Intended for healthcare professionals

Practice Practice Pointer

Safeguarding LGBT+ adolescents

BMJ 2019; 364 doi: (Published 31 January 2019) Cite this as: BMJ 2019;364:l245

Linked Opinion

NHS staff are in a perfect position to be advocates for LGBT+ people when they most need it

  1. Jessica Salkind, ST1 paediatric trainee,, academic clinical fellow in paediatrics, teaching lead for LGBT+, health module126,
  2. Rosanna Bevan, CT2 core psychiatry trainee,, volunteer youth worker37,
  3. Ginger Drage, expert patient educator,, fundraising co-ordinator6 74,
  4. Donna Samuels, general practitioner5,
  5. Gayle Hann, paediatric consultant, lead for paediatric emergency, named doctor for child protection,, project lead for IBSc Paediatrics and Child Health16
  1. 1North Middlesex University Hospital NHS Trust, London, UK
  2. 2Imperial College London, London, UK
  3. 3East London Foundation Trust, London, UK
  4. 4Groundwork, London, UK
  5. 5NHS Enfield Clinical Commissioning Group, London, UK
  6. 6University College London Medical School, London, UK
  7. 7Gendered Intelligence, London, UK
  1. Correspondence to J Salkind jessica.salkind{at}

What you need to know

  • The LGBT+ population is diverse and it is important not to conflate sexual orientation with gender identity

  • LGBT+ adolescents have higher rates of self harm and suicide than the rest of the adolescent population, linked to potentially serious safeguarding risks at home, school, online, and elsewhere

  • Establish rapport with a non-judgmental and inclusive approach

  • Avoid unnecessarily gendered language and do not give a young person a label that they have not given themselves

  • Take risks seriously and seek support from child and adolescent mental health services, local child protection teams, or social services, particularly in a young person presenting with self harm or suicidal ideation

A 14 year old girl attends the emergency department after taking a paracetamol overdose at home. She explains she has felt really hopeless since telling her mother she identifies as bisexual and has a girlfriend. Her mother told her “I would rather you were dead” and has organised an exorcism through the local church.

Recent years have seen political and social progress for people who identify as LGBT+ (lesbian, gay, bisexual, and transgender; the “+” indicating inclusion of other minority sexual and gender identities). Yet international evidence shows ongoing health and social inequalities in this group, many of which emerge during adolescence and represent unique safeguarding risks.1234567 This article offers an overview of these risks, which include increased rates of self harm, suicide, and family rejection or abuse. The article is aimed at all healthcare professionals who care for young people, including within paediatrics, general practice, emergency medical and surgical settings, and child and adolescent mental health services (CAMHS). We suggest a management strategy based on clinical experience and testimony from LGBT+ young people and organisations. Some suggestions assume legal protection and support services for LGBT+ people that …

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