental health symptoms and their LGBTQ+ identity. When combined with mistrust of health care systems due to personal, family, or community experiences of harm within those systems, stigmatized messages can present significant barriers to accessing mental health treatment for Black, Hispanic, and Multiracial LGBTQ+ youth.
Additionally, how schools offer proactive mental health support can make a difference. Students are most likely to accept support offered within a relationship of trust. Because students tend to have had limited access to mental health professionals prior to seeking treatment services, teachers are often the adults they are most likely to trust. LGBTQ+ students might be particularly wary of offers of support from school staff they don’t know well given concerns about whether these staff will accept their LGBTQ+ identity or whether they can be trusted with private information (see the next section for more on student perceptions of confidentiality). By contrast, mental health supports that are offered within a context of LGBTQ+ visibility and open LGBTQ+ allyship are more likely to be perceived as relevant and accepted.
Students also want assurances that their privacy will be respected.
The LGBTQ+ students in our survey who identified as Black, Hispanic, or Multiracial described concerns about mental health clinicians sharing information with their parents, especially with respect to their LGBTQ+ identity.
Elementary school students often mentioned the importance of being able to talk to a trusted adult, like a therapist, in a private setting.
“Have a private meeting because they may not like sharing their feelings in front of people.”
“Something that can make students more comfortable to talk to someone is that whenever you need to talk to someone you can ask if they can keep it private, or they can tell a family member.”
Middle school students raised concerns about mental health staff sharing information with their parents.
“To understand that when a student says that you should not tell the parent they mean it because if you do tell the parents you will lose the student’s trust.”
“One thing that could make students feel more comfortable for talking to a counselor or a therapist at school when they have a mental breakdown is the counselor/therapist not telling the parents what they said.”
High school students also raised concerns about mental health staff sharing information with their parents, including disclosure of LGBTQ+ identities.
“They could not tell your parents EVERY SINGLE THING you tell them. Just only tell parents the serious stuff. Not take notes so that they can have DETAILED THINGS TO TELL MY PARENTS THAT I SAID.”
“Maybe [students] actually talking about some personal things like their sexuality, or how they feel as a person. And have the therapist keep their secrets so they actually feel like there’s something they can talk about and have no rumors or anything of that subject spread around the school.”
"Say for example a girl is coming out as a lesbian and she doesn't wanna tell her parents. Therapists at schools just blab off [to] the parents, what if they were homophobic? That kid could've been kicked out for something. So I think [therapists] need to give kids personal space to be themselves for a while."
LGBTQ+ youth who have not disclosed their identities at home or school may have specific concerns about confidentiality when it comes to being “outed” (i.e., having their LGBTQ+ identity disclosed without their permission)—especially to peers and family members. Research suggests that LGBTQ+ youth who are outed are at increased risk of experiencing mental health challenges. This is a particular risk for transgender and gender non-confirming youth, who are more likely to experience physical harm as a result of being outed to their families.
While there are serious safety and mental health concerns with respect to disclosing students’ LGBTQ+ identity to their families without their permission, research also suggests that LGBTQ+ youth whose families support their LGBTQ+ identities tend to have better mental health outcomes. Policies and regulations vary across states and school districts regarding how school employees are instructed to engage with parents and families with respect to disclosure of students’ sexual orientation and/or gender identity. Guidance from mental health professional associations—such as the American School Counselor Association— includes calling on mental health professionals to know the impact of family acceptance on student well-being and helping families navigate these important developmental milestones in ways that protect LGBTQ+ students from harm and help families stay together.
Finally, these students want schools to affirm their LGBTQ+ identities and address discrimination.
Elementary school students rarely referenced sexual orientation or gender identity in their remarks. However, the quote below reflects one student’s desire for adults to address bullying and harassment at their school related to sexual orientation or gender identity.
“[School staff] could actually make students feel more comfortable talking about their feelings and catch the students who are making fun of people for their sexuality but they don’t do that :)”
Middle school students also rarely directly referenced sexual orientation or gender identity in their remarks. However, the quote below reflects one student’s desire for their school to ensure that students learn about the LGBTQ+ community to reduce stigma and discrimination:
“My school could make it easier for [students] to come to them. They could also teach about LGBTQ+ to improve some [students’] opinions of that community.”
High school students were no different than their younger peers in rarely directly referencing sexual orientation and gender identity in their responses. However, the quotes below suggest that students are aware of how the LGBTQ+ community is—or is not—represented at their schools.
“… treat trans people with respect. My friend at graduation has to have his dead name [a name no longer used after a gender transition] read out instead of his real name ... that is terrible.”
“They support LGBTQ+ community.”
“A select amount of staff allow students to talk openly about how they feel about themselves involving the LGBTQIA+ community.”
The quote below reflects one student’s perspective on the importance of school mental health staff who reflect the diverse LGBTQ+ community. This sentiment aligns with the findings of a recent study of LGBTQ+ adolescents: that many students would feel more comfortable with a therapist who they perceive as likely to have experienced some form of identity-based discrimination or rejection (i.e., race/ethnicity, immigration status, gender, sexual orientation, disability, etc.) because youth would see them as more likely to understand their own experiences with discrimination and rejection.
“I think something that would make students more comfortable is seeing someone who looks like them or has similar identities as them. Like having a queer Black woman etc.”
Implications for School Mental Health
The above themes carry several implications for practice, shedding light on youth priorities and providing opportunities for school-based staff to improve their strategies. Below, we identify five implications for school mental health:
School staff can provide more effective mental health support to LGBTQ+ youth when they take the time to examine their own beliefs about LGBTQ+ individuals. They can also educate themselves about the experiences of LGBTQ+ youth—including those who identify as Black, Hispanic, or Multiracial—and recall that not every challenge faced by LGBTQ+ students is related to their sexual orientation or gender identity.
The students’ call for building trust may highlight the need for school mental health professionals to be more visible in their school communities. More visibility may help to establish trust and reduce barriers to accessing needed mental health services among LGBTQ+ students who might otherwise be hesitant to seek help due to fears of rejection and discrimination.
Proactive strategies to offer support can reduce stigma while ensuring that students maintain a sense of agency and control regarding their mental health needs. When schools de-stigmatize mental health conversations and help-seeking, equip all students and staff with skills and knowledge to help them recognize a challenge that warrants support from a mental health professional, and ensure their strategies are culturally relevant, LGBTQ+ students across racial and ethnic groups will experience fewer barriers to accessing mental health supports.
Confidentiality is an important part of mental health care for adolescents, and concerns about privacy can prevent young people from seeking mental health support. While state laws regarding minors’ confidentiality rights vary, mental health professional associations—including the American School Counselor Association—provide guidance based on their professional standards and codes of ethics. Those standards include the importance of outlining the limits of confidentiality—such as when minors disclose information that suggests they are at risk of being harmed, harming themselves, or seriously harming others—so that young people can make informed decisions about what to disclose to mental health professionals.
The messages that young people receive about sexual orientation and gender identity—including at school—can influence the mental health of students who identify as LGBTQ+. A recent review of evidence identified four research-supported strategies:
- Adopt anti-bullying and anti-harassment policies that specifically identify LGBTQ+ students to create supportive contexts for all youth, and especially for LGBTQ+ youth.
- Provide professional development that gives educators and other school personnel the tools to support and protect the emotional and physical safety of all students, thereby creating more supportive school environments for LGBTQ+ students.
- Offer curricula and instructional materials that explicitly address LGBTQ+ individuals and communities to provide students with resources and support and foster an inclusive school climate.
- Facilitate student-led clubs or organizations such as gender-sexuality alliances (GSAs), which can improve the school experiences and well-being of all students—and especially for LGBTQ+ students.
Most research supporting these strategies has failed to examine outcomes for Black, Hispanic, and Multiracial students. However, some researchers have begun to examine the differential impacts of GSAs on students of color. Studies suggest that GSAs may not achieve the same benefits for LGBTQ+ youth of color that have been documented for their White peers. In particular, researchers have found that LGBTQ+ students of color often feel doubly excluded because they may feel unaccepted by peers who share their racial/ethnic identity due to their sexual orientation or gender identity and feel excluded within their school’s GSA by their White LGBTQ+ peers, which can lead them to receive less support from the club. More research is needed to better understand the most effective school policies and practices for creating safe and supportive environments for Black, Hispanic, and Multiracial LGBTQ+ students.
Conclusion
The students who responded to our survey about how they want their schools to support mental health mentioned many topics that researchers have examined. However, researchers have often failed to explore the experiences of LGBTQ+ students who identify as Black, Hispanic, or Multiracial. This lack of representation within the research literature should not dissuade educators and school mental health professionals from taking steps to ensure that their own policies and practices create safer, more supportive school environments for Black, Hispanic, and Multiracial LGBTQ+ students. Rather, school leaders should familiarize themselves with the existing evidence while simultaneously partnering with LGBTQ+ students in their schools and LGBTQ+ organizations in their communities to co-create solutions that are evidence-informed and tailored to the needs of their unique school communities.
Resources
Below are some resources that school staff, including school mental health staff, can use to increase their knowledge and skills for meeting the needs of LGBTQ+ students.
Best Practices for Serving LGBTQ Students: A Teaching Tolerance Guide. A guide developed by Teaching Tolerance to assist schools in supporting LGBTQ students through assessing policies, classroom culture, instruction, and family and community engagement.
Erasure and Resilience: The Experiences of LGBTQ Students of Color. (2019). A series of research reports on the school experiences Asian American and Pacific Islander, American Indian and Alaska Native, Black, and Hispanic LGBTQ youth.
How Educators Can Support Families With Gender Diverse And Sexual Minority Youth Promoting Resiliency for Gender Diverse and Sexual Minority Students in Schools. (2015). This resource from the American Psychological Association sets out best practices for educators on meeting the needs of LGBTQ+ students.
LGBTQ Inclusivity in Schools: A Self-Assessment Tool. An assessment tool developed by the CDC to help schools assess and implement strategies, including GSAs, that make schools more inclusive for LGBTQ+ youth.
Guidance from professional associations:
- American Psychological Association
- American School Counselor Association
- National Association of School Psychologists
- School Social Worker Association of America
Confidentiality in the Care of Adolescents: Technical Report. (2024). An assessment published by the American Academy of Pediatrics summarizing the current state and best practices regarding confidentiality when providing health care to adolescents.
Mental Health Promotion and Suicide Prevention for LGBTQIA2S+ Youth: A resource guide for professionals, families, and communities. (2023). This resource guide was designed to provide information for individuals and organizations—including teachers, administrators, school psychologists, social workers, and other school staff—with the knowledge, confidence, and skills to effectively support LGBTQIA2S+ youth.
Toolbox to Promote Healthy LGBT Youth: The Safe and Supportive Schools Project. (2021) A collection of resources and documents to supplement the American Psychological Association’s The Respect Workshop, a professional development curriculum for pre-service and in-service education for middle and high school counselors, school nurses, school psychologists, school social workers, and other specialized instructional support professionals.
We used topic modelling to identify topics in student responses. Topic modelling is a class of methods that automatically categorizes text into groups (called topics) and identifies representative words and examples from the data set to represent each topic. There are many methods available for topic modelling: This project uses contextual document embeddings and neural topic modelling. This form of topic modelling is appropriate for the analysis of open-ended survey responses for several reasons. Contextual document embedding (which is a mathematical way of representing text responses numerically while taking into consideration the nuanced relationships between words) is better suited to model short text responses where the relationship between words is imported. This can help capture more nuanced meanings from survey responses and handle variability in language (e.g., understanding that “I don’t know” and “idk” likely mean the same thing). Building on these contextual document embeddings, we then created the clusters using neural topic modelling. This method of topic modelling uses pre-trained neural networks to cluster responses into similar groups (or topics) using pre-trained neural networks. This method allows us to leverage patterns found in much larger data sets outside of this study (which were used to develop the pre-trained neural networks) and fine-tune them with data from our specific context. Taken together, this is a flexible and robust approach to identifying topics from short open-ended responses.
Acknowledgement
We extend our thanks to the youth who took the time to share their experiences and thoughts on mental health supports in schools. Without their insights, this brief would not have been possible.
Suggested citation
Stratford, B., Balén, Z., Guros, C., & Kelley, C. (2025). School mental health experiences and preferences among Black, Hispanic, and Multiracial LGBTQ+ youth. Child Trends. DOI: 10.56417/7736k5190w