America’s Broken Pipeline of Mental Healthcare for Trans Youth
The first panic attack Quinn Pulsipher remembers having was at 8 years old. They describe it as “a pitch-black ghost that hugs them all over and tries to control their mind.” At the beach on vacation with their family, the wind suddenly picked up, and Quinn began hyperventilating, screaming and crying uncontrollably. Nothing could calm them down.
After that first episode, the panic attacks occurred whenever there was a storm, sometimes even when there was just a light breeze.
By the time Quinn was 14, they were “spiraling down.”
They began failing most of their classes. They rarely left their room, even avoiding going to the store with their mom.
Quinn, who is nonbinary, says the deterioration of their mental health was related to the rejection they received for their identity. At school, teachers continued to misgender them even after their records were updated. They endured cyberbullying, transphobic slurs from classmates and lawmakers across the country restricting their rights.
For those six years, Quinn cycled through five therapists who, according to their mom, Hilary, did not understand the challenges Quinn faced as a queer kid.
Hilary spent hundreds of hours searching for help—filling out intake forms, sending emails and calling therapists across Utah—only to get to the scheduling stage and repeatedly hear that providers “weren’t willing to treat a trans kid.”
The therapists who agreed to work with Quinn often failed to understand how being transgender intersected with their anxiety and depression. Some confused gender identity with sexuality. Others dismissed the idea that Quinn’s gender identity could be connected to their worsening mental health.
One night, after a teacher refused to use their pronouns, Quinn reached a breaking point. They came home and cried for hours.
“The feelings were too much,” they told their mother. “I shouldn’t have to fight for my pronouns and name to be used.”
“They kept repeating, ‘I just can’t do it anymore,’” Hilary told Uncloseted Media and Fierce Healthcare. “So I flat-out asked if they were suicidal, and they said ‘yes.’ I was terrified. I prepared myself for the possibility that my child might not be alive when I checked on them.”
Hilary scheduled an emergency appointment with a nonbinary therapist Quinn has now started seeing after getting off a six-month waitlist.
“It didn’t fix everything,” says Quinn. “But what helped was talking to somebody who got it. [My therapist] is just so kind, respectful, calm and accepting. I don’t know any other way to describe just how amazing it is to have someone like this.”
“I feel so lucky we found [their therapist] when we did because I could have lost my kid,” Hilary says.
As almost 1 in 4 American teens identify as LGBTQ, affirming therapy can be life-saving. Yet availability is shrinking. Access to mental healthcare for LGBTQ youth dropped from 80% to 60% from late 2023 to late 2024, according to The Trevor Project. And in 2025, though 84% of LGBTQ youth wanted mental healthcare, 44% of them could not get it.
Over four dozen interviews with transgender teens, their families, clinicians and researchers reveal a fragmented health system plagued by long waitlists, prohibitive costs, parental consent complications and a shortage of affirming providers. Clinicians receive little to no formal education on LGBTQ health, often leaving young patients to repeatedly explain their identities in spaces intended to support them. Many LGBTQ youth say they have encountered provider homophobia and transphobia. These barriers are compounded by political hostility and school environments where bullying is pervasive.
“It’s really a wall of barriers and there’s these layers and layers of obstacles that, taken together, make accessing care feel impossible,” says Lana Lipe, a licensed clinical social worker and private practice therapist serving queer patients in Indiana.
“Not only is the need growing, but there’s not enough resources,” adds Jenna Glover, chief clinical officer at Headspace.
The Journey to Affirming Providers
On every major mental health and suicide risk indicator, queer youth struggle more than their heterosexual peers. Analysis of 2023 national data found that queer youth are more likely to experience persistent feelings of sadness or hopelessness (66% versus 31%), poor mental health (54% versus 22%) and suicidal ideation (41% versus 13%). They were also more likely to attempt suicide (20% versus 6%).
Experts stress that the mental health struggles of queer youth are not inherent to their identities. Rather, they exist because of the minority stress they experience. Six in 10 LGBTQ teens experienced bullying in the past year. And those who did reported significantly higher rates of attempted suicide.
“They’re struggling because of what’s being done to them, and what isn’t happening for them,” Lipe says.
Finding affirming providers is difficult in part because there is no mandatedLGBTQ cultural sensitivity training for mental health professionals in the U.S. And when training is offered, experts interviewed for this story agree that it’s not sufficient.
“We know that affirming care saves lives,” Lipe says. “The question isn’t whether we can do better; it’s if we’re willing to.”
From 2009 to 2010, medical school curricula included an average of only five hours of LGBTQ-related content, one study found. By 2022, that average had increased to 11 hours, which some maintain is still inadequate. Dustin Nowaskie, a psychiatrist and founder of OutCare Health, a nonprofit offering LGBTQ health resources and provider training, has argued that med schools should require 35 hours of LGBTQ training.
“This leaves the burden of educating providers to patients,” Ellesse-Roselee Akré, assistant professor at Johns Hopkins Bloomberg School of Public Health, told Uncloseted Media and Fierce Healthcare. “It has an impact on people’s willingness to receive care, people’s willingness to continue getting care and contributes to a lot of people finding alternative ways to self-medicate and treat their health themselves.”
Daniel Trujillo, a trans teen from Arizona, was lucky enough to find an affirming therapist.
As early as 3 years old, Daniel expressed his gender identity in drawings. His parents were paying attention and helped Daniel socially transition at 8 years old, which included a haircut and new clothes. Soon after, they found Daniel an affirming care team, including a psychologist for whom they paid out of pocket.
“They had had years of experience navigating how to support transgender youth and how to talk us through things we didn’t know, and help us better understand the needs of our child,” says Daniel’s mother, Lizette Trujillo.
Daniel, now 18, saw his therapist for about eight years. “During my tween and early teen years, it felt really important to have someone to help identify things I was going through,” Daniel says. “As I got older … it was more just someone to debrief with.”
The Trujillos, who have long advocated for trans rights in legislative sessions, moved to Spain in 2025 to keep their family safe due to the current political attacks on trans rights in the U.S. The move meant Daniel could no longer see his therapist.
“The political climate has made it harder and scarier for parents to say that they support their children,” Lizette says.
One way that LGBTQ patients can find providers is through online directories. GLMA, the national association of LGBTQ and allied health professionals, maintains a public list of over 5,000 queer-affirming providers, which it says is the largest online directory of its kind.
To be approved, providers must attest to their approach to LGBTQ care, thereby signaling their commitment to an affirming practice. GLMA reviews each provider’s online presence for anti-LGBTQ activity or affiliations, including social media posts and ties to Southern Poverty Law Center-designated hate groups. In cases where a provider has a limited or no online footprint, GLMA may request professional references. Providers are also asked questions to test their competency in LGBTQ topics and training.
“To be an affirming provider means that you are meeting patients exactly where they are,” Alex Sheldon, GLMA’s executive director, told Uncloseted Media and Fierce Healthcare. “It’s more than just checking a box that says, ‘I’m not going to outright discriminate against you.’ We ask for folks to go a little bit further in their exploration of their own educational ability. … Did you receive LGBTQ-specific training in medical school [or while you pursued your doctorate]? Have you published any LGBTQ related materials? Do you do research in the space?”
In a survey of 375 providers, the findings of which have not yet been published and were shared with Uncloseted Media and Fierce Healthcare, OutCare Health found nearly half of providers stated that the current political climate has made them feel more cautious about being publicly visible as an LGBTQ-affirming provider. “We have witnessed … a shrinkage of LGBTQ+ providers and practices,” Nowaskie wrote in an email.
There are many ways to deepen knowledge. Providers can voluntarily engage with medical association-accredited trainings from organizations like OutCare Health or Violet, which offer provider training on marginalized populations. Companies can either mandate these trainings or offer bonuses to clinicians for completing them.
Violet’s training revolves around a few key questions including whether providers feel confident in their knowledge of a given identity and whether they know what therapies are appropriate. Violet can then track if the training led to changes in provider behavior and patient outcomes.
Violet has seen steady interest in its LGBTQ health training: Across 2024-2026, over seven hours of education per provider were completed each year, suggesting sustained engagement. And the number of providers who completed LGBTQ education grew 51% on the platform, from over 7,600 to nearly 11,600.
Headspace’s Glover says LGBTQ education should not be a specialization: “It should be a general part of education that any provider should be able to provide this level of care.”
Schools Can Be a Source of Pain or Support
The lack of affirming providers has real-world effects. It took Ella Sutton, a 15-year-old trans girl from Fredericksburg, Virginia, years to find an affirming therapist to help with her anxiety and depression and to deal with the daily bullying she experienced. Ella’s mom, Angela Sutton, says that many therapists who use the tag “trans-accepting” themselves still lack expertise.
“They say LGBTQ-affirming and LGBTQ-welcoming, but … do you know how to deal specifically with gender dysphoria, body dysmorphia, all of the unique and complex things that go along with being trans? Ella is still having to explain who she is over and over again. They don’t even have that concept or grasp of it because, where’s the training?” Angela says.
In 2024, Ella and her family left Florida, where she had been bullied for being trans to the point of fearing riding her bike outside. After researching Bloomington, Illinois, Angela felt it would be a safe home for her daughter, joking that half of the 1.6% of the population who identify as trans in the U.S. live in Bloomington.
But a few months into seventh grade, Ella was beaten unconscious in a school hallway.
In footage of the attack as described in a lawsuit, another student—who had been overheard saying she would “bully this girl until [she] transfers”—approaches her from behind, pulls her hair and forcefully and repeatedly slams her head to the ground until Ella loses consciousness. She then punches her in the face until someone pulls her off.
“She has officially lived the purest form of hate,” Angela says. “She was only four feet tall and 50 pounds at the time. She is a kid.”
After the attack, Ella was diagnosed with a concussion, a potential traumatic brain injury and post-traumatic stress disorder, according to the family’s lawsuitagainst the school. She says the trauma left her feeling unsafe and severely disrupted her education and well-being.
“I was just really depressed and I was always in bed. … I couldn’t eat more than a few crackers a day. All I did was sleep,” Ella told Uncloseted Media and Fierce Healthcare. “[The hate and bullying] just kind of makes you feel like a burden and like you shouldn’t be like the person that you are, even if that’s who you should actually be.”
When done right, schools can offer crucial opportunities for community, resources and support, but they are increasingly a breeding ground for bullying and political threats. Queer students reported their school climate felt more hostile during the 2024-25 school year due to an anti-LGBTQ political climate, a Glisten survey found, and over two-thirds of respondents faced harassment or assault because of their gender identity or expression.
Some states have instituted explicit policies to repress LGBTQ identities. In Florida, schools must abide by so-called “Don’t Say Gay” laws that restrict K-3 classroom instruction on sexual orientation or gender identity and prohibit all employees in K-12 public schools from using students’ preferred pronouns. Teachers must also report changes to a student’s name, pronoun use or restroom use to parents, which effectively outs children who haven’t told their parents about their identity. In Ohio, teachers are required to notify the parents if a student requests to identify as a gender that doesn’t align with their biological sex.
And even in Massachusetts, a blue state with the country’s only Commission on LGBTQ Youth, schools have become tight-lipped in their support, whether out of fear of losing funding or retaliation from parents. “Almost all districts [have] some anti-LGBTQ activity,” the Commission’s executive director, Shaplaie Brooks, says. Examples include parents opting students out of LGBTQ-inclusive education; rejection of parent advisory councils meant to ensure LGBTQ inclusivity; bullying from students and rejection from educators; and administrators requesting flag removal or other material signaling affirmation.
Not ‘The Next Nex Benedict’
Angela didn’t want Ella to be “the next Nex Benedict,” referring to the nonbinary 16-year-old who was beaten unconscious by kids in a school bathroom and later died from the injuries.
Even before the bullying started, she created an extensive integration plan with Ella’s junior high school. All was going smoothly until a teacher accidentally deadnamed Ella while taking attendance, even though the records were updated. From there, bullying “spread like wildfire,” according to Angela. And once it began, Angela exchanged over 60 emails with school administrators to ensure that the bullying would stop, but to no avail.
The school did not respond to Uncloseted Media and Fierce Healthcare’s request for comment.
Beyond attacks on queer rights, some lawmakers are deprioritizing mental health in general. In 2025, just a month after President Donald Trump ordered the closure of the Department of Education (DOE), the agency ended $1 billion in grants meant to train and support mental health professionals who work in schools. And in Indiana, Republican legislators removed teacher training requirements related to social-emotional learning and cultural competency.
Schools are the most common institutional entry point into mental healthcare for youth. But staffing models vary wildly. Some districts have well-staffed health centers, while others share a single provider across multiple schools. Half of all U.S. schools cite inadequate access to a licensed mental health professional as a top factor limiting their ability to provide mental health services to students, according to KFF, a nonprofit research organization.
The share of schools reporting inadequate funding for mental health services has grown since 2021 and resources vary by state. In California, public school students on private or government insurance qualify for free therapy and counseling. Meanwhile, Alabama ranks last nationally in mental health access, with many rural districts struggling with staffing shortages and inconsistent funding. Last June, 16 states successfully sued the DOE over terminated grants, with funding restored for those states by a federal judge in October.
Even organizations trying to support schools are hitting roadblocks. Bring Change to Mind, co-founded in 2010 by actress Glenn Close, operates a national student-led high school club program focused on mental health. In 2025, the organization found that 92% of registered club participants said they take better care of their mental health as a result.
Bring Change to Mind had spent seven years building out its high school program in Indiana with the support of the state education department. The organization also launched a middle school pilot at the agency’s request. But in 2025, its DOE funding was not renewed. “I have to find money elsewhere, until things change,” says Pamela Harrington, the organization’s executive director.
And last month in Minnesota, administrators shut down student attempts at Benilde-St. Margaret’s to start a mental health club, despite Bring Change to Mind offering seed funding. The school is near where a shooting took place last year, and the club was intended to support students struggling with the tragedy.
Harrington has also noticed that many students have stopped self-identifying as LGBTQ over the past several years. Registration for the organization’s annual student summit is down, even though participation is up. “Some students don’t feel safe registering,” she says.
Crisis Care Is Another First Entry Point for Many
All of these barriers may be contributing to a surge in youth going to the hospital in a mental health crisis. From 2011 to 2020, despite an overall decrease in pediatric emergency department (ED) visits, the portion of mental health-related ED visits by kids and teens soared, with the sharpest increase for suicide-related visits.
In New York state, Northwell’s Cohen Children’s Medical Center sees a disproportionate number of kids who are queer. Whether it’s bullying, depression, anxiety, trauma or suicidality, “all the rates are much higher for these kids, they’re much more vulnerable,” says Vera Feuer, the former vice president for child and adolescent psychiatry at Northwell, who left the organization in April. “Because community access is so difficult, we are often the first mental health providers that these families ever see,” says Feuer, who is now the chief clinical officer of the Child Mind Institute.
She says the main reasons kids end up in the ED for mental health are suicidality and self-harm, or behavioral problems like aggression. Conflicts involving sexuality or gender identity are often part of the trigger, and can get worse in a hospital environment if staff are not properly trained. “Feeling like you add value to the people around you versus feeling like you’re a burden, are really important components of suicidal crises,” Feuer says.
Many patients in the ED deal with trauma. And while evidence suggests that trauma-informed care has a positive impact on patients, the approach isn’t always used in EDs. The psychiatry team at Northwell is trained to be trauma-informed and affirming, which could look like wearing a Pride badge, asking a patient their pronouns or determining if they want to disclose their identity to their parents.
Feuer says even in cases of significant self-harm, some parents are “in utter denial” about their child’s identity. They might see the behavior as attention-seeking and be more concerned about their school test the next day. “The parent is also in crisis, and their brains don’t work particularly well when they’re with us,” she says.
When Ella was admitted to Carle Foundation Hospital in Illinois after the attack at school, Angela says she was offered “zero resources.”
Speaking generally about the hospital’s policies, Holly Cook, director of the Carle Foundation Hospital ED, wrote in an email that the ED has multiple protocols in place for patients experiencing mental health crises, including referrals to the outpatient psychiatric team and community mental health resources. “The top priority … is keeping the patient safe, treating the patient with dignity and helping to explain the processes as they occur,” Cook wrote.
But Angela says none of those supports were offered to Ella after her hospitalization. She says they were left without referrals for counseling, trauma services or clear guidance about where Ella could receive ongoing emotional support.
“The hospital ER doc was aware of the situation,” Angela says. “They didn’t even give me the proper ‘victim information’ paperwork that includes those types of resources. … We got nothing regarding mental health resources from the hospital. … I ended up finding resources on my own for crisis counseling because I just really needed somebody to help my kid.”
A Carle Health spokesperson declined to comment on Ella’s case, citing HIPAA, and reiterated the hospital’s priority of patient safety and dignity.
In other parts of mental healthcare, resources are strained. Last year, the Trump administration cut the LGBTQ-specific option on the 988 suicide hotline, even though suicide rates dropped 11% below projections since its rollout. And the 10 states with the largest 988 service uptake saw rates drop 18% below projections.
All of this is occurring when research demonstrates that LGBTQ youth who are able to access affirming mental healthcare report lower rates of suicide attempts.
Angela, aware that her daughter needed urgent support after she was attacked, found Project Oz, an Illinois nonprofit that provides survival aid to youth. They provided crisis care weekly to Ella, which helped her process the trauma of the attack. But the care was limited to six weeks due to their care model.
“She really listened and included my [trans identity] in the care,” Ella says. “I wish I had a little bit more time because I got to a point of recovery but it wasn’t complete. I get it could only be six weeks, but it takes time to process this stuff.”
“My biggest barrier to mental healthcare has honestly been people not understanding,” she says. After searching for years, Ella has found a trans therapist that Angela says “sees all the trans youth in [their] town.”