Suicide Risk Factors and Signs

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Population-specific hotlines increase help-seeking by providing culturally sensitive care.

LGBTQ individuals continue to face pervasive and dangerous threats to health and wellbeing.

The 988 "Press 3" option, established to support LGBTQ youth in crisis, has been discontinued.

Providers, researchers, and advocates must continue to show up in meaningful ways for LGBTQ youth in crisis.

In the United States, lesbian, gay, bisexual, transgender, and queer (LGBTQ ) history is a tangled web of civil rights battles, mental health challenges, and political warfare. Psychoanalysts and other early- and mid-20th-century students of the mind considered queerness a disease or something to be fixed. Homosexuality was classified as an illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973. Less frequently discussed is that language pathologizing queerness remained explicit (e.g., “ego dystonic homosexuality” or “marked distress about one’s sexual orientation”) until the publication of the DSM-5 in 2013 (McHenry, 2022), and the pathologization of queer identities has still not disappeared entirely, with gender dysphoria remaining a diagnosable condition to this day. Alongside the use of pathologizing language in psychology and psychiatry, LGBTQ individuals faced pervasive and dangerous threats to their health and well-being, from the devastation of the Stonewall Uprising in the late 1960s to the AIDS epidemic in the 1980s and the Don’t Ask, Don’t Tell policy of the 1990s.

Nevertheless, resiliency flourished in the LGBTQ community, with the creation of organizations like PFLAG (originally Parents and Friends of Lesbians and Gays), the Human Rights Campaign, and the Trevor Project. These organizations recognized the need for community support and resources to address the physical, mental, and social challenges that queer individuals, and particularly youth, face every day, not least of which is an increased risk of suicidal ideation, behaviors, and attempts (Wallace et al., 2024). As the 21st century has progressed and societal views on queer civil rights have shifted in a generally positive direction (Minkin et al., 2025), there has come added awareness of the need for queer-focused resources, particularly those focused on suicide prevention and intervention.

One manifestation of this recognition has been the development of targeted crisis intervention services designed specifically for LGBTQ individuals. In 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) partnered with the Trevor Project to provide specialized subnetwork services for LGBTQ youth, a three-digit hotline to simplify access to mental health crisis support across the United States. After calling the 988 Suicide and Crisis Lifeline, LGBTQ callers could “Press 3” to access trained volunteers with specific knowledge and skills to assist queer youth. Evidence indicates that such population-specific hotlines increase help-seeking by providing culturally sensitive care (Zabelski et al., 2023).

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