Specialized counseling services for LGBTQ+ youth are set to return to the 988 Suicide & Crisis Lifeline by the year’s end, as confirmed by the Trump administration last month. However, young people hoping to “press 3” for support might find the experience altered. Federal health officials are ensuring that the services align with President Trump’s executive order from last year, which essentially denies the existence of transgender and nonbinary identities.
Last July, the Trump administration closed the specialized services for LGBTQ+ youth. However, a subsequent congressional appropriations bill allocated $33.1 million to reinstate the line, with the law mandating support for all LGBTQ+ youth.
The Trevor Project, a suicide prevention organization that has run its own LGBTQ+ youth hotline since 1998 and has handled about half of the calls to 988’s specialized line since its 2022 launch, might not be included in the restored service due to a technicality in the application process, as reported by the Associated Press.
Despite this, the Trevor Project has submitted a proposal to provide the reinstated services, as stated by Mark Henson, the group’s vice president of advocacy and government affairs, to STAT. Although their eligibility has not been directly confirmed, Henson stated, “Regardless of the decision, we remain deeply committed to the importance of specialized services for LGBTQ+ youth, and are eager to support anyone providing crisis services on 988 or otherwise.”
There is concern among advocates that changes to the services that exclude transgender youth could be more harmful than having no services at all.
Aaron Almanza, executive director at the LGBT National Help Center, expressed worry that if transgender youth seek support from the crisis line and are told they are incorrect, it could lead to more individuals spiraling. He stated, “The biggest fear that I have is that it’s going to kill them.”
Alex Boyd started volunteering with the Trevor Project’s independent suicide hotline in 2019. By 2022, he was among the staff members launching the specialized LGBTQ+ services with 988. In an interview, he emphasized the importance of trusting experts who work with transgender youth daily, stating, “When there are external individuals or entities coming into that space and limiting what can or can’t be covered within what we know to be best for LGBTQ young people, that’s going to cut off the opportunity for quality care at the end of the day.”
A year after the shutdown of 988’s “press 3” option by the Trump administration, Boyd, the Trevor Project’s director of crisis intervention, discussed with STAT the unique challenges faced by crisis counselors and the critical need for these services in the present climate.
The conversation has been edited for length and clarity.
We don’t yet know how the Trump administration may try to reinstate 988’s specialized LGBTQ+ services while complying with last year’s executive order. But advocates have told me they’re worried that training for 988 counselors may be impacted, or that counselors could be prohibited from affirming trans identities when people call in. What would be the risk if counselors are restricted in that way?Â
Gender identity isn’t always a topic during conversations, but many environmental factors and support systems depend on the individual’s sense of safety and support regarding their identity. Feeling free to be authentic is crucial.
Crises often stem from gender identity challenges. Trans or nonbinary individuals who haven’t come out may seek affirmation to navigate their internal reflections. Even if not the main issue, it often underlies family, relationship, or financial challenges. They turn to services like ours for validation and to ensure they aren’t mistreated based on their identity, finding a space for authenticity and transparency.
What are the common types of calls you get from young trans people?Â
The challenges faced by transgender and nonbinary youth are similar to those of the broader LGBTQ community, but more pronounced in terms of resources, especially medical support. Beyond essential gender-affirming healthcare, other care avenues are also crucial.
Recently, I observed a call with a young person who had a negative hospital experience unrelated to gender-affirming care. During a necessary surgery, they were misgendered and identified as a different gender identity.
This individual confided that they first contacted us as a preteen and are now in their early 20s, reaching out over nearly a decade whenever they felt unsafe. They currently live independently as an adult. However, recent medical issues forced them to rely on family, which had been abusive in the past and unsupportive of their identity, causing harm. This scenario isn’t uncommon, as young adults often turn to harmful systems for health or safety.
Are there other calls to the hotline that have stayed with you over the years?Â
I recall a call from a young person who had already attempted suicide. They regretted it and sought guidance on their next steps. Fearful of calling 911 or emergency services, they prioritized building rapid rapport and trust to maintain connection, as disconnection could mean losing support.
We established rapport and assessed the harm they had inflicted on themselves. However, the rapport was briefly broken when the caller became agitated by the idea of involving 911 and ended the interaction. They reached out again 20 minutes later, willing to try again. We convinced them to engage with emergency services, contacted them on their behalf, and were able to deescalate the situation. Emergency services arrived and treated them within 30 minutes.
That sounds like the harrowing type of emergency call that people might imagine a suicide hotline handles. But how can a counselor support someone in a situation like the first caller you mentioned?
When dealing with thoughts of suicide or self-harm, we focus on addressing these feelings and their root causes, particularly when environmental factors, such as an unsupportive family, are involved. We assess the feasibility of distancing from harmful individuals, though sometimes it’s impossible, such as when living at home would mean homelessness. We empower callers to understand their capabilities and comfort levels, encouraging them to reach out to additional supports. We also identify coping strategies to help them endure their environment and explore accessible professional resources.
What are the common mistakes that new counselors tend to make when working on the suicide hotline?Â
New counselors often assume that various supports are accessible outside of crisis services. While we may refer individuals to local therapists and medical facilities, some callers reside in rural areas with limited access to such services. Additionally, they may lack a traditional support system of parents, close friends, or school. When these avenues are unavailable, creativity is needed to help callers understand their experience.
What sort of logistical work does it take to establish these specialized services on a hotline?
Establishing specialized services requires building technical processes and operations that transform a single stream of volume into multiple streams. The most impactful factor is getting people in place. Even experienced crisis workers need training to ensure policy alignment and refined best practices, especially for specific populations like LGBTQ youth. This process takes about two to three months.
Frequent starting and stopping of a subnetwork service results in losing two to three months each time. A major concern is the significant resources spent on figuring out how to operate, build, or close a service, like last year. This detracts from understanding and addressing the needs of LGBTQ young people. A lot of unseen work has been affected, particularly in recent years.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
