Last month, the federal government announced it would eliminate the national suicide prevention hotline’s specialized services for LGBTQ+ callers — a decision that pulls vital support away from some of the most at-risk young people in America. The end of the service on July 17 is a crushing moment, but it should also be a wake-up call.
This isn’t just a political decision. It’s a public health failure.
Culturally competent care acknowledges and responds to the lived experiences of high-risk populations, offering an effective approach to suicide prevention. This targeted support works because it addresses the specific challenges facing groups like veterans and LGBTQ+ youth. Abruptly removing these services in the midst of a mental health crisis for LGBTQ+ youth is both dangerous and deeply out of touch with clinical best practice.
The Trevor Project’s 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People found that 39% seriously considered suicide in the past year. Among transgender and nonbinary youth, those rates are even higher. Half of LGBTQ+ youth surveyed said they wanted mental health care in the past year but were unable to get it. The biggest reason for not getting the mental health care they needed was “fear” — fear of talking about their mental health, fear of being outed, and fear of not being taken seriously.
As leaders in suicide prevention and crisis response, we’ve seen firsthand the power of care that reflects and respects the individual receiving it. When LGBTQ+ youth in crisis are met with understanding and validation — not confusion or judgment — they are more likely to contact help, to trust the care being offered, and ultimately, to survive that moment and go on to thrive.
A 2019 survey found that about a quarter of 12- to 25-year-old callers to an LGBT-specific national service provider in the U.S. said they would not have contacted another helpline. Nearly half — especially transgender, nonbinary, queer, and pansexual youth — said they called specifically because of the affirming counselors.
Since 988 launch, mental health crisis services have faltered
The LGBTQ+ services within 988 weren’t just a symbolic achievement. The unique service was built on evidence and was then evaluated for its impact as a specialized part of 988. Since the program’s launch in 2022, these services have connected more than 1.3 million LGBTQ+ youth in crisis with counselors trained to understand their specific risk factors, trauma, and strengths. For many, this was their first — and only — experience with person-centered care.
Now, that option is slated to go away.
The argument from federal officials is that “all counselors are trained to help everyone.” But general training is not enough. LGBTQ+ youth face unique, well-documented disparities in mental health outcomes and access to care. The government’s rationale — that all crisis counselors receive general training — misses the point entirely. Generalized training is not a substitute for training and care that is specifically designed with cultural competence to produce improved outcomes.
As a psychiatrist and public health professional, I (Moutier) can tell you: Culturally competent care improves access, engagement, and outcomes. When people feel seen, they are more likely to reach out, disclose with greater depth and vulnerability, adhere to care plans, and return to health professionals. Research shows that although LGBTQ+ individuals face significantly higher rates of psychological distress, they often delay or avoid care due to fear of discrimination or previous negative experiences. Cultural competence directly counters this.
The American Psychiatric Association and others have long championed tailored mental health approaches for underserved groups. A 2019 review found that culturally informed care helps clinicians understand the social context of mental illness, and is crucial to addressing health inequities and achieving better health outcomes.
The U.S. Department of Veterans Affairs, for example, recognizes that LGBTQ+ veterans face unique stressors and barriers to care. That’s why the VA implemented LGBTQ+ veteran care coordinators at every medical center nationwide.
As a nonbinary Black leader in the mental health space, I (Jaymes) know how much it matters to see yourself reflected in the care you receive. I’ve lived the reality of having to explain my identity to a provider, before even getting to the reason for being in crisis. This delays actual care, and it increases stress and discomfort.
When young people — or anyone, for that matter — reach out and find someone who doesn’t just tolerate them, but truly understands them, it can make a lifesaving difference. A 2023 study concluded that culturally tailored services increased trust and retention across diverse populations.
We call on the Trump administration to restore funding for the 988 Suicide & Crisis Lifeline’s LGBTQ+ specialized services — and to recommit to expanding culturally competent care across the crisis response system. This isn’t a budget issue; the overall 988 Lifeline funding will remain the same. This is about priorities.
We urge Congress to provide oversight, pass legislation that supports culturally competent, evidence-based mental health services, and hold agencies accountable for following best practices to achieve better mental health outcomes. The most effective mental health care is rooted in connection, understanding, and trust. This approach to health care has been proven effective, and this decision is moving backward on what we know works in the public health model. Cultural competence isn’t an option; it’s essential.
Jaymes Black is the CEO of The Trevor Project. Christine Yu Moutier, M.D., is the chief medical officer of the American Foundation for Suicide Prevention.
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.
