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[MUSIC PLAYING] KIMBERLY ADAMS: Coming up from Call to Mind, we look at the unique mental health concerns of queer teens and young adults. According to the latest annual survey from the Trevor Project, a suicide prevention organization for LGBTQ+ youth, 41% of them considered suicide in the past year.

DANIELLE RAMO: Queer teens have higher levels of depression and anxiety. They're more likely to experience bullying and have higher rates of suicidality and completed suicide than their cisgender or heterosexual counterparts.

KIMBERLY ADAMS: I'm Kimberly Adams. Ahead on Queer Youth Resilience and Mental Health, experts discuss the impact of anti-LGBTQ+ legislation, like bills restricting gender-affirming health care for trans young adults.

LAURA HOLT: This is already such a vulnerable population to suicide. And this is not because they're trans. It's because of the impact of attacks on trans people.

KIMBERLY ADAMS: All this and much more after this news.

KORVA COLEMAN: Live from NPR News in Washington, I'm Korva Coleman. President Biden has expressed some cautious optimism about negotiations over the nation's debt limit. The US will run out of cash as early as June 1 to pay its bills unless Congress votes to increase the borrowing limit. Republicans say they won't unless Biden agrees to some spending cuts. Top negotiators for the Republicans and for the President will now meet to try to find compromise.

President Biden is leaving for Japan today for the G7 Summit. He has decided to call off the last half of his trip because of the debt ceiling negotiations. NPR's Scott Detrow says one canceled stop was supposed to be in Australia to meet leaders of four allied nations.

SCOTT DETROW: Australia was going to be a meeting of what's called the Quad-- that's the US, Japan, Australia, and India. It's a group of like-minded democracies in the region that's all about containing China. So Biden and the other leaders were going to be meeting at the Sydney Opera House. It's not going to happen, but Biden will see these other leaders at the G7 and will likely talk to them there.

KORVA COLEMAN: NPR'S Scott Detrow reporting. A federal lawsuit has been filed today against a school district in Florida. This is for banning books that discuss racial and sexual issues. As NPR'S Neda Ulaby reports, the lawsuit was filed by a major publisher, a free speech group, and parents whose children are affected by the ban.

NEDA ULABY: There's a long list of books that Escambia County Public schools has restricted or removed. They range from books with transgender characters to young adult bestsellers, such as The Perks of Being a Wallflower, which became a popular film.

SPEAKER 1: Welcome to the island of misfit toys.

NEDA ULABY: Dozens of books are being challenged in Escambia County-- 16 successfully so far. Among them, Toni Morrison's classic novel, The Bluest Eye. Its publisher, Random House, is challenging the ban on First Amendment grounds with PEN America. The writers advocacy group says the number of book bans is sharply increasing, up nearly 30% this year compared to six months ago. Neda Ulaby, NPR News.

KORVA COLEMAN: Stocks opened mixed this morning as the Commerce Department reported a jump in homebuilding activity. NPR's Scott Horsley reports the Dow Jones Industrial average rose about 65 points in early trading.

SCOTT HORSLEY: Builders broke ground on more homes in April than they did the month before. Housing starts rose 2.2% last month. Permits for future construction of single-family houses were also up, although permits for apartment buildings were down. Target stores reported smaller than expected drop in quarterly profits, but the discount retailer offered a cautious forecast for the spring selling season. Target's getting plenty of customers in its stores, but they're mostly buying groceries and other necessities rather than products that might carry a larger profit margin.

Disgraced Theranos founder Elizabeth Holmes will soon be heading to prison. A federal appeals court has rejected Holmes' effort to remain free while challenging her conviction on fraud charges. Scott Horsley, NPR News, Washington.

KORVA COLEMAN: This is NPR.

SPEAKER 2: Support for NPR comes from NPR stations. Other contributors include Paycom, an HR and payroll tool designed to prevent lost hours during the week and maximize employee productivity. Learn more at paycom.com/radio. This is NPR.

PHIL PICARDI: For NPR News in the Twin Cities, I'm Phil Picardi. A big education funding bill has passed in both the Minnesota House and Senate. The House yesterday passed a bill adding $23 billion to K-through-12 school funding over the next two years. And early this morning, the Senate voted 35 to 32 to pass the same plan.

Governor Tim Walz has signed a bill that provides funding for the removal and replacement of lead pipes across the state. The $240 million will help cover costs for homeowners to replace lead lines around their homes. Lead exposure, even in small amounts, can have significant impacts on health, especially for young children. The governor says the bill is a job creator.

TIM WALZ: This is the golden age of infrastructure. From lead pipes to roads, bridges, transit, broadband, we're going to see investments over the next decade or so that we've not seen for a generation. And those are all good-paying union jobs in Minnesota.

PHIL PICARDI: Union officials at the press conference yesterday estimated the project could create and maintain around 2,400 jobs each year over the next 10 years. A Twin Cities man who was allegedly preparing for a violent exchange with police has pleaded guilty to buying machine gun parts from an FBI informant. Matt Sepic reports.

MATT SEPIC: A retired police officer working at a gun range contacted authorities in September after spotting 21-year-old River William Smith setting up a plywood barricade and shooting off several hundred rounds in 20 minutes while wearing body armor. According to court documents, Smith told an informant that he's, quote, "pro mass shooting," expressed hatred of Jews, African-American, and LGBTQ people, and said he was preparing to fight police. The FBI arrested Smith after he bought machine gun conversion parts and three inert grenades from another informant.

At a hearing, he pleaded guilty to machine gun possession just before a prosecutor dropped a count related to the explosives. At age 17, Smith shot his grandmother in the hand, but she continued to buy him ammunition while he was under age and drive him to gun ranges. I'm Matt Sepic, Minneapolis.

PHIL PICARDI: 52 degrees in the Twin Cities. This is NPR News.

SPEAKER 3: Wellness Wednesdays programming is supported by UCare. New to Medicare? You can talk with a Medicare de-complicator for help finding a plan that fits your needs. Learn more at ucare.org/medicare.

KIMBERLY ADAMS: Before we get started, a note to our listeners. This program mentions suicide. If you or someone you know is struggling, please know that trained help is available to you 24/7. Call or text 988, and you'll be connected to a crisis counselor as soon as possible.

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You're listening to Queer Youth Resilience and Mental Health, a broadcast special from Call to Mind, American public media's initiative to foster new conversations about mental health. I'm Kimberly Adams. Youth mental health has been an increasing concern over the last few years.

So much so that a coalition of leading pediatric health organizations put out a declaration stating the issue has reached national emergency levels. This is especially true for teens and young adults in marginalized communities. The Trevor Project is a suicide prevention organization for LGBTQ+ young people.

And in the group's latest survey, it found that 41% of LGBTQ+ teens and young adults seriously considered suicide in the past year. And 14% tried to hurt themselves. Within the queer community, young people who are transgender and non-binary reported higher rates of suicide ideation than their cisgender peers. So did all queer youth who were people of color.

So what are the specific mental health concerns for queer young people today? Dr. Danielle Ramo is a psychologist and an Adjunct Associate Professor at the University of California San Francisco. She's a teen mental health expert and says there are unique mental health concerns for LGBTQ+ youth based on experiences they have to navigate every day.

DANIELLE RAMO: Queer teens have higher levels of depression and anxiety. They're more likely to experience bullying. They have lower self-esteem on average and have higher rates of suicidality and completed suicide than their cisgender or heterosexual counterparts. There are a lot of reasons for this-- environmental factors, such as queer and trans phobia, legislation that regulates queer teens away from being their true selves, hatred in community, school settings, and even in homes.

These all impact young people greatly. Adolescence is a time of a lot of questioning, and uncertainty, and a time when relationships are extremely important and impactful. And for some queer teens, when their primary, especially adult, relationships are alienating or even dangerous, this can pose extremely big consequences that have impacts well into the adult years.

So adolescence is a time when, if relationships are strong and if young people develop skills that they can use to manage and cope with some of the stressors in their homes and in their environments, they can get through the adolescent years as thriving individuals and be able to manage the stress during those years and come out as happy, healthy adults.

KIMBERLY ADAMS: Are there specific mental health needs unique to queer youth?

DANIELLE RAMO: There are a lot of unique issues that queer young people face during the adolescent years in particular. And this is in part due to differences in how the mental health system has treated queer young people historically. Queer young people might show an even greater mistrust in traditional clinical services, like therapy or psychiatry, than their peers.

And this is grounded in reality. The traditional mental health system hasn't served the queer community very well historically by pathologizing sexuality or diversity in gender identity. And queer young people might have even additional mistrust than their peers.

There is also a real challenge in finding supports that speak to queer young people, even when they do want to reach out. Trevor Project survey said that 60% of queer youth who wanted mental health treatment couldn't get it. So we have, on the one hand, a valid mistrust and, on the other hand, a shortage of providers overall and those that a young person who identifies as queer might find particular support with. So there's a huge need among LGBTQ+ adolescents to feel safe in self-expression and see images of themselves in the world at large, and also in their providers, and among mentors, and among other trusted adults. And interventions that take this into account are going to be more impactful during the adolescent years for queer people.

KIMBERLY ADAMS: That was Dr. Danielle Ramo from the University of California San Francisco. Dr. Ramo is also the Chief Clinical Officer at BeMe Health, a digital mental health platform made for and with teens in mind. You're listening to Queer Youth Resilience and Mental Health from Call to Mind. I'm Kimberly Adams.

This year, Miami Beach had its 15th annual Pride Festival and Parade. The festivities were mostly focused on gathering and celebrating LGBTQ+ communities living in Florida. But the events took place against the backdrop of Republican Governor Ron DeSantis's Parental Rights in Education Act, also known as the "Don't Say Gay" law. Florida also has a number of proposed bills that would, among other things, ban gender-affirming health care and censor performances like drag shows. 21-year-old Steven Rocha serves as the policy director at Prism Florida, a youth-led organization working for LGBTQ inclusive education in schools and to expand access to sexual health resources for queer youth.

STEVEN ROCHA: Yeah. My first name is Steven-- so S-T-E-V-E-N.

KIMBERLY ADAMS: We met him at Pride in Miami Beach, and our producer, Jessica Barry, followed up with him to learn more about his experiences.

JESSICA BARRY: Good morning, Steven. How are you doing today?

STEVEN ROCHA: Good morning. I'm doing well. So I came out as bisexual when I was 12. So I figured that out very young. I came out as a trans man in 2020, and it was a pretty difficult time for me.

I struggled with depression, anxiety, at points at that time, suicidal ideation. Thankfully, I did not follow through. But it was definitely one of the hardest times in my life for my mental health.

JESSICA BARRY: How did it go coming out to your family and friends?

STEVEN ROCHA: So my friends, I am very thankful for. My friends are largely queer. Most are not trans, but largely queer. And they welcomed me with open arms, and that was so important to me when I was really struggling because I did not get that same warm reception from my family.

JESSICA BARRY: How did your family respond?

STEVEN ROCHA: My family's reaction was something that was really important to me and delayed myself coming out. I really was terrified to open that conversation, and it's been complicated navigating that. My parents weren't very accepting. It's been an uphill battle trying to explain to them and try to maybe get them to understand. But it was a combination of just the pandemic already tanking all of our mental health-- I came out during the pandemic-- as well as just cultural differences.

My parents are both Colombian immigrants. And I am very proud of that part of my identity, but there is a lot of cultural baggage that comes with that. They did not feel that it was a good thing. They thought that it was like they were losing a daughter, that someone was dying.

And they used those words very frequently. And it really tanked my mental health because I felt guilty all the time. I felt like I was walking on eggshells, that maybe I was being selfish. And I was already someone who struggled with self-esteem prior to this, so it really took a toll on me.

Another aunt of mine did not want me around her children any longer. And it was very difficult for me to all of a sudden be seen as some kind of threat to her children. It's something that I still am trying to process and deal with that pain because I love my cousins very much. I want to be there for them, but I just can't right now.

JESSICA BARRY: I'm sorry to hear that.

STEVEN ROCHA: Yeah. Thank you.

JESSICA BARRY: How do you feel your experiences are different from cis peers?

STEVEN ROCHA: My experiences are very different from cis peers. There are so many things that I think about constantly that my peers-- it never even crossed their mind. My cis peers, they don't have to walk on eggshells, at least when it comes to gender. They don't have to worry about coming across as some kind of predator just for being who they are.

Additionally, I think a thing that I've seen a lot with cultural discourse around trans people and around pronoun usage is that using someone's pronouns is a favor that you're doing them, that it's out of politeness. But with my cis peers, there's no conditional approach to their gender. They just are who they are. I am someone who deals with dysphoria, so I'm-- a lot of it is personal. But I'm thinking about the way that I talk, the pitch of my voice, the way that I'm standing.

I'm using the male facilities. I'm using male bathrooms. And I wonder, am I going to be approached by someone who thinks I shouldn't be here? Whereas for a cis male peer of mine, it would just be another day. You use the bathroom, and you wash your hands, hopefully, and leave.

JESSICA BARRY: You shared with me that it was really important for your mental health to start hormone therapy. Can you explain that a little bit more?

STEVEN ROCHA: So I started HRT-- I started testosterone on April 7, 2021. I remember the exact day. And it was probably one of the best decisions that I made in regards to my mental health. I struggled with extreme dysphoria after coming out. I was every day distressed that the way that my body looked didn't match the way I perceived myself.

People on the street-- they don't know what's going on in my head, in my inner world. So I was still being by and large treated as a woman. And it was very distressing for me. It took a while for me to make the decision to start, but am very glad that I did.

And I have just felt so much more comfortable. I am able to pass in most situations in public as a man. I'm read as a man. And not only does that make it safer for me to navigate through the world, but I just feel more confident.

A lot of people have this misconception that medical transition is rejecting yourself. But for me, it's been really embracing my true self. Even if that looks different than the typical man, I am happy with how I look and who I have become.

KIMBERLY ADAMS: That was Steven Rocha from South Florida.

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Florida is one of several states with legislation targeting the rights of transgender people. Steven says it's a struggle living in the state, and he wonders if it's safe for him. Does he need to move? But he says he loves Florida.

It's home. More than a dozen states now have laws or policies banning gender-affirming care for minors and young adults, though the courts have blocked some of them. Many more states are considering similar bans.

That means families who support their trans kids' gender identities are faced with a difficult and often expensive decision-- stay and fight or uproot their lives and move to a more welcoming state. A year ago, Marketplace's Amy Scott spoke with several families in Texas who were weighing that very choice. And she recently checked back in with two of them to see how they're doing now.

AMY SCOTT: When we first talked last March, Karen was scared. She and her husband, both lifelong Texans, have a transgender daughter who was approaching puberty. Texas Governor Greg Abbott had ordered the state's child welfare agency to investigate parents for abuse if they helped trans kids access gender-affirming medical care, including medicines that pause the physical changes caused by puberty. Back then, Karen told me that one afternoon while they were driving home from acting class, she had explained the situation to her daughter.

KAREN: And I went, well, do you have any questions? And she got really quiet. And then she asked, am I going to die?

AMY SCOTT: Karen pulled over, opened the back door--

KAREN: And I just said, no. Oh, my gosh. No, you're not going to die. Why would you ask me that? And she said without a beat, because everybody hates me. And that was when I just knew I can't do this.

AMY SCOTT: So last June, the family packed up their house in Austin, put it on the market, and drove 2,000 miles to Portland, Oregon. They happened to arrive during the city's Pride Festival.

KAREN: We drove through this sea of rainbows. It was unbelievable. I mean, what a welcome.

O: It feels great here.

AMY SCOTT: That's Karen's daughter. We're calling her O to protect her privacy.

O: I mean, it was hard to leave my friends because I liked them so much. But I knew that it would be a much better place here in Oregon and much safer for me.

AMY SCOTT: O Is 11 now and in fifth grade. She has long, brown hair and a sweet smile. And she seems to be settling right in to her new home.

O: I like the scenery a lot. Like, the nature, it's very green, and all the trees are massive, and it's really cool. Yeah.

AMY SCOTT: She plays Ultimate Frisbee, and loves to draw, and is really into the Japanese manga series Demon Slayer. She even learned to play the theme music on cello, which she was happy to demonstrate on Zoom.

[O PLAYING DEMON SLAYER THEME ON CELLO]

For Karen, though, the move has been harder. She and her husband were lucky, they could both keep their jobs and work remotely. But they had to spend more than $30,000 on movers, and storage, and hotels. And moving hasn't solved the larger issue-- the onslaught of legislation targeting trans kids' rights to play sports, to use the bathroom, to choose their pronouns at school shows no sign of slowing down.

KAREN: I do feel safer, with that R in parentheses. But I don't feel safe. And I worry about what I've seen in Texas, and I worry that people don't think it can happen here.

AMY SCOTT: She also feels a lot of guilt for leaving behind those who are still fighting for trans rights in Texas. One of them is Ed in San Antonio.

ED: We're still here. We haven't moved.

AMY SCOTT: Ed also has deep roots in Texas. He and his wife both own businesses that employ a lot of people. They share custody of Ed's transgender daughter, Charlie, with Ed's ex-wife. So moving would be challenging. Plus, Charlie loves her school.

She's 11 and has started puberty blockers. When we talked, the governor's child abuse order was tied up in the courts, but the Texas Senate had just passed a bill banning such care for all minors in the state. And the House was weighing a companion bill.

ED: Like a lot of the parents, I mean, we're all pretty scared because if they make her care against the law, I mean, what choice do we have but to move. And I don't really want to move. It'd be really difficult.

AMY SCOTT: Proponents of these bans say they're trying to protect children from interventions they might later regret. Recent studies have found that those regrets are rare. And numerous studies have shown that transgender youth who receive gender-affirming care and family support have lower rates of depression, substance abuse, and suicide risk. Major medical groups, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society, all support the developmentally appropriate use of puberty blockers and hormone therapy for trans youth. When Charlie first told her parents she was a girl at age four, Ed says--

ED: I didn't know anything about it. And so we hired professionals, and we got curious, and we waited, and we observed, and we supported her. And we watched as her life became more joyful the more support she got. And so there's no going back at this point.

AMY SCOTT: And he worries about trans youth who don't have that support at home. If everyone else leaves, he says, who would fight for them? For Call to Mind I'm Amy Scott for Marketplace.

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KIMBERLY ADAMS: According to the Trevor Project, one in three young queer people struggled with their mental health most of the time or all of the time. And many of those youth blame anti-LGBTQ+ policies and legislation for that struggle. Nearly two in three queer youth said hearing about potential state or local laws banning people from discussing LGBTQ+ issues and people at school made their mental health a lot worse.

Dr. Laura Holt is a licensed psychologist and LGBTQ+ mental health specialist. She has a private practice and works in the Mental Health Services Center at Washington University in Saint Louis, Missouri. According to tracking from the American Civil Liberties Union, Missouri lawmakers have introduced more anti-LGBTQ+ bills than any other state. Dr. Holt says the wellbeing of queer young people she works with depends on their circumstances.

LAURA HOLT: So much of it hinges on the environment they grow up in and the environment they are living in because there's a stark divide between the students I talked to who grew up in affirming families. And so I'm not here to dump on parents who need to catch up. But the parents that either are already hip to the science and have a more gender-expansive, respecting all level of queerness and all expressions of sexuality, romantic attraction, the whole nine, and the people that are trying to get there, their students come to campus feeling less taxed by their identities.

And so they may have these experiences we're still trying to work through and still trying to heal from because parents can't protect their kids from the way the environment is responding to them. People that have had attacks by strangers, people that had attacks by classmates-- that's still painful. But their gift of a supportive family makes such a difference.

Then you have the students who didn't feel safe coming out to their families or tried to come out and were bombarded with anger and violence or threats of violence. And it doesn't un-queer the person. It just makes the person hate themselves and makes the relationship with their family incredibly painful. And we need our families. My best and highest hopes at all times is that my clients will have a loving, supportive relationship with their parents.

Landing on a campus like this, where, by and large, tends to be more affirming. There's an efforts on the part of the University, like where we are trying to catch up and not repeat medical trauma they may have experienced and do trauma-informed care. But we've lost ground. I mean, people are showing up with real trauma. And then layered on top of all of this is Missouri is a state that is vigorously attacking trans health care, the ability to talk about LGBTQ+ identities. And so I hear students wrestle with, do I leave? Do I give up what I've worked for and try to find a place that's safe?

And cis/het students don't have to worry about that. And that's the burden of oppression on mental health is there's a whole level of pain, and trauma, and difficulty, and internalized hatred that cis students just skate off and just never have to cope with that. Did that professor react to me that way because I'm trans? Did I not get that internship because I look queer? That's just a whole burden that cis/het students just don't have to cope with.

KIMBERLY ADAMS: What are the mental health consequences of walking around in a place like Missouri where, as you've said, there are active laws and initiatives to criminalize various aspects of the queer experience? What is it like for young people walking around with that fear all the time?

LAURA HOLT: When the amygdala-- which is the emotion, control, fear center of the brain-- starts to get activated a lot, its ability to perceive real threat from not real threat starts to go haywire, and we start existing in a heightened state of fear. That's what anxiety is, where we're constantly anticipating danger, and it's so grueling on the body. It's so grueling on the mind. And it's horrible. And our ability to approach the anxiety rather than retreat from the anxiety is essential for treatment, but it's so hard to do on our own.

And students will come to me, and I'll be like, well, we have to approach what you're worried about. We have to do work around this anxiety. It's so much work to even get to that place because it's so common for young people to struggle to tolerate the discomfort of approaching rather than avoiding.

But when we live in a state where it's not OK, there is a genuine threat to safety, your health care is gone. Your fear that someone on the street is going to be empowered to yell at you or possibly assault you, that's real. It's much harder to work with. How do you keep yourself safe in an environment where your anxiety is accurately noting constant de-personhood and no real clear path for it to get better? And so we talk about, how do you find your community? We talk about, how do you accept the fear and gently ask yourself, what do I need to recharge and find safety?

KIMBERLY ADAMS: Outside of the political discussion around this, what does the research tell us about the mental health impacts of gender-affirming care for queer kids or the lack thereof?

LAURA HOLT: Outcomes are much, much, much better. 81% of trans people tell us that they knew they were trans before they turned 16. And so while it's not uncommon for young people to explore their gender identity, and especially in this day and age, as the conversation is freed up, and cis isn't compulsory anymore, it's not at all uncommon for young people to explore and just like they do every other aspect of their identity.

But we're talking about trans people who settle and understand this about themselves. Young people need providers to be able to have the freedom to give them health care that aligns with their medical needs and aligns with their gender identity because what we know from such loud, consistent research is that if they are afforded that opportunity, their mental health outcomes get better. It's not at all uncommon for depression and anxiety to be comorbid in trans people.

But what we see is that when we allow trans people, including young adults, to have their medical care, then the depression and anxiety get better. And if they don't, if trans people are not allowed to transition, if trans people's trans identities are attacked and their mental health gets worse, their risk for suicide gets worse. And that's one of the most horrifying things about watching this happen is that we scientists, we psychologists, we literal mental health experts-- we are so scared of what's to come because this is already such a vulnerable population to suicide.

And this is not because they're trans. It's because of the impact of attacks on trans people that causes such an incredible mental health burden. If trans people are raised in affirming environments, by families who are able to give them the freedom to be themselves, their mental health outcomes are really good. It's the folks that are attacked and maligned and told, you're not real, and told, that's not a real thing, and told, this makes you bad that, understandably, when you lay it out, of course that's going to be devastatingly painful.

And once people are allowed to transition, there's such a small 1% or less number of people who ever de-transition. This is not something people try on and say, just kidding. The people that do overwhelmingly tell us they transitioned because of social, and environmental, and occupational pressures. They're still trans. They just didn't feel like it was safe to be out and trans.

KIMBERLY ADAMS: How has the current political climate in Missouri and in the country changed your job and your experience?

LAURA HOLT: It's so scary. We had an active shooter training, as one does in Missouri. And I couldn't sleep for three days because I'm so scared somebody's going to see my name on the staff directory, and we're going to be the next news story because I'm providing trans health care, because I'm part of a University that thinks LGBTQ people are worthy of being accepted and supported, and somebody's going to kill us for it.

And so it's personally very scary. I'm hearing from my colleagues that are also doing work with trans people that they're also really scared because this is-- again, I'll pull in the anxiety thing-- I would love to be able to work my way through the anxiety and say, no, no, there's lots of evidence to suggest that I'm going to be safe. I'm going to be fine. I can't do that. Yeah, it's really scary.

KIMBERLY ADAMS: That was Dr. Laura Holt, a psychologist in private practice and at Washington University in Saint Louis, Missouri.

SPEAKER 4: Programming is supported by Ecolab, a global leader in water, hygiene, and infection prevention solutions and services that help protect people, planet, and business health. Ecolab protecting what's vital.

SPEAKER 3: Support comes from the Minnesota Beethoven Festival in Winona June 25 through July 16 with Joshua Bell, the Academy of Saint Martin in the Fields, the Minnesota Orchestra, and more. Tickets on sale at mnbeethovenfestival.org.

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JORDAN PRUITT: My name is Jordan Pruitt, and I'm 18 years old, a freshman in Georgia College and State University. And I am currently an Art Graphic Design major. I am passionate about mental health, LGBTQ issues, and racial equality. Honestly, the biggest part of queer mental health is just the societal discrimination that comes with being queer.

I know that before this year, I was very comfortable in my identity. But the idea of being hate crimed or being looked at differently and shamed because of my identity was definitely something that was in the back of my mind. But as this year progressed, there's definitely been a lot of mental health issues as far as the anti-trans legislation that has been going on. And it's been very much a weight on my back.

I do see a therapist. And some things that I've learned is that underlying emotions can develop as anger, which has definitely been something that has been prevalent for me. Obviously, due to the anti-trans legislation, I can be very angry. But the underlying emotion to that is sadness, and worry, and fear.

Having a mental health provider has been the saving grace, honestly. Knowing that there's someone who can listen to me and who is unbiased to all the things that I'm talking about, who is outside of the situation is especially helpful. I definitely cherish her, and she has helped me just calm down and think through what I can do, how I can stay safe in this situation.

I think the most important thing for queer youth right now is to build a support system of people that care about you, people that are willing to fight for you. If you can join a support group in person or have friends in person or even resort to online support groups or online friend groups-- just stay safe, of course-- then that can really, really help us get through whatever we're going through right now.

KIMBERLY ADAMS: That was Jordan Pruitt, a student at Georgia College and State University. While several states are passing laws to prevent trans people from getting gender-affirming care, the state of Minnesota is doing the opposite. Earlier this year, the state's Governor, Tim Walz, signed an executive order to guarantee access to care for trans adults and youth. Nina Moini of Minnesota Public Radio reports.

CROWD: Trans kids belong. Trans kids belong.

NINA MOINI: Against the backdrop of a rainy and cloudy spring day--

SPEAKER 5: Happy Trans Day of Visibility, everybody.

NINA MOINI: Bright pride flags lined the steps of the Minnesota State Capitol on a day meant to honor the triumphs and struggles of transgender adults and youth.

SPEAKER 5: And I am a proud transgender girl.

NINA MOINI: Hildy Edwards came out as trans in kindergarten. She's 12 now.

SPEAKER 5: For a long time after that, I felt invisible. But once I was able to feel safer, I came out at my school. It was so fulfilling.

NINA MOINI: Watching in the crowd was Kat Weller--

CROWD: Trans kids belong.

NINA MOINI: --and her seven-year-old child, Charlie--

CHARLIE: I use she/her.

NINA MOINI: --who told her parents at four years old that she was a girl.

SPEAKER 6: And once we started listening, behavior problems straightened out. Sleeping trouble straightened out.

NINA MOINI: Charlie's mom feels fortunate to be raising her child in Minnesota, where Democratic Governor Tim Walz signed an executive order in March, protecting the rights of transgender Minnesotans and people from other states to receive gender-affirming care, making Minnesota a so-called trans refuge state and slamming against a wave of states rolling back transgender rights.

SPEAKER 6: And to think that people are in fear for their kids' lives, and their kids' education, and their kids freedom, to know that my kid can show up at the Capitol with a trans flag on and we feel relatively safe-- it's a big difference.

NINA MOINI: Living in Minnesota has made a huge difference for Wes Samuelsson and his child, 11-year-old Liz, who moved to Duluth, Minnesota from the state of Wyoming in 2020 after they couldn't get the care they needed.

WES: I was going to be worried, honestly, if I stayed in Wyoming much longer.

NINA MOINI: There wasn't adequate access to gender-affirming care in Wyoming or much social support, which Samuelsson says forced him into the closet and deeply hurt his mental health. But that changed when he got to Minnesota and was able to get on state health insurance and receive hormone treatments within two months.

WES: And then by six months, I actually had top surgery. So I was able to get surgery in six months of moving here, and I had full support, a therapist, a doctor, a primary, a surgeon. And I had a full care team.

NINA MOINI: Liz uses the pronouns she/they right now and feels supported at school in Minnesota.

LIZ: I just have a lot of good friends here, and it's really nice.

NINA MOINI: Samuelsson says Liz's anxiety calmed, and sleep improved once they came out and felt accepted.

WES: I don't need my child gatekeepeed from experiencing support early. I mean, the reality is that trans health care or health care for anybody exploring their gender saves lives. They don't have to struggle and suffer for years. They can instead just get care and support early on.

NINA MOINI: Pediatrician Dr. Angela Kade Goepferd of Children's Minnesota Hospital system says developmentally, some kids know their gender identity at a very young age. It may take longer for others because they know their gender identity but are not permitted to express it. Data indicate that 82% of transgender individuals have considered ending their lives, and 40% have attempted suicide, with suicidality highest among transgender youth.

ANGELA KADE GOEPFERD: Access to gender-affirming care, access to supportive families improves mental health outcomes for kids, and they just do better.

NINA MOINI: Gepford serves as medical director for Children's gender health program, which provides gender-affirming care. With young patients, a lot of the need is just about promoting good mental health.

ANGELA KADE GOEPFERD: Family situations, coming out to grandparents, social transitions, how things are going in school.

NINA MOINI: To clear up some of the misinformation and disinformation swirling around this type of health care, Goepferd explains a few things. For example, there are no medical treatments for kids before puberty. And there are no genital surgeries done on children under the age of 18.

Less than 1% of trans adolescents under age 18 access chest or top surgery. What is true-- at puberty, some young people do take medication to delay puberty, and some young people might take hormones to initiate puberty in the gender they identify as. Medical studies have shown these treatments to be safe and effective.

ANGELA KADE GOEPFERD: There has been a manufactured controversy specifically around this type of care to advance a political agenda that, to me, is really doing a huge disservice to kids.

NINA MOINI: Goepferd's program has been running since 2019. But with a slew of states, including many that border Minnesota, passing laws to restrict or ban gender-affirming care for minors, Goepferd says Minnesota providers are stretched too thin to help an influx of out-of-state patients. And the wait for a new patient in their program is currently nine to 12 months.

WES: I'm a 30-year-old trans man.

NINA MOINI: Every passing moment without proper care is critical, Wes Samuelsson says.

WES: I never thought I could get this far.

NINA MOINI: He reflects on his journey while in the kitchen of his Duluth home. He's preparing BLTs for his partner and his child.

WES: Super easy BLTs. [LAUGHS]

NINA MOINI: He wishes he had access to gender-affirming care and support earlier in life. But he, like many others, persevered.

WES: And I'm excited to show that trans people can grow older, and be successful, and have families, and have-- I have a partner, and a kid, and a steady income.

NINA MOINI: He feels more hopeful for Liz's generation, believing they will have more choices and less tragic outcomes.

WES: We don't see ourselves usually growing older. We hear about bad things that happen. And so it feels nice to feel like I can show that, look, I'm living a normal life, and that feels nice.

NINA MOINI: For the time being, Minnesota feels like a safe place to keep on building that life. For Call to Mind I'm Nina Moini from NPR News.

KIMBERLY ADAMS: You're listening to Queer Youth Resilience and Mental Health from Call to Mind. I'm Kimberly Adams. Earlier in the show, we mentioned survey findings from the Trevor Project, the LGBTQ+ youth suicide prevention group. Those findings underscore the fact that queer teens and young adults are hurting at a higher rate than their non-queer peers.

But the survey also points out that transgender and non-binary young people whose pronouns were used by people in their homes reported lower rates of attempting suicide. But home isn't the only place youth are looking for support. How they're received and treated at school also has a big impact on their mental health.

Brian Coleman is a licensed clinical professional counselor. He works at Jones College Prep High School in the Chicago Public School District. And in 2019, he won the National School Counselor of the Year Award, making him the first Black person to win the honor.

Brian is known by his colleagues and students as the cartwheeling unicorn counselor. He really can do cartwheels-- one-handed, even. But the nickname really ties to his motto that everyone is unique and special. And I asked him if his high school counselor had a similar approach when he was growing up.

BRIAN COLEMAN: [LAUGHS] I wish, right? I certainly wish. Unfortunately, my school counselor was not a cartwheeling unicorn counselor. I didn't feel particularly seen, heard, or affirmed by my school counselor.

But I think the profession has changed so much since I was a youth. I think counselors are often stereotyped as being in their offices with the doors closed and doing work that no one sees. And I really believe in the visibility of the work. In order for students, and families, and communities to access school counselors, they got to know what the work is.

KIMBERLY ADAMS: From your lens as a school mental health professional, what are some specific mental health concerns that are unique to LGBTQ+ youth in high school?

BRIAN COLEMAN: Well, I first think about the reality that LGBTQAI youth are disproportionately impacted by bullying, harassment, that they are disproportionately expressing anxiety, and depression, and suicidality, and self-harm. And that can be connected to or related to multiple factors, some of them being student self-acceptance, the family constellation and how identities are affirmed or validated at home, the peer-to-peer relational aggression, the safety of the school environment. And none of these factors exist in isolation. You add on top of that all of the stressors of puberty. I don't know about you, but puberty was awful.

[LAUGHS]

It's such an awkward time. And you think about the pressure placed on students around their academic performance, and planning for their future, and all of these competing interests of trying to have a social life, and extracurricular involvement, and all of the things that students feel called and pressured to do, and then on top of it, not being affirmed and validated existing in institutions or systems that oppress you based on your gender and sexual identities and/or other marginalized identities if we're thinking in an intersectional way. All of these pieces together, I think, can uniquely impact LGBTQAI youth.

KIMBERLY ADAMS: There are likely people listening to this program who believe that these discussions of gender identity and sexuality really do not belong in schools. This is something for families alone, if they're really to be addressed at all. What do you have to say to people who are just like, it's not the school's business?

BRIAN COLEMAN: I mean, my first thought is, on some level, I get it. I understand that sex and sexuality is very triggering for many people, that it's taboo in many communities and cultures. When I think about schools, one of the question often comes up, do we want our students to feel safe at school? I think the answer is often yes. For the overwhelming majority of people, yes, we want our students to feel safe at school.

Do we want our students to show up authentically as themselves? I think the answer is also often yes. LGBTQAI students are students. Like every other student, they deserve education. Like every other student, they deserve safety in their school environments like every other student. And how can their schools be safe if their identities are not affirmed and valued and if we can't talk about the reality that LGBTQAI people have existed always?

Whether we talk about us or not, we have always been here. And being able to acknowledge that and name that lends itself to safety in a way that is just so incredibly important for LGBTQAI youth. If we can agree that we want our students to feel safe, and we can also look at the evidence that LGBTQAI youth are disproportionately impacted by mental health issues and concerns, then there is work that has to be done in our schools to make them safer.

And I think what is often confusing for people, especially people that are concerned around talking about sex and sexuality, is they think about talking about specifically the act of sex. Gender, and sex, and sexuality are not just about sexual activities. They're about identities.

They're about healthy decision making. They're about coping. They're about giving students tools to make informed decisions. And if we can't talk about comprehensive sexual health education in our schools, then how are we setting our students up to make healthy, safe choices that, yes, I absolutely hope that our families are talking to students about this.

But I know that it's so incredibly taboo. Our families don't feel like they have the knowledge or awareness to talk meaningfully about these things. So I do think that does put an onus and a responsibility on our schools, as our schools are responsible for so many other things in the lives of our students to be affirming and validating of LGBTQAI youth.

KIMBERLY ADAMS: Specifically in the school setting, you do have situations where doing the kind of work that you've been talking about can be specifically criminalized in the school setting. What do you think are the mental health consequences of that for queer youth?

BRIAN COLEMAN: The consequences are damning. We are setting up various marginalized identity groups, particularly LGBTQAI youth for higher rates of depression, higher rates of anxiety and self-harm, potentially higher rates of suicidality. That's horrifying. If we truly believe that we want our students to be well and we value their lives, then fighting LGBTQ rights, fighting against the rights of LGBTQ people and youth is absolutely, absolutely setting us up for a significant variety of tragedies that it's extremely unfortunate, and it's deeply upsetting.

KIMBERLY ADAMS: What are some of the things that can be done to better support LGBTQ+ youth in schools?

BRIAN COLEMAN: Well, one, can we create space for students to be affirming and validating who they are? You don't have to lead lessons on comprehensive sexual health education to be affirming and validating of students, to use the pronouns that they wish that you use, to call them by the names that they see themselves as and that they are. Those are simple pieces, making sure all students understand that they are worth boundaries and healthy relationships.

For me, whether or not you can talk about gender and sexuality openly, as a counselor, you're still expected to show up and support each and every student. That's an ethical obligation, period. And as an educator, I would think and hope that you are expected to show up for each and every student.

If you are showing up for each and every student, then there's no way you're going to be able to avoid affirming and validating LGBTQAI youth because we're here, and we're there. Whether or not you know, whether or not it's obvious, whether or not you heard through the grapevine, we are here. And if you can show up for and treat each student as worthy of love, and care, and education, those are the building blocks-- for now, in some communities, maybe the baby steps.

KIMBERLY ADAMS: There's a lot of language about resilience right now, and we even use this in the title of our show. Can you give a couple of examples of times that you've really seen youth doing that?

BRIAN COLEMAN: Specific examples I think about recent months-- I was talking with a student who was able to have a really healthy conversation with a teacher around their pronoun use, where the student was able to say, hey, you know what, teacher, you made a mistake in terms of my pronoun usage. The student was empathetic with the teacher in terms of understanding all of the things that the teacher does and why that error may have occurred but still held firm with these are the pronouns that I would like you to use, and I would hope you respect as we move forward.

And that type of self-advocacy, like just naming it, calling a thing a thing, and moving forward in solidarity with that teacher-- great. My students who advocated now several years ago or several years ago for gender-affirming bathroom spaces at our school at a time where it was not popular or mainstream, but then we got spaces, and I think about my students who come forward and say, you know what, I don't feel supported at home, and I need help in terms of not only accessing my own mental health care, but also in terms of navigating relationships with my parents and guardians. And students who have every day live in situations where they're not affirmed, and validated, and just keep fighting, and keep showing up for themselves-- that is the empowerment students who went in facing extreme depression and anxiety contemplate suicide, and they choose to live.

That just gives me so much hope because sometimes, in some communities, hope is all that exists. And trying to instill hope and possibility is so incredibly important. And I watch students do that for themselves. And I watch students do that for each other each and every day. And I think it's so incredibly powerful.

KIMBERLY ADAMS: That was Brian Coleman, a licensed clinical professional counselor in the Chicago Public School District. To wrap up, let's hear more from young people at the Miami Beach Pride Festival.

SPEAKER: It is so unfortunate that the very being of who we are and who we love has become something to debate. I am not up for debate. Who I love is not up for debate. It just is.

SPEAKER: At the end of the day, it is what it is. We're going to exist all over the place. You might not understand. You might not agree with certain things that people personally do, but it's a matter of respect.

SPEAKER: Coming out is one of the better things that I've done for my life because it allows me to be my true authentic self. And I think that it was really scary to come out because I didn't know how other people would react. As you get older, you do find out that the people that matter will stick around, and the people that don't-- just don't think about them.

SPEAKER: A lot of resources seem out of reach. But social media is such a powerful thing, talking to your friends, to supportive family, reaching out to your local trans orgs-- they are more than happy to help. Their arms are open. The LGBT community is here for you.

SPEAKER: I need you to know that the negative people around you do not define who you are. You are your own person. And if you want to be whoever you are, that's you. So you should surround yourself with people who love you and support you the way that you are.

SPEAKER: And that no matter how hard things get, these are not new fights. These are fights that we've been through before. And we came out of those not only alive, but thriving, and that there is a light at the end of this very, very dark tunnel.

SPEAKER: So it's all about love. Love is love. [LAUGHS]

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KIMBERLY ADAMS: You've been listening to Queer Youth Resilience and Mental Health, part of a national series from Call to Mind, American Public Media's initiative to foster new conversations about mental health. Support for this program is provided by the Sozosei Foundation and the David and Laura Lovell Foundation. This special was written and produced by our senior producer, Jessica Barry.

Our technical director was Alex Simpson. Amber Mortegi provided production support. A special thank you to our consultant, Cassius Adair, and John Gordon and Brant Williams for their editing help.

This show was edited and hosted by me, Kimberly Adams. Follow Call to Mind on our social channels at @CallToMindNow. And you can find helpful resources and our past programs on our website, calltomindnow.org. Thank you for joining us for Queer Youth Resilience and Mental Health, a broadcast special by Call to Mind from American Public Media.

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