In March 2021, the board of directors of the American Psychiatric Association voted to commend the Advancement of Psychiatry Group (GAP) for its contribution to the well-being of LGBT youth, applauding the psychiatry and religion committees and GAP’s LGBTQ + for their brochure, Faith-Based Communities and the Well-Being of LGBT Youth.1 Published online, the booklet discusses ways in which religious leaders and faith communities can support LGBT youth in their communities to alleviate mental health issues.
Almost 5 years ago a friend of mine was discussing the problem of suicides among LGBT youth with his local bishop. The bishop asked if there was any material from mental health experts that could address this concern. My friend told me about it because of my previous LGBT advocacy in a religious context. As I was not aware of such a resource, I contacted Mary Barber, MD, of the LGBT GAP committee, and she pointed me to the work of Caitlin Ryan, PhD, and the Family Acceptance Project (FAP). . This started a collaboration between the 2 GAP committees and Ryan, resulting in a booklet to meet this need.1
The booklet recognizes the common interests shared by medicine and religion in the well-being of young people. Next, it describes the multiple mental health issues facing LGBT youth, including suicide, depression, anxiety, substance use, bullying and homelessness. Included is data showing that compared to their non-sexual minority peers, LGBT youth are about twice as likely to be bullied or use illicit drugs, more than twice more likely to feel constantly sad or hopeless, more than three times more likely to inject illegal drugs and consider suicide or make a suicide plan, and more than 4 times more likely to attempt suicide.1
The booklet deals with factors contributing to stress, including those related to a specific religious context, such as the inability to marry according to one’s faith or to be open in one’s religious community, and rejection by family and community over widely. Religious traditions vary in their teaching about sexual orientation and same-sex marriage, but no religious tradition intentionally wishes to harm its young members or discourage young people from remaining in their tradition. In addition, faith communities do not have to abandon their doctrines (where tensions exist) to contribute to more positive outcomes for the health and mental health of young people. In fact, most faith communities generally have doctrines that promote family harmony and interpersonal kindness. Through religion and medicine, we seek to relieve pain and address difficult aspects of life to improve physical, social, emotional and spiritual well-being.
Over 20 years of research have shown ways to mitigate risks for LGBT youth, including increasing acceptance behaviors and decreasing rejection behaviors within families.2 The FAP identified around 100 common behaviors observed in families, about half of them being favorable and the other half rejecting. These findings form the basis of FAP’s family support model to prevent health risks and promote the well-being of LGBT youth. They provide an empirical basis for FAP family education materials; this information is disseminated through posters for use in homes, health care offices, schools, places of worship, service agencies and other community settings. The posters are available for free download in English and Spanish and are available in Chinese, Hindi, Korean, Japanese, Punjabi, Tagalog and Vietnamese.3
Helpful parenting behaviors include talking openly with children about their LGBT identity; express affection when they learn the identity of their child; support their child’s LGBT identity even if he or she feels uncomfortable; work so that their congregation supports LGBT members; and believe that their children can have a happy future as LGBT adults. The more accepted the behaviors, the better the results.4
Likewise, less rejection behaviors are associated with better outcomes.5.6 Harmful parenting behaviors include actions such as hitting, physically harming, or verbally harassing their children because of their LGBT identity; exclude LGBT children from family events; blame their children when they are abused or discriminated against because of their LGBT identity; tell their children that God will punish them; express the shame of their children; and not allow their children to disclose their gay, bisexual, transgender or non-binary gender identity.
Hopefully this booklet will be used by religious leaders and community members to facilitate dialogue, inclusion and a welcoming spirit. Faith communities are encouraged to work with health care providers to stimulate and enhance these conversations and work towards the aspiration of increased human fulfillment. A set of resources is provided for further investigation and discussion.7-12
The GAP booklet is written to apply more broadly to members of any faith community and is offered as a common concern of faith communities and health care providers and organizations, but some faith communities are already adopting and adapting the material. . FAP has produced a brochure on the welfare of LGBT children specifically for members of the Mormon Church.13 The Evangelical Lutheran Church in Finland has agreed to consider publishing a Finnish translated version of the brochure, with additional resources and local research. Psychiatrists can contribute to their own community by becoming familiar with the brochure and its underlying database.
Dr Norko is Chairman of the GAP Psychiatry and Religion Committee and Professor of Psychiatry at Yale University School of Medicine, where he is majoring in forensic psychiatry. In 2010, he received a Masters in Religion from Yale Divinity School.
1. Faith communities and the well-being of LGBT youth. Group for the Advancement of Psychiatry: Psychiatry and Religion Committee and LGBT Committee; 2020. Accessed May 20, 2021. https://ourgap.org/resources/Documents/GAP%20LGBT-Religion%20Project.pdf
2. Cohen J, Ryan C. The Trauma-Focused CBT and Family Acceptance Project: An Integrated Framework for Children and Youth. Psychiatric schedules. 2021; 38 (6): 15-17.
3. Family Acceptance Project Posters to Build Healthy Futures for LGBTQ and Gender Children and Youth. Family Acceptance Project. Accessed May 20, 2021. https://familyproject.sfsu.edu/poster
4. Ryan C, Russell ST, Huebner D, et al. Family acceptance in adolescence and the health of young LGBT adults. J Children Adolescents Psychiatrist Nurses. 2010; 23 (4): 205-213.
5. Ryan C, Huebner D, Diaz RM, Sanchez J. The rejection of family as a predictor of negative health effects in young white and Latino lesbian, gay and bisexual adults. Pediatrics. 2009; 123 (1): 346-352.
6. Ryan C. Generating a revolution in prevention, well-being and care for LGBT children and youth. Review of temple political and civil rights laws. 2014; 23 (2): 331-344
7. Thematic dossier: LGBTQ change efforts (called “conversion therapy”). American Medical Association. 2019. Accessed May 24, 2021. https://www.ama-assn.org/system/files/2019-12/conversion-therapy-issue-brief.pdf
8. Official actions of the APA: position paper on conversion therapy and LGBTQ patients. American Psychiatric Association. December 2018. Accessed May 24, 2021. https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Conversion-Therapy.pdf
9. Drescher J. Hors DSM: depathologizing homosexuality. Behav Sci (Basel). 2015; 5 (4): 565-575.
10. Ghazzawi A, Suhail-Sindhu S, Casoy F, et al. Religious Faith and Transgender Identities: The Dear Abby Project. J Gay Lesbian Mental Health. 2020; 24 (2): 190-204.
11. Hatzenbuehler ML. The influence of state laws on the mental health of sexual minority youth. JAMA Pediatrician. 2017; 171 (4): 322-324.
12. Martin J. Building a Bridge: How the Catholic Church and the LGBT Community Can Build a Relationship of Respect, Compassion and Sensitivity. HarperCollins Publishers; 2018.
13. Ryan C, Rees RA. Supportive Families, Healthy Children: Helping Latter-day Saint Families with Lesbian, Gay, Bisexual and Transgender Children. Family Acceptance Project, Marian Wright Edelman Institute, San Francisco State University; 2012. Accessed May 24, 2021. ❒