"Being Able to be Myself": Useful Aspects of Inpatient Psychiatric Care from Perspectives of LGBTQ Youth Previously Hospitalized for Suicide Attempts

Background: Suicide is the second leading cause of death among youth ages 10-24 (CDC, 2020) and lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth are disproportionately at risk. LGBTQ youth are more than four times as likely to attempt suicide than their non-LGBTQ counterparts (Johns et al., 2019; Johns et al., 2020), with rates continuing to rise. Given that a prior suicide attempt is one of the most robust predictors of death by suicide (e.g., CDC, 2013; Brendel, 2013) and the most common reason for admission to inpatient psychiatric units (e.g., Plemmons, 2018), it is critical to understand the ways in which inpatient psychiatric care facilitates stabilization and recovery following a suicide attempt from perspectives of LGBTQ youth themselves.

Methods: During the first phase of a larger intervention development study, semi-structured interviews were conducted with 15 youth who had been psychiatrically hospitalized for a suicide attempt within the past six months. Participants were asked about their experiences of inpatient psychiatric care following a suicide attempt. Because most youth (60%, n=9) identified as members of the LGBTQ community, qualitative secondary analysis (QSA; Heaton (2004)) was used to explore experiences of LGBTQ youth specifically (n=9). Data were analyzed using a combination of deductive and inductive applied thematic analysis (Guest et al., 2011).

Results: Participants (n=9) ranged in age from 12-17 years old (M=14.5, SD=1.7). The sample was predominantly nonbinary/gender non-conforming (55.6% nonbinary/gender non-conforming (22.2% gay/lesbian cisgender; 22.2%) and white (55.6% white, 11.1% American Indian/Alaska Native; 11.1% multiracial, and 22.2% Hispanic/Latinx). Qualitative analyses produced several salient themes pertaining to inpatient psychiatric staff behavior, care standards, and therapeutic processes that facilitate stabilization and recovery following a suicide attempt. Specifically, observable demonstrations of respect by staff related to gender identity and sexual orientation influenced decision-making processes related to a) whether youth disclosed this information to unit staff b) whether youth disclosed this information or ‘come out’ to other people (e.g., family members). Youth who were already ‘out’ to family members and experiencing dismissive invalidation as a result expressed a desire for more parent/caregiver guidance consistent with LGBTQ affirming care as a standard component of treatment provided by unit staff. Youth who had not disclosed information about their gender identity or sexual orientation to parents/caregivers or staff cited a perceived lack of safety, fears of rejection, and inducing disappointment as primary reasons. Youth who were able to acknowledge these parts of their identities considered this process an integral and foundational component of their mental health treatment and attempt recovery trajectories.

Conclusion/Implications: Findings highlight the importance of providing LGBTQ affirming care during inpatient psychiatric stays for youth recovering from a suicide attempt. With the marked proliferation of anti-LGBTQ legislation in most states across the country, it is critical for health care organizations to institutionalize and codify LGBTQ affirming care as the only acceptable standard of care for youth in inpatient psychiatric settings, as well as other settings in which care is provided.