By Philip A. Rutter, Ph.D., Faculty Widener University, Private Practice/Consulting Counseling Psychologist
Above are the main constructs of a novel way of looking at why or how sexual minority youth (Lesbian Gay or Bisexual; LGB) can be at greater risk for suicidal behaviors (Anderson, 2002). Since Gibson’s (1989) study, where he argued that it is more than demographics that cause a person to consider suicide, leading research has moved to the ‘context’ of why LGB youth may be at risk (Portes, Sandhu & Longwell-Grice, 2002). Recent work has evolved to consider the protective as well as risk factors that fall within the queer youth experience R Malone, et al., 2000; Rutter & Estrada 2007). The Cumulative Factor Model (Rutter, 2008) above starts to incorporate this in an operational way.
This approach was first applied to youth under juvenile justice system (Seidman et al 1998; Yoshikawa & Seidman 2000) where youth’s contextual or cumulative risk and protective factor experiences were brought into intervention strategies. This bimodal cumulative strategy was quite successful with these incarcerated youth with dramatic drops in recidivism, improved school performance and attendance, and general improvements in youth citizenship (Yoshikawa & Seidman).
This protective and risk factor approach has been a novel strategy in youth suicide assessment and interventions during the most recent years with new assessment tools to ascertain potential resilience against suicide, combined with assessments honed to determine risk factors salient for certain ‘at-risk’ groups (Rutter, 2008).
Assessment and interview questions can focus on culling the ‘accumulation’ of suicide risk factors or conversely, of suicide protective factors. Most salient and in line with leading research (Osman, Gutierrez, Kopper, Barrios & Chiros, 1998; Estrada & Rutter, 2006) is the incorporation of those aspects of resilience and positive coping strategies, while also incorporating assessment of risk factors pertinent to LGB Identities including gender atypicality or presence of physical/psychological maltreatment. You might now ask “How do I cull for the presence of suicide potentiality with my sexual minority youth clients? It is at times straightforward, and at others circuitous.
Let’s begin with the straightforward. There are four crucial constructs that impact LGBT youth significantly. 1) Social Isolation, 2) Hostility, 3) Negative Self Concept, 4) Hopeless-ness (Rutter & Soucar, 2002; Rutter & Behrendt, 2004). As times appear to improve for queer youth, school settings and cyberspace/social network sites continue to be riddled with anti-gay bullying, harassment and at times spurning physical assaults (Bontempo & D’Augelli, 2002; Hershberger & D’Augelli, 2002; Rutter & Leech, 2006).
Our ability to assess these constructs in paper/pencil form can be accomplished through several brief surveys; a) Child and Adolescent Social Support Scale for perceived levels of social support or isolation (CASSS; Malecki & Demaray, 2002) b) the Adolescent Coping Orientation for Problem Experiences which ascertains levels of resilience and help seeking behaviors during problem experiences (A-COPE; Patterson & McCubbin, 1987), and c) the highly salient survey which assessing temporal levels of hope or hopelessness, the Beck Hopelessness Scale (BHS; Beck, 1988) to name a few. A separate useful tool for assessing hopelessness, hostility, suicidal ideation and negative self-evaluation is the Suicide Probability Scale (SPS; Cull & Gill, 1989).
For the model included, it is important to look at strengths and protective factors. The ACOPE above is actually a good instrument for this as well in that it covers seeking help, healthy coping strategies, etc. The converse of hopelessness would be future optimism, and these can be addressed through using the Reason For Living Inventory-Adolescent (RFL-A; Osman et. al., 1998) or a distinct survey exploring the suicide protective factors-the Suicide Resiliency Inventory (Osman et. al., 2004). It is important to note that these surveys work best in tandem with a personal interview. The Symptom Check List 90 Revised, Brief Symptom Inventory (SCL-90R/BSI; Derogatis 1994, 2001) or the Beck Scale for Suicidal Ideation (BSSI; Beck & Steer, 1991) are both good ‘flag’ assessment tools that could proceed the interview.
The context or more circuitous side of our gay youth’s life experience needs explanation. In brief, it is still the experience of many LGBT youth that they are kicked out of their homes, become homeless and experience school stress, truancy and academic failure (Rutter & Leech, 2006). The LGBT communities still struggle with presenting visible successful and non-stereotypical adult models for youth to emulate resulting in a poor concept of future optimism/direction. Given adolescents’ already temporal frame, no visible presentation of gay or lesbian parents, athletes, politicians and teachers suggest a dearth of tacit models to aspire toward emulating.
Finally, families still struggle with their adolescent child’s sexuality, let alone a queer identity. School administrators and teachers also struggle, with a) how a 12 or 13 year old can identify as gay or lesbian? b) Often question whether this is a transient or attention seeking label, and c) what to do when peer bullying or harassment begins in the neighborhood or at school or most recently if this bullying spills over into texting or online social media bullying.
Echoing the “It Gets Better” campaign of 2010, LGBT youth support systems appear to be building and promoted. Given the high visibility of several suicides in the Fall of 2010 and the Spring of 2011, the nation appears to be listening. The curious omission from many stories is that queer youth have always been at greater risk for suicide. While funding dollars and mental health experts rally to see the quick fix or core issues pertinent to reducing this rate, the dilemma is broader in scope than merely sensitivity trainings at school or strategies to assess risk in a certain group.
Beyond the presence of hateful rhetoric or oppressive treatment, there are bastions of light-the It gets better campaign for one, is brilliant and tacitly relevant for social media connected youth-to see videos of prominent gays, lesbians, straight leaders, inclusive of President Obama, all send a powerfully supportive message-and are true to the adolescent experience. To speak on this further, it is important moving forward to enhance visibility of lesbian, gay and transgender individuals, couples and families living life as contributors to society-whether in stereotypical or non-stereotypical fashion. Separately, the absence of dual minority adult models (that is sexual and ethnic minorities) adds to the marginalized status of our gay youth of color.
Further improvements include a broadening presence of two crucial groups, one the Youth Service Organizations or YSO’s and the Gay, Lesbian and Straight Educators Network (GLSEN). In two separate fashions, one enhances community and family acceptance of queer youth while bridging to mental health or coping strategy education of needed. GLSEN’s strivings to improve school environments are monumental in the past five years with increased presence of gay straight alliances, networking sites and supports for youth and parents alike, and the broadening of the message of straight allies being a powerful agent of change.
There is a reason this write up moved from assessment to limits to community based group supports. It is to truly emphasize the context of working with the LGBT client youth or adult actually, to assess their level of coping, and for youth their suicide potentiality. Equally important though for youth counselors reading this is to cull out sexual orientation from potential mental health concerns (Rutter & Leech, 2006; Rutter, 2008). It is how they are received, accepted and supported that dictates much more of the queer youth’s experience. The caveat inherent is while we do want to ask how a gay lesbian or transgender youth is doing, we don’t want to assume suicide risk merely because of queer identity. It is indeed the context of these youth’s ability to navigate the risk factors, and steer toward building the protective factors that will truly help buoy them from harm. We as clinicians and researchers can tap into these contexts, and pulling from narrative therapy terminology, ‘allow them to describe their story, keeping them as expert.’
www.GLSEN.org, The Gay, Lesbian and Straight Educators Network;
www.GSANetwork.org, Gay Straight Alliance network; empowering youth to fight homophobia and transphobia in schools
www.PFLAG.org, Parents Friends and Friends of Lesbians and Gays, promotes well-being and acceptance from a family system stance.
www.thetervorproject.org; The Trevor Project, focused on prevnting suicide among LGBTQ youth.
The Author would also welcome inquiries or request for reprints;
www.philrutterphd.com Dr. Philip A. Rutter, Faculty Widener University, Private Practice/Consulting Counseling Psychologist
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