Parental Experiences of Supporting the Mental Health of Their LGBTQA+ Child

Abstract

Young people who are lesbian, gay, bisexual, trans, queer or questioning, asexual and other diverse genders and sexualities (LGBTQA+) are at greater risk of adverse mental health outcomes and suicide, with additional barriers to accessing safe and affirming physical and mental health services in comparison to the general population. Parents of LGBTQA+ young people who are supportive and accepting can take on additional responsibilities and an active role in supporting young people, and more information is needed to understand how parents support LGBTQA+ young people in times of acute mental health difficulties (including suicide risk) and what parents experience while navigating support systems. It is imperative these experiences are better understood to inform other parents, clinicians and service providers alike. We aimed to develop a nuanced understanding of the experiences of Australian parents of LGBTQA+ young people in providing support during times of acute distress and suicidal crisis. We utilized an exploratory qualitative design using semi-structured one-on-one interviews with 11 parents. We provide clinically useful recommendations, with the aim of aiding enhanced parental support for LGBTQA+ young people, given this population’s unique needs.

Keywords:

• Suicide
• parenting
• adolescent
• sexual orientation
• gender identity
• transgender

Background

The limitations of and need for more mental health services for young people (under 25 years old) in Australia is an area of increasing public and political concern (Carlisle et al., 2019; Irteja Islam et al., 2020). Mental health difficulties typically first emerge in young people under 25 years, predominantly during the critically important period of adolescence, with 50% of mental health difficulties emerging during this stage (Kessler et al., 2012; Sawyer et al., 2012). Rates of mental health difficulties in young Australians continue to rise and the need for appropriate services and early intervention has become increasingly important (McGorry & Mei, 2018; Sawyer & Patton, 2018), as more than one third (34.7%) of Australian adolescents have been found to have a mental health disorder (Irteja Islam et al., 2020). Young people attempting to access support and mental health services face unique challenges; services are often poorly designed, under-resourced, and unwelcoming, leading to mistrust of services (McGorry & Mei, 2018). Australia has made advances in providing mental health support in a way that is more responsive to the needs of young people (Rickwood et al., 2019), however, gaps and obstacles remain in service provision, as well as economic and geographical disparities in accessibility (Meadows et al., 2015; Mei et al., 2020).

Young people who are lesbian, gay, bisexual, trans, queer or questioning, asexual and other diverse genders and sexualities (LGBTQA+) are more likely to be subjected to adverse experiences such as bullying, discrimination and stigma, and have difficulty accessing services that meet their needs, which in turn elevates risk of poor mental health (Hill et al., 2021). Within the Australian population, exact statistics of the proportion of LGBTQA+ young people are not currently available (Lyons et al., 2021; Wilson et al., 2020), however the proportion of young people under 25 who identify as LGBTQA+ has been estimated to be almost 20% (Hall, 2024, reporting on Mathews et al., 2023) to as high as 30% (YouthSense, 2022). The minority stress model posits that LGBTQA+ identity is not a predisposition to poor mental health, but rather asserts that these health disparities are predominantly explained by unique stressors induced by the prejudice and stigma they encounter (Meyer, 2003; Testa et al., 2015). LGBTQA+ young people experience many factors that can confer risk for mental health difficulties and/or suicide, including bullying, lack of acceptance, social rejection, discrimination, abuse, and limited access to care or support services (Bartholomaeus et al., 2021; Hill et al., 2021; Jones, Power, et al., 2021; Strauss et al., 2020a, 2020b, 2021). In addition to increased rates of anxiety and depression, suicide attempt rates for LGBTQA+ young people are concerningly high (Bretherton et al., 2021). This is especially true for trans, non-binary, and gender diverse (hereafter referred to as trans) people, as approximately 50% of young trans people have attempted suicide at least once (Austin et al., 2020; Hill et al., 2021; Strauss et al., 2020a). Heteronormativity and cisnormativity, the cultural assumptions of heterosexuality and being cisgender as the expected standard or norm (Bell, 2009), underpin many barriers to addressing key issues that impact the wellbeing of LGBTQA+ people (Marzetti et al., 2022). As reported in healthcare and school settings (Jones, Jones et al., 2021; Stewart & O’Reilly, 2017), hetero- and cis-normativity presumes and polices a certain way of being that ultimately positions LGBTQA+ people as different and the “other” (Edwards & Watson, 2020). Although support for trans people has expanded to encompass new approaches and establishment of gender-affirming care guidelines (Telfer et al., 2018, 2020), many trans people face further unique barriers to accessing appropriate services to manage gender dysphoria or coping with other adversities unique to their identity (Austin et al., 2022).

Some health and medical services for young people have shifted toward a model of care that is patient- and family-centred, in recognition of the complex relationships and systems in which the individual is embedded, as well as external factors (Bronfenbrenner, 1979; Eriksson et al., 2018). Addressing contextual factors which may potentially influence the mental health of young people, such as supporting their family and social networks, can be beneficial and effective (Hopkins et al., 2021; Izon et al., 2020). Around 49% of LGBTQA+ young people, however, report experiences of parental rejection rather than acceptance and support (Rhoades et al., 2018; Ryan et al., 2010; Strauss et al., 2020b), and this rate is even higher (approximately 66%) in trans youth (McDermott et al., 2016; Strauss et al., 2017; Travers et al., 2012). Parental support for LGBTQA+ young people has been found to be strongly protective in reducing mental health difficulties and improving wellbeing outcomes (Johnson et al., 2020; Matsuno et al., 2022; Simons et al., 2013), and such support is a critical protective factor for young people at risk of suicide more generally (Czyz et al., 2018). Parental acceptance and support of identity and experience has the potential to significantly decrease risk of suicide (Andrzejewski et al., 2021; Green et al., 2021; Klein & Golub, 2016). The role of the parent is critical for LGBTQA+ young people who often face barriers in accessing safe and affirming support and health services (Kerr et al., 2021; Strauss et al., 2017; Telfer et al., 2018), culminating in parents being required to become the consistent and key support (Riggs et al., 2020).

Family systems theory posits that the family operates as an emotional system with interdependent members that cannot be fully understood independent of the context of that system (Cox & Paley, 1997). Consequently, when a child experiences their sexuality and/or gender identity as different from that presumed for them through cultural and parental expectations (of hetero- and cis-normativity), it necessitates a change within the family system and within parents themselves (Katz-Wise et al., 2018; Mills-Koonce et al., 2018). This change can be difficult for families and parents, and they may need resources and information to aid in adjusting and to support their child (Morgan et al., 2022, 2023; Tyler & Abetz, 2020). These changes in the family system, and the parental needs in supporting their child, are important to understand to protect the wellbeing of all family members (Katz-Wise et al., 2018). Parents may experience a range of emotional responses including positive, negative, or neutral/avoidant reactions (Mills-Koonce et al., 2018), worry about their child’s wellbeing and fear for the future (Abreu et al., 2019), a need for mental health support (Schimmel-Bristow et al., 2018; Wells et al., 2022), and may also experience their own identity shifts in acknowledging they are a parent of an LGBTQA+ child (Morgan et al., 2023; Tyler & Abetz, 2020). Parents may face a learning curve to develop language to describe their experience and understand their child, requiring information, services, and social support (Morgan et al., 2023; Schimmel-Bristow et al., 2018). The journey of adjustment and understanding for parents and children can be a continual process, as initially the experience of disclosure of child’s identity can be markedly different for parent and child (Pullen Sansfaçon et al., 2022). Over time, there can be space to allow for the development of a shared narrative of their experience (Morgan et al., 2023; Tyler & Abetz, 2020).

The social support provided by parents to their children is a vital protective factor (Cohodes et al., 2021). Social support is known to buffer against stress, mental health conditions, loneliness and isolation, and encourage overall wellbeing (Wilson & Cariola, 2020). Parental support buffers against a range of adverse outcomes for LGBTQA+ young people (Klein et al., 2023). While parental support is an established and vital protective factor, the experiences of parents in providing support specifically for LGBTQA+ young people (under 25-years) at risk of suicide remain relatively unknown (Johnson et al., 2020). There has been emerging evidence that parents of LGBTQA+ children have been found to experience personal barriers and challenges when they provide social support to their children, for instance, rejection and/or criticism from their usual social circle and family, discrimination and minority stress connected to their child being LGBTQA+, significant shifts in family and relationship dynamics, and feeling out of depth with parenting practices (Hidalgo & Chen, 2019; Matsuno et al., 2022; Morgan et al., 2023; Newcomb et al., 2018). The importance of parental support necessitates a greater understanding of parental experiences in order to promote support of LGBTQA+ young people and their families. The aim of this study is to understand parents’ experiences in supporting their LGBTQA+ young people during times of elevated suicide risk (and associated indicators, such as mental health concerns). Drawing on the unique insights provided by parents, this study sought to record and draw on their insights to develop recommendations for parents, mental health professionals, and medical practitioners alike.

Method

Design

This project used an exploratory qualitative design, to explore the experiences of parents supporting their child during a time of crisis and elevated risk of suicide. The interview data for this study was collected as part of a larger study to inform the development of best practice guidelines for suicide prevention of LGBTQA+ young people in community and clinical settings (Strauss et al., 2022). The data reported here includes semi-structured interviews with parents analyzed using reflexive thematic analysis (Braun & Clarke, 2021a). The researchers approached the study from a contextualist epistemological perspective and drew on family systems theory (Biglan, 2004; Cox & Paley, 1997; Kelly, 2006; Kingry-Westergaard & Kelly, 1990).

Participants

Eleven parents participated in the study and self-identified as mothers (n = 10) or fathers (n = 1). Parents were eligible to participate in the study if their child/ren were between 14 and 25 years of age. Most parents (n = 9) described their children’s gender identity with binary gender terms (e.g., male, female), and many (n = 5) also used words such as trans, non-binary, or otherwise gender diverse (e.g., genderfluid) in addition to or instead of binary gender terms. Most parents described their children’s sexual identity as being bisexual or pansexual (n = 9), heterosexual (n = 1), or gay/lesbian (n = 1). Parents of trans young people made up the majority of the sample. Parents resided in Western Australia (n = 4), New South Wales (n = 3), Victoria (n = 2), and Queensland (n = 2).

These interviews were conducted over 2019–2020 as part of a larger study led by Telethon Kids Institute (Strauss et al., 2022). The interviews include rich stories and experiences shared by participants. Given the richness of the data, the sample size was considered sufficient (Guest et al., 2006). Qualitative research does not require the large sample sizes that quantitative research may need, and instead depends on the saturation and richness of meaning inherent in the interviews rather than focusing on number of participants (O’Reilly & Parker, 2013). Given the aim of the study, and target population, the sample size is considered to have sufficient information power (Malterud et al., 2016).

Materials

An interview guide was used to collect the interview data. The participants were asked some demographic questions about themselves and their child, and then about the young person’s experience with their mental health. Participants were asked about the strategies they used to support their child or other support systems and services engaged with that were helpful or unhelpful. Some example questions include:

• Can you tell me a bit about the mental health experiences of your child?

• Prompt: Since we are talking specifically about suicide today, can you tell me a bit about when your child was thinking of suicide?

• What kind of support did they have when they were going through that time?

• If you could go back and tell someone how to help their child who is experiencing suicidal thoughts, what would you say?

Interviews were professionally transcribed verbatim.

Procedure

The overall project was granted ethics approval from the participating institutions (UWA RA/4/20/5467; ECU REMS2021-02940-GILBERT). Participants were provided with a participant information and consent form. The interviews were conducted by experienced researchers from Telethon Kids Institute with collective research experience in supporting the mental health of LGBTQA+ young people and understanding the experiences and needs of parents of LGBTQA+ young people. Participants were recruited through social media (e.g., Facebook) and support groups for parents of LGBTQA+ young people. Participants consented to have the interview recorded and used for research purposes and were provided with support information before and after the interview. A member of the research team followed up with participants three days post-interview to check on their wellbeing and were remunerated for their time.

Analysis

The interview transcripts were analyzed using reflexive thematic analysis guided by Braun and Clarke (2006, 2019) using NVivo software (QSR International, 2021). The analysis was exploratory, guided by the research question, What are the experiences of parents in supporting their LGBTQA+ young people during times of elevated suicide risk? Thematic analysis is a well-suited analytic approach to identify patterns of meaning and is compatible with the exploratory and epistemological approach of this project (Braun & Clarke, 2021b; Kelly, 2006). Two of the research team members regularly reviewed recruitment as it progressed to ensure as diverse a sample as possible was recruited holding the importance of transferability in mind (Carpenter & Suto, 2008). As interviews were conducted the same team members reviewed field notes to explore the themes arising from the interviews until such time as few new data were being generated and saturation was indicated (Bowen, 2008).

Following Braun and Clarke (2006, 2019), transcripts were first read and re-read to become familiar with the data, noting down initial ideas or points of interest as governed by the research question. Secondly, initial codes were generated in a systematic line by line coding of the entire dataset, searching specifically for segments within transcripts which give insight into the focus of interest. Next, in consultation with another member of the research team, these clusters of initial codes were reviewed to search for overall patterns to develop themes capturing the experiences of parents in providing support and navigating services to meet the support needs of their LGBTQA+ child during times of elevated suicide risk. These preliminary themes were then reviewed and refined. In the final stages, themes were defined and named to refine the boundaries of each theme. Lastly, themes were presented with illustrative de-identified quotations from the data (Braun & Clarke, 2006, 2019). Supporting quotes presented in the findings were checked to ensure representation across the full sample of participants with quotes drawn from all transcripts. Rich description with regard to participants’ experiences, and the study methods and processes, was provided to ensure rigor whilst balancing participants’ right to confidentiality (Holloway & Galvin, 2023).

Findings

The core of the findings identifies the barriers parents experience in the process of providing (or seeking out) support for their LGBTQA+ child. Parental experiences were largely characterized as “struggles,” with references to “battles” being navigated across multiple domains. While parents were asked about supporting young people in times of elevated suicide risk, parents more often described their experiences in supporting their LGBTQA+ child’s mental health more generally. To reflect this, the themes here are expanded beyond incidences of elevated suicide risk to explore mental health and parental experiences in seeking to protect against suicide risk. The five themes outlined capture parental experience of battles to support their child and resultant impact upon the child, the family system, and the parent. The themes described here comprise Battling the cis/heteronormative world; Continually advocating across systems; Fighting for appropriate and informed care; Searching for information and guidance; Navigating familial pressures; and “You just want them to stay alive.” Elements of the themes intersect; however, the themes reflect the parental experience as moving from distal to proximal levels, as assumed cis- hetero- normativity that LGBTQA+ children, and by extension their parents, must navigate in a variety of contexts. The theme Battling the cis/heteronormative world is identified as an overarching issue that underscores many other experiences parents described, however, different and more specific contextual and relational situations where this may emerge are described in following themes. All quotes presented are verbatim; at times parents used multiple pronouns for their child.

Battling the cis/heteronormative world

In the process of supporting their LGBTQA+ child’s mental health, parents described their experience of navigating a world that was not accepting of their child’s identity and positioned them as the “other.” Parents described witnessing their child commonly coming up against restrictive assumptions that were incongruent with their sense of identity. They noted the detrimental impacts on their child’s mental health, as one parent reflected when thinking about the spectrum of LGBTQA+ diversity:

Their reality of who they truly feel that they are is questioned by society in many ways. Sure, girls might say, “Well, the boys always get their way.” But that’s just so widely accepted, I suppose. Whereas look how diverse [referring to LGBTQA+ youth], they’re so diverse in what they think, how they act, how they express themselves. That is a big one, because if you can’t even be accepted in society, I mean that’s going back to basic human needs. We need to be accepted to feel safe.

An overall sense of feeling the world was fundamentally unsafe for their child was reported by parents. This worry was particularly heightened in parents of trans young people. Parents relayed feelings of confusion and mental load particularly due to social and media commentary around their child’s identity. Changing politics and discussions about gender affirming care left them with a sense of anxiety and worry about what others thought, especially when their child was vulnerable or in crisis. Parents experienced this cis/heteronormativity as influential on general attitudes toward necessary care for their child, for instance,

There’s a lot of tension caught up for her around stage two hormonal treatment [i.e., gender-affirming care], and particularly over the last week or two with what’s been going on in the media about transgender kids and supportive care. With taking the Family Court decision out of the way and now having this lack of understanding around actual protocols and… are we still … are kids still having to wait until they’re 16 to be prescribed cross-sex hormones?

This quote was made in the context of a recent change in law in Australia regarding access to gender-affirming care (for a summary, see Kelly et al., 2022). The experience for parents was shaped in part by heteronormativity and cisnormativity, as they endeavored to support their child and engage in appropriate care, yet they experienced a pervasive culture that did not accept or support their child’s identity and access to essential care. At times, parents said they experienced overt prejudice and discrimination from health providers,

One GP just berated her, “Just snap out of it, just go to school, just do as you’re told.” And the other older doctor who we’d seen prior – when she was quite little, we used to see him, and he was like, “Oh, well, I’ll see her, but I don’t want any trouble.” So, their attitude has convinced her that she needs to be at an LGBT + specific surgery.

Societal beliefs and stigma surrounding LGBTQA+ people influenced parental experiences as they described coming up against prejudice, assumptions, and discrimination when accessing support, at times making parents feel as if they were quite alone and “different.” Parents described fearing for their child as they judged the world around them to be openly hostile toward LGBTQA+ people and the need for connection to others who understood their fear,

I cannot overestimate how incredibly supportive that is even within the last week where we’ve had, you know, the death of a trans-woman in Melbourne and it’s really fluctuated through the community, we’ve been on the parent group saying, “This is really fearful, this scares us.” So even – anything that comes up, if you’ve got that [support], it just means everything.

As described above, in battling these broader cultural issues, especially in times of loss and fear, parents described the importance of connection to other parents to express and process their experiences.

Continually advocating across systems

The experiences of parents in supporting their LGBTQA+ child meant engaging with multiple systems, across domains of health, education, and the legal system. Parents described that while accessing services, specifically public health, they were challenged by rigid administrative systems that made no allowance for the use of the young person’s name (when different from birth/legal name), or to identify gender outside of binary conventions. Parents indicated these challenges meant their child was often referred to by the wrong name and/or misgendering occurred, placing the parent as continual advocate for appropriate care, as this parent described,

Most [support services] have now made provisions to specify another gender, but not the health system, and they just constantly reinforce, “We can’t call you that legally. We have to –” and we know that, we know we had changed their name then and we understood through Medicare and all that but there was no attempt to really cater for it, ‘cause we had a lot of outpatient visits but just things like everyone, pathology, they were really bad. Like, they’d totally – we tried to use their name, but no one has – it’s just there’s no provision for it and I don’t think [the service providers] had any education.

In education settings, some parents detailed that despite initial support from their child’s school in managing their concerns, this commitment may not have been ongoing, and parents consequently had to decide to push for the required support or withdraw their child from the school. Parents needed to balance the mental health needs of their child and the importance of their child’s education, which was made difficult by schools not being supportive or cooperative, for instance,

She cried for two weeks about going back to school for the next term. Every night was – like crying for hours. All day, it was just despair and worry and grief and panic and anxiety. And we just got to the point we said, “We just can’t send her to that school. We just can’t go back.” The school stopped being supportive, they’ve got another 300 children to deal with and we were on the edge of that bell curve, and that’s just too hard, so we just had to leave. And it fit my other two kids perfectly, but it did not fit this kid and I had to put that kid first.

Parents discussed the cultural and political landscape that was particularly influential regarding access to gender affirming care. Parents identified the international influences that informed legal precedents closer to home, which meant navigating legal hurdles,

I was keen to try and work out the pathway that we had to follow, because at that point too, there’s not that requirement for families to go through and get Court approval for treatment, but at that point, that was still the case. So we were just really concerned to have everything that we needed to have in place and some supportive care for her prior to her getting to puberty.

Parents experienced these systems as dehumanizing, and commented that there was a gap in the system where a human touch would have greatly assisted them,

I feel like there’s a gap. There’s a human being shaped gap in that space. But that human being shape probably will take up a few other spaces as well along this journey, because of those strange gaps, you don’t know what’s actually missing.

Parents described the systems they interacted with as not fitting with their needs or those of their child, meaning that parents had to constantly battle to be heard and push for special considerations to make appointments and access services,

I’ve been pushing the whole time, “Can we get on a waitlist? Can we this? Can we that? Yes, we will drop anything to rock up to an appointment,” so we managed to get in but then even though they went, “Yes, you are transgender,” they went, “But you’re gonna have to wait another –” They said six months wait for testosterone and that was like, “Oh, my gosh.” And then [child’s name] got really flat, really depressed.

As parents endeavored to support their child, they described an overall “ill-fit” of many of the systems they interacted with. Systems did not recognize the specific needs of LGBTQA+ clients, and parents described their experience of needing to demand and push for their child’s needs to be met. The inadequacy of the systems they encountered, in turn, had detrimental impacts for their child and the family.

Fighting for appropriate and informed care

Parents described difficulties in receiving LGBTQA+ inclusive care and in finding LGBTQA+ inclusive environments for their child. As part of this, parents identified significant concerns about the clinical competency of mental health and other health professionals and services for working with LGBTQA+ young people. Parents noted that some individuals were accepting, but overall, professionals failed to understand the LGBTQA+ young person or their needs at a fundamental level. This was especially true for parents of trans kids,

There were isolated [health professionals] who really made an effort and were lovely and shone in the role they did, generally just outstanding, but on the whole, personally – in all of the personal interactions, it was just constant misgendering or – even though we’ve said they wanna be known as [child’s name] ‘cause they have been for quite a while before we could change it legally, and it was in the notes. You know, just constant – we had to keep repeating ourselves every time.

Parents also described the service environment (e.g., the presence of LGBTQA+ symbols and signage) as at odds with the actual practice of the practitioners,

If you walk in, there’s a huge, you know, the big inclusive “LGBTI Welcome Here” stock signs or stickers. So, there was a huge one of them on the floor as you walked in the entry, which would – it appeared that they are supportive but nothing of our stay there over a couple of weeks, the system, the way their records are kept, the staff, there was no – they’re constantly misgendering.

Parents described that service providers did not adequately understand their LGBTQA+ child’s experience, especially for trans young people. Parents described the disappointment and hardship in convincing service providers of their child’s experience and reality, as well as their frustrations with gatekeeping and the battle to be recognized and receive appropriate care,

So it took him a longer time to go, “I am male,” and that is the date that they were working off. They wanted two years of, “I am male.” He wanted a binder when he was 12, or 13 whatever the year was. This has been an issue for him for a long time, he explored it really thoroughly, which is what you said was a good thing but now he feels like he’s been punished for that because of that exploration, he’s got to wait for testosterone so much longer.

Participants described “moving goalposts” as a frustrating part of their experience, as they worked hard to meet the requirements set by health professionals only to find the requirements or decisions would change,

When we first started, it all sounded great. We’re seeing a psychologist and he was saying, “you have to see me for six months and then if I think you’re working good, we’ll move you on to the psychiatrist,” the carrot being female hormones. Then when we got to the psychiatrist, then we got to the endocrinologist, and then she did give blockers out very reluctantly… When you’re 16, you can get hormones, and then as [child’s name] approached 16, it was like, “I think we’ll wait ‘til you’re 17, I think we’ll wait ‘til your mental health issues are under control.” You were never gonna get there no matter how much – all these appointments, time off work, time off taking her in, our drive into [city name] to get her in there, it wasn’t gonna happen for her.

While many parents discussed gatekeeping and “moving goal posts” in relation for accessing gender affirmative care, parents also described gatekeeping regarding referrals for mental health support,

I think we were just at CAMHS [Child and Adolescent Mental Health Service], and it wasn’t really working well for him. I went to his GP and asked for referral to headspace and the GP wouldn’t do it. So I took him to my GP, and she put a referral through to headspace [youth mental health service]. So everything was like we really had to fight for everything to happen.

Attempting to access appropriate and informed care for their child was especially challenging for parents. Parents identified many examples where they felt that services were not prepared, trained, or welcoming of their child’s identity and what appropriate care included.

Searching for information and guidance

Parents experienced immense difficulty in finding accurate and useful information that would assist them in understanding their young person but also how to support them. Parents highlighted the lack of available information as significantly distressing for them and as a major factor that held them back,

I don’t know what to do now. And that’s part of it too. It’s – you don’t get guided. You don’t get an information book that says anything and you just gotta – all right, so now I’m just supposed to be at work but I’m Google-ing madly trying to figure out – do I have to have her enrolled in a school? Am I gonna get in trouble for not having her at [a school]? It’s just trial and error. That’s how I find the whole process at the moment.

Parents identified difficulty in finding clarity with referral pathways and meeting unclear eligibility criteria, and feeling they were often missing important information and being left out of the loop,

I ended up, finally, I got a referral to a psychiatrist due to this doctor, and then just a random psychiatry for the service, and I got a letter back from them – at this point, I’m worried that my child is gonna kill themselves. I got a letter back saying – no, they rang me, so we’ve waited two weeks. The receptionist rings me and goes, “No, psychiatrist won’t take [child’s name] on,” and I’m like, “Why? Can you tell me why?” And they’re like, “No, they don’t tell us why.”

Parents expressed the information that they required was hard to find, exacerbating an already hard and burdensome experience, and noted that they found information almost by “luck” or “chance,” rather than resources being appropriately informed and complete,

I’d looked at other options and distance ed[ucation] – it is quite expensive, so I ruled it out. And I said that to her [Distance Education advisor]. I said, “I can’t afford thousands of dollars on distance ed,” and she went, “Oh, no, if you got a mental health problem, you can get it for free.” And I said, “Well, where does it say that?” And she goes, “Oh, no, it won’t be on the internet.” And I thought – that’s another thing. The hidden information that – how do you find it?

The importance of peer support groups was identified as a source of informal information, especially when groups were local. Word of mouth recommendations for services, gaining basic understanding of their child, and safe and nonjudgmental spaces were greatly appreciated by parents,

Peer support was the most helpful to us early on because I felt like I could ask questions that might have been a really intense conversation with someone outside of this community, it was so helpful just to be able to ask than think, “Oh, god. I don’t know if this is stupid” I never felt judged. I always felt it was a safe place. We constantly still learn together as a peer support group. You know, whether it’s – it’s everything from where you get a binder to where do you find mental health support.

The most useful information and guidance was identified as coming from other parents and within peer support groups; parents felt they could raise any question without fear of judgment or prejudice. Parents also identified LGBTQA+ specific services and community organizations as helpful in finding the “hidden” information they needed.

Navigating familial pressures

Processing their own internal experience and responses to their child’s identity, as well as managing family dynamics against the backdrop of their child’s mental health crises, were core facets of the parental experience. Parents observed that their child’s identity created a shift in the family and some parents acknowledged the potential for shame or difficulty with this transition, and how they observed this in other parents,

I think as ridiculous as it is in this day and age, I think it’s still shame. I think people are still really uncomfortable to say, “My child is gay –” or lesbian, or trans, or whatever … so, for [child’s name]’s partner who’s come out as trans, he’s 18. And his dad has said, “I want you to wait three years before you start taking hormones because then you’ll be in a better mindset to do that.” That’s just not on. That’s completely unacceptable. And I think that’s around him being uncomfortable –the dad being uncomfortable to say to people, “My son is trans.” I think there’s a lot of discomfort.

Parents described difficulties in their familial relationship dynamics, with some noting that they needed to advocate for their child’s identity or mental health issues to be recognized by other family members. This was an additional demand on parents to ensure their child was seen and supported,

It would [have] helped if family didn’t just brush it off, “Oh, it’s a boy thing. Boys are just late bloomers, boys are this, boys are that.” I know they say she’s got a learning difficulty but do you really think that’s what the issue is? So I’m the only one standing in her corner saying, “She needs help,” and everybody else around me, including her father are saying, “No, she doesn’t. She’s right. That’s just what kids do,” and I’m saying, “It’s not. There is a problem.”

Further, parents reflected that the child’s circumstances and wellbeing greatly affected the family as a system, such that when the child was struggling to cope, there were impacts on the family as a whole,

We have the sense that she’s doing okay and we’re doing okay as a family and then we have an episode like that [mental health crisis] come up and you go, “Oh, shit, really actually, we’re not doing okay. She’s not doing okay. She’s just holding it together quite well most of the time.” Maybe that’s all that we can expect at this point.

Parents described that in supporting their child through times of crisis, in addition to impact on the child, parents and the family system generally were greatly impacted by their child’s mental health.

“You just want them to stay alive”

Many parents reported that they would consider any possible measure to support their child, with their child’s mental health taking precedence over their own wellbeing, work and career, other family, and social lives. Parents described considerable sacrifice in their role of supporting a young person to keep them safe,

It had become a sadness more than an anxiety, really, that there’s anxiety about school issues because learning was obviously really tricky now, and she had missed so much, so much about groundwork stuff, and I think that’s something we, as a parent, you give up on that bit. You just want them to stay alive. You just want them to be somewhere with someone looking after them.

Parents talked often about the necessity of changing schools or home schooling their child, which further had impacts in terms of the financial and time cost. Parental wellbeing and self-care were often put aside, but in some cases, this meant they had less capacity to care for and support their child. While they were at the core of supporting their child’s mental health, some parents described that their own experience was often not acknowledged by others,

If you are between jobs or trying to just juggle a mortgage and a kid with needs – we did it okay. We’re super lucky because we put ourselves in debt before with our eldest child. I literally had start to working for her so – and then this one comes along and it’s the same thing. I think that I actually had PTSD going down the path again, and it was really confronting on lots of levels, but nobody asked me about me at all. Not anyone has ever asked how I’m doing.

While parents described the pressure, distress, and often desperation associated with their experience of supporting their child during crises, they also acknowledged that when their child was able to be themselves and be supported, it was incredibly meaningful,

[child’s name] was happy and that was pretty amazing. So that was the last term of year five, and when she went into year six as a boy, I think she had a different colour hair, so first day of school, she put on a backpack, gone on a skateboard, and just skated off to school, barely saying goodbye. After years of separation anxiety, to just skating off down the road with no issues, I think I must’ve cried for about three hours. I was just like, “Oh my God.” This is incredible.

The personal impact on parents was significant, where their own wellbeing was innately connected to the wellbeing of their child.

Discussion

To further understand the experiences of parents of LGBTQA+ children, we conducted an inductive study about the experiences of parents that held no presumptions about what we may find. Our findings led us to understanding that the core theme was that of the barriers parents experience in supporting their child and underpinning these struggles was the dominant cis/heteronormative worldview. The findings indicate that parents of LGBTQA+ young people face significant challenges in supporting their child’s mental health and enable a clearer understanding of the parental experience of supporting a child during times of acute distress and elevated suicide risk. It is evident from parents’ accounts that being able to support their child during elevated mental health and suicide risk meant accessing broad support for their child. It must be acknowledged from the outset that some of the findings regarding barriers are general and apply beyond LGBTQA+ identities to the general youth population and the Australian mental health system more broadly and systemically. Other Australian studies indicate that children and young people more generally have considerable levels of unmet needs (Sheppard et al., 2018). Specifically, they lack information on the range of available services (Radez et al., 2021) or are reluctant to access services due to potential stigma and embarrassment (Aguirre Velasco et al., 2020). Services are often perceived as unfriendly and untrustworthy by youth (Hawke et al., 2019; McGorry & Mei, 2018), who also experience issues with service cost and availability (Radez et al., 2021; Rickwood et al., 2019).

While broader systemic barriers to accessing support and care are acknowledged, the focus of this paper is on understanding the specific experiences of Australian parents of LGBTQA+ young people. The findings from this study identified several specific barriers for these parents. In addition to general barriers, parents described challenges such as accessibility of LGBTQA+ specific information, continuity of care, and availability of services that suited their needs. Further, parents described the burden of navigating services in which health and mental health professionals lacked clinical competency for working with LGBTQA+ young people, or where systems were rigid and exclusionary including challenges in discriminatory behavior and inflexible administrative systems. These challenges have further been reported by LGBTQA+ young people themselves, highlighting the apparent wide-reaching inadequacies of services in meeting the needs of this population (Hill et al., 2021; Newman et al., 2021; Strauss et al., 2021).

With respect to trans people specifically, family support has been identified as an especially important protective factor for social and psychological wellbeing (Healy & Allen, 2020; Malpas et al., 2022). Supporting the family and improving family functioning through family therapy interventions has been found to reduce adverse mental health outcomes and reduce risk of suicidality for young people (Katz-Wise et al., 2018). Specifically, trans people who are under the age of 18 years but wish to access hormone or medical treatment for gender affirmation need parental consent (Telfer et al., 2020), and as such families are involved in the treatment and care of trans young people and require support to better understand and support their child (Andrzejewski et al., 2021; Frigerio et al., 2021; Pullen Sansfaçon et al., 2020). Parents and families of trans young people may experience difficulties in adjustment to their child’s gender diversity and have been shown to benefit from family interventions (Riggs et al., 2020; Russon et al., 2021). Interventions including providing psychoeducation and access to LGBTQA+ community information, emphasizing the importance of acceptance, allowing space for emotional processing, and promoting opportunities for families to demonstrate allyship and advocacy have all been found to be effective (Malpas et al., 2022).

A key finding from this study was that parents of LGBTQA+ young people experience a sense of marginalization. Multiple marginalization has been shown to make navigating support services even more challenging (Robards et al., 2019). Parents are often required to manage both general and specific issues simultaneously. For example, accessing an adolescent health service in a regional area is already known to be difficult, but parents of LGBTQA+ young people found it even more challenging to access a service that would be accepting and affirming of their child. This experience of parents in navigating a world that felt unsafe for their child, as well as the lack of availability of services and practitioners with clinical competency, meant that parents often found accessing peer support from other parents or LGBTQA+ specific services safer and more useful. Parents often relied on peer support for information and guidance rather than professionals. While peer support groups were described as invaluable, those needing the support were also then tasked with providing support for their own community. This in effect creates a closed loop system in which the community needing support is also expected to provide the support.

Other research has found that parents experience minority stress vicariously through their child’s experiences or through judgment directed at them, for instance, for being a parent of a LGBTQA+ child and supporting their child’s identity (Hidalgo & Chen, 2019). While the parents in this study did not overtly discuss the impact of discrimination relating to their child’s identity directly affecting them personally, they did discuss the difficulty in witnessing how their child was treated by the wider world, including media coverage of trans affirming care and the devastating impact of LGBTQA+ people being physically harmed or harassed due to their identity. This adds further weight to the need for parents to be adequately considered and supported, as they undoubtably experience personal distress while seeking to support their young person in crisis, but are themselves seldom acknowledged (Pullen Sansfaçon et al., 2015; Wells et al., 2022).

While the parents included in this study were likely highly accepting (given they were recruited through peer support groups and LGBTQA+ organizations), other research has documented that parents may undergo a process of adjustment to their child’s identity and to transformations within family system (Abreu et al., 2019; Morgan et al., 2023). Within the framework of family systems theory (Cox & Paley, 1997), clearly a young person’s wellbeing, and their mental health crisis, impacts the other family members (Katz-Wise et al., 2018). Services need to acknowledge that there will be an impact on the family system, and that care or appropriate referrals are required to support parents of young people—effectively supporting the support network (Hopkins et al., 2021). Parents are often the safe haven for young people, especially in times of crisis (Kerns et al., 2015). Unless services and wider supports ensure parents are well supported, they may not have capacity to provide a secure base for the child. The findings from this study highlight the need for parents to be supported and included in order to secure the best outcomes for LGBTQA+ young people.

Recommendations

The findings from the present study were used to inform several general and specific recommendations for health and other social services (see Table 1).

Table 1. General and LGBTQA+ specific recommendations for health and other social services.

Category	Recommendations
General recommendations
1.	Ensure funding and availability of health and other social services to ensure accessibility, reasonable waiting periods, appropriate case management and continuity of care.
2.	Services to acknowledge the importance of working with family and how to involve them, including provision of good quality and appropriate information and support for parents.
LGBTQA+ Recommendations
1.	Comprehensive LGBTQA+ training be made available for service providers and their staff, both through upskilling of current workers as well as the inclusion of LGBTQA+ information in education and training curricula. Services to employ competent providers trained in working with the LGBTQA+ population and their families. This may include specific dedicated LGBTQA+ services.
2.	Services to reflect their commitment visibly, meaningfully, and consistently to working with LGBTQA+ young people.
3.	Service providers working with families should consider what unique support parents need, advocate for parental needs, and consider referral to appropriate services.
4.	A standalone comprehensive website for parents in accessing all forms of support, both for their child but also for themselves.
5.	Facilitate access to existing peer support groups to harness the utility of peer support for parents. Increase accessibility of such support, such as by providing funding and other resources for peer support groups to ensure stability and longevity.

These recommendations have been directly informed by parental experiences regarding what may optimally aid families; crucially, supporting the environment of the young person facilitates support of the whole family system. Practitioners and services involved in care for LGBTQA+ young people can find additional suggestions in the recent publication Suicide prevention in LGBTQA+ young people: Best practice guidelines for clinical and community service providers (Strauss et al., 2022). It is further acknowledged that the recent development of the Transforming Families online website (Telethon Kids Institute, 2024; https://transformingfamilies.org.au) for the Australian context will attend in part to what is described in these recommndations, however the recommendation is retained as more information is needed that is available for parents of LGBTQA+ young people more broadly.

Limitations and future research directions

The findings presented here are novel and informative given the paucity of Australian research about parents of LGBTQA+ young people (including the impact upon parents themselves) and the important role they play in supporting young people. This was a small qualitative study exploring an area that is relatively unknown. In terms of limitations, the study sample was small, as is common in qualitative research. Secondly, the study sample was not heterogeneous and therefore unlikely to represent the diversity of the population or the diversity of all experiences. Thirdly, the sample was mostly parents whom we can assume are highly supportive—not only have they been striving to support their child, but they are amenable to participating in research about it. Further, as is common in research about parenting, this study sample was predominantly mothers and therefore may not adequately represent other parent and guardian perspectives. While we have gained some insight into parents of young people who are diverse in gender and sexuality, further understanding of other diverse experiences that may intersect for trans young people is needed to understand factors influencing both their experiences and those of their parents.

Future studies with larger samples and mixed method approaches are warranted to extend understanding of parental experiences and needs. It would be useful for future studies to recruit parents who might present with a spectrum of accepting and non-accepting stances to gain a broader perspective of parental experiences and support needs. Future research should also seek to gain insight into other parental and guardian relationships and experiences, as well as more comprehensively capture demographics of families to ascertain if demographic characteristics (such as social economic status, cultural background, regional location) play a significant role in the experiences of families.

Conclusion

The findings here strongly reflect the importance of the family as a potentially safe and consistent base for safeguarding LGBTQA+ young people’s mental health and protecting against suicide risk. The findings show that parents of LGBTQA+ young people face significant challenges at multiple levels in their efforts to support their child. Because most health systems and services are currently seen as not appropriately designed to meet the specific needs of their LGBTQA+ child, parents often face barriers beyond those usually faced by youth in accessing mental health services. As such, parents often rely on peer support to provide assistance and key information. While this peer support is invaluable, it appears to set up a “closed loop” whereby the parents who need support are also tasked with providing it. Further, parents experience personal distress because of their experiences, however their needs are often ignored or go unacknowledged. Supporting parents is fundamental to providing a safe and supportive environment for LGBTQA+ young people.

Acknowledgements

The authors would like to thank our partner organizations for their assistance in study recruitment and the parents who participated in this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).