Last month, three national medical groups sounded the alarm that America’s children and adolescents are in a state of emergency when it comes to mental health. The doctors shared alarming statistics about how mental health-related emergency room visits have risen.

Children are also dealing with the fallout from COVID-19-related deaths of loved ones. Children of color have been disproportionately impacted.

The statement, from the Association of American Pediatrics, along with the American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association, did not specifically point out mental health struggles experienced by some youth identifying as LGBTQ. As a psychiatrist who works extensively with LGBTQ youth, and as someone who identifies as a gay man, I am advocating for this particular group, as I have witnessed their struggles.

Approximately 9.5 percent of teens ages 13 to 17 living in the U.S. identify as LGBTQ. Even before the pandemic, these kids were 4 times more likely than heterosexual youth to attempt suicide. Those numbers have risen; LGBTQ youth are now 5 times more likely to attempt self-harm, according to the Trevor Project, a Bay Area-based nonprofit for at-risk LGBTQ youth.

Some of this has to do with pandemic-related side effects, such as teens spending much more time on social media and being separated from peers who often serve as their sounding boards. After all, adolescence is a time of identity formation.  For LGBTQ youth, it is extremely important to talk to peers and receive validation of their experience. Many kids are also struggling to cope in less-than-ideal home environments; 4 out of 5 LGBTQ youth have reported their home life has been more stressful during the pandemic. 

As a society, it’s our responsibility to step up and better support LGBTQ youth, giving them the means to explore their questions, work through their complex feelings and express themselves. Our policymakers need to be held accountable, too. In California, it took a pandemic to get our state lawmakers to pass new laws allowing students to take mental health days beginning in 2023 and requiring mental health education at middle and high schools.

The new laws are a start. But as a mental health professional, I believe that home is where we can make a positive impact first. 

For starters, families of LGBTQ teens need to be acutely aware of warning signs. Behavior changes, such as acting withdrawn or angry, are often signs that something is amiss. Sudden appetite or sleeping pattern changes are indicators that it’s time to check in. Often kids don’t understand their own feelings and won’t say anything because they can’t pinpoint what’s wrong, so families need to take the first step.

The most important piece is to create safe spaces for teens to talk at home. Teens who are struggling with sexual identity need to know that they can share their feelings and emotions without fear of rejection or retribution.

Never ignore even subtle warning signs. The worst thing families can do is just assume “everything is going to be okay,” and ignore the issue. That’s how teens end up in the emergency room after trying to harm themselves. If the teen won’t open up at home or doesn’t feel safe doing so, there are hotlines for LGTBQ youth to call, or the family should schedule a visit with a mental health professional. The most important takeaway here: Don’t assume. Take action.

One 17-year-old who identifies as non-binary comes to mind. They were feeling sad, confused and isolated, and reached out to our practice for help early in the pandemic. A junior in high school, they could no longer see their friends in person, and this lack of connection led to significant depressive symptoms. The youth needed a safe environment to discuss identity issues, challenges with acceptance and social difficulties. Weekly behavioral therapy did wonders, and provided them with skills for labeling and challenging negative thoughts.

Perhaps one day we’ll live in a society where LGBTQ youth have enough support to feel comfortable with fully being themselves, and the number of kids harming themselves will drop. Until then, we have a lot of work to do to ensure teens and young adults of all sexual orientations feel safe and supported.

Michael Enenbach is a psychiatrist and the clinical director of the Child Mind Institute in the San Francisco Bay Area, as well as president-elect of Pride CAPA, the national organization of gay, lesbian, transgender and queer child psychiatrists.