Blog Post: How Policy, Healthcare Systems, and Ethics Shape the Mental Health of Gender Minority Youth
How Policy, Healthcare Systems, and Ethics Shape the Mental Health of Gender Minority Youth
Over the past decade, youth suicide rates have continued to rise in the United States. For gender minority adolescents, this risk is not driven by individual factors alone – state policies can either exacerbate or mitigate this risk. Today, 27 states have enacted laws limiting access to gender affirming care (1), and 24 impose legal penalties on clinicians who have provided such care to minors (2). In contrast, some states, such as Massachusetts and California, have enacted “shield” laws to protect access to transgender health care (3).
While political debates often focus on the legitimacy of gender identities, gender minority youth face the real-world repercussions of having their existence be subjected to legislative decisions. Policy choices shape whether young people can access care, whether clinicians feel safe providing it, and whether healthcare systems respond to their social needs. These downstream effects can manifest as mental health crises, unmet social needs, provider shortages, and amplified fear among patients and clinicians.
At a time of rising youth suicide risk and political turbulence, it is important to understand how policy environments impact mental health outcomes among gender minorities. Recent research from HERLab researchers and collaborators offers critical evidence. To share this evidence, we synthesized findings from three recent peer-reviewed studies examining state-level policy, healthcare system practices, and ethical calls for action.
State Policy and Adolescent Suicidality
Overhage et al (2025) (4) assessed whether state bans on conversion therapy – attempts to change a person’s sexual or gender orientation – were associated with adolescent suicidality. Using data from more than 420,000 high school students who participated in the national Youth Risk Behavior Survey between 2011 and 2019, the authors compared suicide outcomes in states with and without these bans.
The findings were striking: adolescent suicidality was lower in states that adopted conversion therapy bans, providing compelling evidence that policy can function as a population-level mental health intervention or risk.
Inequities within Healthcare Systems
Policy effects can extend beyond legislation and into clinical settings. Breslow et al (2025) (5) evaluated how structural inequities appear within a New York health system by looking at social needs screening among transgender and cisgender patients.
Their findings were troubling: transgender patients were screened for social needs less often than cisgender patients. Yet among those who were screened, transgender patients were significantly more likely to report housing instability, poor-quality housing, and high healthcare costs. While these results reflect a single health system, they signal how inequities can plague the very institutions designed to protect and promote wellbeing.
Neutrality is Not Neutral
Breslow et al (2026) (6) raises the ethical harms of mental health clinician neutrality amid the rising anti-transgender legislation. The authors argue that inaction can perpetuate the very outcomes documented in prior studies, including increased suicide risk and reduced access to care. They then outline four pathways through which clinicians can advocate while remaining within their professional obligations:
Grassroots efforts (e.g., supporting trans-led organizations),
Organizational action (e.g., mandating trans-affirming care),
Municipal collaboration (e.g., partnering with city council), and
State-level engagement (e.g., working with legislators to support protective policies).
Two of these approaches – organizational and state – could directly address the system-level and policy-driven inequities identified in the earlier studies, demonstrating that action can yield concrete and practical outcomes.
Why This Matters: Making the Right Choices
Viewed together, these studies make one point crystal clear: mental health outcomes among gender minority youth are shaped by policy environments and healthcare system practices. Accordingly, Breslow et al (2026) (6) offers a roadmap forward, highlighting how healthcare providers can act during uncertain times.
These pathways extend well beyond clinicians:
Policymakers can evaluate and propose legislation with mental health and social consequences in mind.
Health systems can close equity gaps by standardizing social needs screening and affirming care practices for all patients.
Clinicians can use their professional expertise to aid evidence-based policies and advocacy.
Community members – people like you and me – can support local, state, and national efforts that affirm diversity and defend dignity.
When identity is politicized, evidence matters. This evidence is clear: policy and institutional actions matter for mental health services and outcomes. As a nation, we must collectively make choices with the wellbeing of all groups in mind, with lasting consequences for the mental health of our youth.
References
1. Dawson L, Kates JF. Policy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions. KFF. August 11, 2025. Accessed February 3, 2026. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
2. Legislature Strengthens Protections for Reproductive and Gender-Affirming Health Care Services. Accessed February 3, 2026. https://malegislature.gov/PressRoom/Detail?pressReleaseId=236
3. State Shield Laws: Protections for Abortion and Gender-Affirming Care Providers | KFF State Health Facts. KFF. Accessed February 3, 2026. https://www.kff.org/state-health-policy-data/state-indicator/shield-laws/
4. Overhage LN, Cook BL, Rosenthal MB, Hatfield LA, McDowell A. State Bans on Sexual Orientation and Gender Identity Change Efforts and Youth Suicidality. Health Serv Res. 2025;60(5):e14635. doi:10.1111/1475-6773.14635
5. Breslow AS, Babbs G, Cavic E, et al. Fewer screens, greater needs: housing insecurity and healthcare costs for transgender patients in a safety-net system. Health Aff Sch. 2026;4(1):qxaf226. doi:10.1093/haschl/qxaf226
6. Breslow AS, Restar A, Cavic E, Alpert JE, Lê Cook B. From Crisis to Action: Psychiatry’s Ethical Imperative to Defend Transgender People’s Rights, Dignity, and Access to Care. Am J Psychiatry. 2026;183(1):13-17. doi:10.1176/appi.ajp.20250051