Last month, the Trump administration confirmed that professional counseling services for LGBTQ+ youth would return to the 988 Suicide and Crisis Lifeline by the end of the year. But as federal health officials want to make sure services comply with President Trump’s executive order last year that essentially denies the existence of transgender and non-binary identities, young people looking to “press 3” to seek that assistance may find themselves in for an unusual experience.
Shortly after the Trump administration shut down LGBTQ+ youth services last July, a Congressional spending bill earmarked $33.1 million to reopen them. This legislation states that services must support all LGBTQ+ young people.
But The Trevor Project, a suicide prevention group that has operated its own LGBTQ+ youth hotline in some form since 1998 and has answered about half of the calls to its 988 specialty line since its launch in 2022, may not participate in the restored service due to technical issues with the call for applications, The Associated Press recently reported.
Nevertheless, The Trevor Project has submitted a proposal to provide restored services, according to a statement to STAT from Mark Henson, the Trevor Project’s vice president of advocacy and government affairs. Although he has not received direct confirmation of eligibility, “Regardless of the decision, we remain deeply committed to the importance of specialized services for LGBTQ+ youth and are eager to support those providing 988 or other emergency services,” Henson wrote.
Advocates fear that if specialist services are changed to exclude transgender young people in any way, it will be worse than doing nothing.
Aaron Almanza, executive director of the LGBT National Help Center, said he worries that when transgender youth call the crisis line for help, “if they’re told they’re wrong, it’s going to send more of them into a spiral. … My biggest fear is that they’re going to lose their lives.”
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Alex Boyd began volunteering with The Trevor Project’s Independent Suicide Hotline in 2019. By 2022, he was one of the organization’s few staff working with 988 to launch LGBTQ+ specialist services. “Maintaining trust in the professionals who work with trans youth every day is paramount,” he said in an interview. “When outside individuals and organizations enter that space and limit what we can and cannot cover within what we know is best for LGBTQ youth, what we end up with is cutting off opportunities for quality care.”
A year after the Trump administration shut down 988’s “Press 3” option, Boyd, director of crisis intervention at The Trevor Project, spoke with STAT about the unique challenges crisis counselors face trying to help LGBTQ+ youth and why this service is so important right now.
The conversation has been edited for length and clarity.
It remains to be seen how the Trump administration will restore 988 LGBTQ+ specialty services while complying with last year’s executive order. But advocates told me they were concerned that the training of 988 counselors would be affected or that counselors would be prohibited from affirming that they are transgender when they call. What are the risks if counselors are so restricted?
Someone’s gender identity doesn’t always come up in conversation. For example, you don’t necessarily need to know whether someone identifies as a man, a woman, or a gender-fluid non-binary person. But many of their environmental factors and how they receive support depend on whether they experience safety, experience support around their identity, and feel able to be open and authentic with themselves.
Sometimes their crisis begins with challenges related to their gender identity. Perhaps they are a transgender or non-binary person who has not come out and would like to have their identity explicitly affirmed so that they can reflect with us on what it means to them. But when someone comes to us for a non-direct issue, it’s often at the heart of why they’re having family issues, relationship issues, or issues with work or financial security. They seek services like ours to gain validation that they don’t deserve to be treated unfairly, directly or indirectly, based on their identity, and to find a place where they don’t have to protect themselves or filter themselves in any way, but can just be completely authentic about their identity and provide us with the level of transparency they need.
What are the common types of calls you receive from transgender youth?
Many of the challenges that transgender and non-binary youth experience are not all that similar to those of the larger LGBTQ community. But I think specifically about what is most aggravating for transgender and non-binary people. One is resources, especially for medical assistance. And not just gender-affirming health care, which is foundational to our ability to be ourselves and be healthy, but other means of care as well.
I was just on the line observing a conversation with a young man who had had a really bad experience in a hospital environment that had nothing to do with gender-affirming care. It was a surgery they had to undergo, and they had a very negative experience of being misgendered and perceived as a different gender identity.
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Near the end of the conversation, this person told us that she first contacted us when she was a teenager and is now in her early 20s. They have been contacting us intermittently for nearly 10 years when they feel they are in danger. They are now adults and live on their own. However, due to medical issues, they had to rely on their family for the first time in years, who had suffered abuse in the past. They were not supporting this person’s identity and were actually causing harm. I share that opinion because it’s not unlike the stories we often see, where young people who are otherwise healthy are forced to rely on systems that are harmful to them.
Are there any other hotline calls that have been going on for years?
I remember a conversation in which a young man who had already tried to take his own life contacted us. They contacted us to say they regret their actions and were wondering what to do next. They were very afraid to call 911 or call local emergency services. This is a very frequent concern. Our main priority in that conversation was to quickly build relationships and trust with them so that we could stay connected, as there is always a risk of disconnection occurring and lost support opportunities.
We built a trusting relationship with this person and were able to understand the level of damage that had already been done to us. That relationship broke down at some point because they became so animated by the idea that they didn’t want 911 to be there and actually ended their interaction with us unexpectedly. They contacted me about 20 minutes later and said they would like to try again. We were able to convince them to join the emergency services and we contacted them on their behalf. We were able to de-escalate. In fact, they had started self-harming at that very moment as well. Then, about 30 minutes later, we received confirmation that emergency services arrived on scene and were providing direct medical treatment.
It sounds like the gory kind of emergency call that people would imagine handling at a suicide hotline. But how can a counselor help someone in a situation like the first person you mentioned?
If there are any thoughts of suicide or self-harm, we really try to address them and the root causes behind those thoughts, especially in situations where there are environmental factors, i.e. unsupportive family members. Often we are trying to understand how reasonable it is for them to leave these supports — can they distance themselves from individuals who are harming them? For example, if it’s your own family, you might not be able to do that. Otherwise, you will end up homeless. It’s about putting a card in the hands of the caller to understand what they can do or feel empowered to do and how that comfort can be increased, perhaps by reaching out for additional support. Also, identify what coping strategies exist to help you withstand the environment and stress. What professional resources are available to them?
What are some common mistakes new counselors make when working at a suicide hotline?
There are often assumptions about the range of support available to people outside of crisis services. We may be trained to refer you to a therapist or medical provider in your area, but that person may be in a rural area with limited access. They may also be people who don’t have a traditional support system around them, such as parents, close friends, or school. And when you start to realize that that avenue of support doesn’t exist for someone, there can be a lack of creativity in putting it into their hands to understand their experience.
What kind of logistics are required to establish these specialized services in a hotline?
First and foremost is the operational reality. For example, you need to build technical processes and operations to change what could be a single volume stream into multiple volume streams. And the most influential consideration to inform that is staffing. Crisis work training, even if you’ve been doing crisis work for, say, three years in the past, requires some training to ensure policy alignment, refine best practices, and tailor it to the audiences you’re serving, especially for sub-network populations like LGBTQ youth. In our case, it takes about two to three months to staff someone. So, for example, if you think about a world where subnetworks go down and start up a lot, you’re losing two to three months every time you start them up.
One of my main concerns is that, like last year, so many resources are being spent thinking about how to run a service, how to build a service, or how to terminate a service. And so much energy is being wasted on truly understanding LGBTQ youth, hearing directly from them, and understanding what their needs are. Especially in recent years, many invisible jobs have been affected.
If you or someone you know may be considering suicide, contact the 988 Suicide and Crisis Lifeline: Call or text 988 or chat. 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
