LGBTQ youth advocacy organizations are reporting sharp increases in calls to suicide prevention hotlines, with the overwhelming majority of callers saying the election is the source of their fears. In addition to teens and children, the groups say that in recent days they have also been contacted by unprecedented numbers of families and teachers.

Starting Nov. 3, the number of crisis-service calls, texts and online chats received by The Trevor Project increased 125% over the week before, with an additional spike “beginning Nov. 5 approximately around midnight ET,” an organization spokesperson told ����Ӱ��. Trevor also reported a 200% rise in the number of callers who specifically mentioned the election. 

After former President Donald Trump’s re-election, Trevor posted an advisory note at the top of : “TrevorText and TrevorChat are currently experiencing long hold times due to the election. If you need immediate assistance, please call the TrevorLifeline at 1-866-488-7386.”

The organization has a number of online resources for youth, caregivers and educators, including guidance on , a and . 

“The Trevor Project wants LGBTQ+ young people to know that we are here for you, no matter the outcome of any election, and we will continue to fight for every LGBTQ+ young person to have access to safe, affirming spaces — especially during challenging times,” CEO Jaymes Black said in a statement to ����Ӱ��. “LGBTQ+ young people: Your life matters, and you were born to live it.”

The , which typically receives 3,700 calls a month, logged 2,146 between Nov. 3 and 6 alone. Young people generally make up the vast majority of contacts, but the rate of calls from parents, grandparents and teachers concerned about someone in their family or class jumped from less than 7% of all contacts to 28% during those three days. 

“Most of the time, we take calls from kids in crisis who don’t have supportive families, who are afraid of being evicted or afraid of being outed,” says Lance Preston, the organization’s executive director. “Parents are now calling us about, ‘What am I going to do? What if this turns into a situation like Texas, where if I support my child, I’m going to be investigated by CPS?’ Teachers reaching out and saying, ‘What if I am a supportive ally and my school decides that I [shouldn’t have a] license anymore? Is this election going to create a situation where I could lose my job?’ ” 

The weekend before the election, Rainbow’s hotline took a call from an Alabama 16-year-old who reported he was part of a four-teen suicide pact, Preston says. His colleagues were able to intervene to stop the plan.  

“They had decided that if Trump won the election, that they were going to kill themselves because that meant that the United States people did not want them here and did not want their existence to be accepted,” he says. 

“I’m so thankful that that young person reached out to report that, because we were able to get to the other kids, get their parents involved and do some mitigation and get them some help. But that would have been four kids that we would have lost. That is unacceptable.”

Last winter, the number of calls to Rainbow Youth from young Oklahomans more than tripled after transgender teen Nex Benedict died by suicide following months of in-school bullying. The suicide occurred in February, after a fight in a girls’ restroom that Nex had been forced to use under a new state law.

Nine in 10 callers reported bullying in their school, Preston said at the time. Since the start of this calendar year, the organization has heard reports of nine LGBTQ teen and nine adult suicides in the state. It now operates a crisis support center in Oklahoma City. 

The Southern Equality Project, which to families in the 25 states that have banned LGBTQ youth health care, also reports a “slight uptick” in requests from families of trans youth: “Many of the requests specifically mentioned fears about Trump, a national ban or needing to leave the country for care,” says Communications Director Adam Polaski. 

Because young people have no experience advocating for and securing LGBTQ rights, Preston says, they are particularly vulnerable to political rhetoric. “They didn’t fight for these rights,” he says. “They were born with them, and now they are seeing them taken away.”

He and other advocates say they expect the volume of calls to stay high through at least February, as a second Trump administration presumably begins acting on campaign promises to end gender-affirming care and curtail in-school LGBTQ protections throughout the country. 

“The best thing for us to do is to accept where we are, but also to send a positive message to these young people that we may be heartbroken, but we’re not broken,” he says. “We need to be putting that positive message out there that we need them to stay with us. They have an army of allies behind them, and we’re going to get through this.”

Hours after the publication of this article Friday, The Trevor Project announced in a tweet it would return a $25,000 donation from the student surveillance company Gaggle, acknowledging widespread concerns about the monitoring tool’s “role in negatively impacting LGBTQ students.”

“Our philosophy is that having a seat at the table enables us to positively influence how companies engage with LGBTQ young people, and we initially agreed to work with Gaggle because we saw an opportunity to have a meaningful impact to better protect LGBTQ students,” the nonprofit said in the statement. “We hear and understand the concerns, and we hope to work alongside schools and institutions to ensure they are appropriately supporting LGBTQ youth and their mental health.” 

The move came after widespread condemnation on social media, with multiple supporters threatening to pull their donations to The Trevor Project moving forward. 

In a Friday statement, Gaggle spokesperson Paget Hetherington said the company wanted The Trevor Project’s “guidance on how to do what we do better.” The company also where it previously touted the partnership. 

“We’re disappointed that The Trevor Project has decided to pause our collaboration,” she said. “However, we are grateful for the opportunity we have had to learn and work with them and will continue with our mission of protecting all students regardless of how they identify.” 

Original report below:

Amid warnings from lawmakers and civil rights groups that digital surveillance tools could discriminate against at-risk students, a leading nonprofit devoted to the mental well-being of LGBTQ youth has formed a financial partnership with a tech company that subjects them to persistent online monitoring. 

, The Trevor Project, a high-profile nonprofit focused on suicide prevention among LGBTQ youth, began to list Gaggle as on its website, disclosing that the controversial surveillance company had given them between $25,000 and $50,000 in support. Meanwhile Gaggle, which uses artificial intelligence and human content moderators to sift through billions of student chat messages and homework assignments each year in search of students who may harm themselves or others, noting the two were collaborating to “improve mental health outcomes for LGBTQ young people.” 

Though the precise contours of the partnership remain unclear, a Trevor Project spokesperson said it aims to have a positive influence on the way Gaggle navigates privacy concerns involving LGBTQ youth while a Gaggle representative said the company sees the relationship as a learning opportunity.

Both groups maintain that the partnership was forged in the interests of LGBTQ students, but student privacy advocates argue the relationship could undermine The Trevor Project’s work while allowing Gaggle to use the donation to counter criticism about its potential harms to LGBTQ students. The collaboration comes at a particularly perilous time for many students as a rash of states implement new anti-LGBTQ laws that could erode their privacy and expose them to legal jeopardy. 

Teeth Logsdon-Wallace, a 14-year-old student from Minneapolis with first-hand experience of Gaggle’s surveillance dragnet, said the deal could eliminate any motivation for Gaggle to change its business practices. 

“It really does feel like a ‘We paid you, now say we’re fine,’ kind of thing,” said Logsdon-Wallace, who is transgender. Without any real incentives to implement reforms, he said that Gaggle’s “seal of approval” from The Trevor Project could offer the privately held company reputational cover amid growing concerns that such surveillance tech is disproportionately harmful to LGBTQ youth. 

“People who want to defend Gaggle can just point to their little Trevor Project thing and say, ‘See, they have the support of “The Gays” so it’s fine actually,’ and all it does is make it easier to deflect and defend actual issues with Gaggle.” 

Following an investigation by ����Ӱ�� into Gaggle’s monitoring practices, the company . Gaggle’s algorithm relies on keyword matching to compare students’ online communications against a dictionary of thousands of words the company believes could indicate potential trouble, including references to violence, drugs and sex. Among the keywords are “gay” and “lesbian,” verbiage the company maintains is necessary because LGBTQ youth are more likely than their straight and cisgender peers to consider suicide. 

But privacy and civil rights advocates have accused the company of discrimination by subjecting LGBTQ youth to heightened surveillance — a concern that has taken on new meaning this year as states like Florida adopt laws that ban classroom discussions about sexuality and LGBTQ youth to their parents.  

A by the nonprofit Center for Democracy and Technology found that while Gaggle and similar student monitoring tools are designed to keep students safe, teachers reported that they were more often used to discipline them. LGBTQ youth were disproportionately affected. 

In a statement, a Trevor Project spokesperson said it’s important that digital monitoring tools keep students safe without invading their privacy and that the collaboration was built on Gaggle’s “desire to identify and address privacy and safety concerns that their product could cause for LGBTQ students.” 

“It’s true that LGBTQ youth are among the most vulnerable to the misuse of this kind of safety monitoring — many worry that these tools could out them to teachers or parents against their will,” the statement continued. “It is because of that very real concern that we have worked in a limited capacity with digital safety companies — to play an educational role and have a seat at the table so they can consider these potential risks while they design their products and develop policies.” 

But it remains unclear what policy changes have occurred at Gaggle as a result of the deal. Without offering any specifics, Gaggle spokesperson Paget Hetherington said in a statement the company is “honored to be able to align with The Trevor Project to better serve LGBTQ youth,” and that the company is “always looking for ways to learn and to improve upon what we do to better support students and keep them safe.” 

‘Faceless bureaucracy’ 

At its core, the partnership between Gaggle and The Trevor Project makes sense because both work to prevent youth suicides, said Amelia Vance, the founder and president of . But their approaches to solving the problem, she said, are fundamentally different. 

By combing through digital materials on students’ school-issued Microsoft and Google accounts, Gaggle seeks to alert educators — and in some cases the police — of students’ online behaviors that suggest they might harm themselves or others.

“It really is about collecting details that kids may not be voluntarily sharing — information that they may be looking up to learn, to explore their identities, to otherwise help them in their day-to-day lives,” Vance said. At The Trevor Project, “you have proactive outreach from youth who know that they need help or they need a community.” 

The West Hollywood-based Trevor Project, which and funding from including Macy’s and AT&T, was founded in 1998 and in contributions in 2020. Gaggle, founded in 1999, does not publicly report its finances. The Dallas-based company says it monitors the digital communications of more than 5 million students across more than 1,500 school districts nationally. 

The Trevor Project to train volunteer crisis counselors and assess the risk levels of people who reach out to for help. If counselors with The Trevor Project believe a student is at imminent suicide risk, to call the police. But it’s ultimately up to youth to decide which information they share with adults. 

It’s important for LGBTQ students to have trusting adults with whom they can confide their experiences, Vance said, rather than a system where “some faceless bureaucracy is finding out and informing your parents” about information they intended to keep private. 

A by The Trevor Project offers troubling data about the realities of the youth suicide crisis. Nearly half of LGBTQ youth said they seriously considered attempting suicide in the past year and 14% said they made a suicide attempt. 

This isn’t the first time The Trevor Project has faced scrutiny in recent months for its ties to companies that could have detrimental effects on LGBTQ youth. In July, a HuffPost investigation revealed that CEO and Executive Director Amit Paley previously and helped create a strategic plan to boost opioid sales amid an addiction epidemic — one that’s in suicide attempts among LGBTQ youth. 

The group knows firsthand how data can be weaponized. Just last month, that target the transgender community launched a campaign to clog up The Trevor Project’s suicide prevention hotline. 

Persistent student surveillance could exacerbate the challenges that LGBTQ youth face by subjecting them to disproportionate discipline and erroneously flagging their online communications as threats, Democratic Sens. Elizabeth Warren and Ed Markey warned in an April report. 

Nearly a third of LGBTQ students say they or someone they know has experienced the nonconsensual disclosure of their sexual orientation or gender identity — typically called “outing” — due to student activity monitoring, by the nonprofit Center for Democracy and Technology. They were also more likely than their straight and cisgender peers to report getting into trouble at school and being contacted by the police about having committed a crime. 

In response to the survey results, a coalition of civil rights groups called on the U.S. Education Department to condemn the use of activity monitoring tools that violate students’ civil liberties and to state its intent “to take enforcement action against violations that result in discrimination.” The letter argues that using the tools to out LGBTQ students or to subject them to disproportionate discipline and criminal investigations could violate Title IX, the federal law prohibiting sex-based discrimination in schools. 

Among the letter signatories is the nonprofit LGBT Tech, which about the harms of digital surveillance on LGBTQ people. Christopher Wood, the group’s co-founder and executive director, said The Trevor Project’s partnership with Gaggle could be positive if it’s used to ensure that LGBTQ youth who are struggling have access to help. But once Gaggle gives student information to school administrators, the company can no longer control how those records are used, he said. 

“If that information is provided to someone who is not accepting, who has very different views and who willfully brings their political, personal or religious views into the school system, and they are not supportive of LGBTQ youth, then what they’ve done is harm the student,” Wood said. 

Yet as schools increasingly turned to student activity monitoring software during the pandemic, The Trevor Project portrayed their growth as an inevitable result of districts seeking “to avoid liability issues.”  

“It is our stance that since these tools are not going anywhere, we think it’s important to do our part to offer our expertise around LGBTQ experiences,” the spokesperson said. 

The power of trust

In interviews, students flagged by Gaggle said their trust in adults suffered as a result. Among them is Logsdon-Wallace, the 14-year-old transgender student. Before the Minneapolis school district stopped using Gaggle this summer and state lawmakers put strict limits on digital surveillance in schools, the tool alerted district security when he used a classroom assignment to reflect on a previous suicide attempt and how music therapy helped him cope. That same assignment, which included references to his gender identity, was flagged to his parents. 

And while his parents are affirming, he has friends who live in less supportive environments.                                                                                                       

“I have friends who are queer and/or trans who are out at school but not to their parents,” he said. “If they want to be open with teachers, Gaggle can create a bad or even dangerous situation for these kids if their parents were contacted about what they were saying.” 

In The Trevor Project’s recent survey, nearly three-quarters of LGBTQ youth reported that they have endured discrimination based on their sexual orientation or gender identity, just 37% said their homes are affirming and 55% said the same about their schools. 

Given that reality, reported sharing information about their sexual orientation with teachers or guidance counselors. 

While Gaggle has maintained that keywords like “gay” and “lesbian” can also prevent bullying, Logsdon-Wallace said their approach is out of touch with how students generally interact. At school, he said he’s been called just about every “slur for a queer or a trans person that isn’t from like 80 years ago.” While slurs are common, terms like “lesbian” are not.

“As an actual teenager going to an actual public school, those words are not being used to bully people,” he said. “They’re just not.”

The rates of suicidal thoughts among LGBTQ youth have ticked upward over the last three years, according to the fourth annual survey conducted by The Trevor Project, a nonprofit suicide prevention and crisis intervention organization for LGBTQ youth. While 45% of LGBTQ youth said they seriously considered suicide in the last year — including 53% of those who are transgender or nonbinary — and 14% reported they had carried out a suicide attempt. 

The survey comes at a particularly fraught moment for advocates of LGBTQ rights as Republican lawmakers push for rules that prohibit classroom instruction about sexual orientation and gender identity, ban books featuring LGBTQ themes, curb transgender students’ ability to access gender-affirming medical care, participate in school athletics or use restroom facilities that match their gender identities. 

“When we take a group of young people who are already very vulnerable to poor mental health and then we initiate these conversations,” the hardships compound, said Jonah DeChants, a research scientist at The Trevor Project. Not only are young people being targeted by these laws, but they also now have to wake up and log onto social media or turn on the news and hear elected officials talking about their identities in very misinformed, ignorant and in many cases very anti-LGBTQ perspectives.”

DeChants stressed that LGBTQ youth are not “inherently more suicidal” than their straight and cisgender peers. Poor mental health outcomes, he said, are the result of “minority stress” like social stigma and are not the direct result of their sexual orientation or gender identity. 

“It’s the fact that you wake up and you have to navigate a society that doesn’t want to allow you to love who you want to love or express your gender the way you want to express it,” he said. “That is what creates these poor mental health outcomes, not young peoples’ internal identity.”

The survey suggests a simple path forward that could shield young people from serious harm: Welcoming communities. LGBTQ youth who felt strong affirmation from their families reported attempting suicide at less than half the rate of those who lacked social support. Suicide attempts were also reported at lower rates among LGBTQ youth who found affirmation in their schools and broader communities compared to those who felt ostracized. 

Yet fewer than a third of transgender and nonbinary youth reported that their homes were gender affirming. In the face of the stark uptick in anti-LGBTQ legislation in the last year, officials at The Trevor Project argue that affirmation isn’t political — it’s a matter of life or death. 

“The science actually shows that when communities push back against these attacks and choose to affirm LGBTQ young people — whether that’s talking openly about these issues and not banning discussions or books from libraries — those steps are actually potentially life-saving,” DeChants told ����Ӱ��. “Those have a real, positive impact on young people’s mental health.” 

The survey also identified stark racial disparities among LGBTQ youth who attempted to die by suicide in the last year. About a fifth of Black youth carried out a suicide attempt, compared with 12% of those who are white. 

Almost all youth who are transgender or nonbinary — an overwhelming 93% — said they worry about state or local laws denying them access to gender-affirming health care, and a similar share said they were concerned about being denied access to the bathroom. More than four-fifths of transgender and nonbinary youth said they worried about being denied access to school athletics. 

The survey also highlights the extent that LGBTQ youth are targeted with harassment and physical violence — attacks that ultimately heightened their risk of suicide attempts. More than a third of LGBTQ youth reported that they have been physically threatened or harmed due to their gender identity or sexual orientation, and 73% said they’ve experienced discrimination at least once in their lifetimes. 

The pandemic has also taken a detrimental toll on LGBTQ youth, the survey found. More than half of survey respondents — 56% — said their mental health was poor most of the time or always due to COVID-19. 

The online survey was completed by nearly 34,000 LGBTQ youth in the U.S. between the ages of 13 and 24 between September and December 2021 — even before officials in states like Texas and Florida launched the latest round of policy attacks against LGBTQ youth. Among survey respondents, 45% are youth of color and 48% identify as transgender or nonbinary, making it one of the most diverse surveys of LGBTQ youth ever conducted, according to the nonprofit. 

Another recent survey, released in March and conducted by Morning Consult for The Trevor Project, found that or censor school curricula featuring LGBTQ topics. Just 1 in 3 adults expressed support for laws that ban gender-affirming medical care for minors. 

The latest survey results resemble data released in March by the Centers for Disease Control and Prevention, which found that LGBTQ youth were significantly more likely to consider or attempt suicide during the pandemic than their straight and cisgender peers. Reported rates of physical abuse, homelessness and hunger were also disproportionately high among LGBTQ youth, the CDC survey found. 

While 73% of LGBTQ youth reported experiencing anxiety and 58% said they struggled with depression, Trevor Project survey respondents also highlighted major barriers to mental health care. In total, 60% of those who wanted mental health care in the past year said they were unable to receive the help they needed due to a range of issues including the fear of discussing their mental health concerns, the lack of affordability and the fear of getting outed to their parents. 

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741. For LGBTQ mental health support, contact The Trevor Project’s toll-free support line at 866-488-7386.

Fifteen-year-old Jordyne Lewis was stressed out. 

The high school sophomore from Harrisburg, North Carolina, was overwhelmed with schoolwork, never mind the uncertainty of living in a pandemic that’s dragged on for two long years. Despite the challenges, she never turned to her school counselor or sought out a therapist.

Instead, she shared her feelings with a robot. to be precise.  

Lewis has struggled to cope with the changes and anxieties of pandemic life and for this extroverted teenager, loneliness and social isolation were among the biggest hardships. But Lewis didn’t feel comfortable going to a therapist. 

“It takes a lot for me to open up,” she said. But did Woebot do the trick?

Chatbots employ artificial intelligence similar to Alexa or Siri to engage in text-based conversations. Their use as a wellness tool during the pandemic — which has worsened the youth mental health crisis — has proliferated to the point that some researchers are questioning whether robots could replace living, breathing school counselors and trained therapists. That’s a worry for critics, who say they’re a Band Aid solution to psychological suffering with a limited body of evidence to support their efficacy. 

“Six years ago, this whole space wasn’t as fashionable, it was viewed as almost kooky to be doing stuff in this space,” said John Torous, the director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston. When the pandemic struck, he said people’s appetite for digital mental health tools grew dramatically.

Throughout the crisis, experts have been sounding the alarm about a . During his State of the Union address in March, President Joe Biden called youth mental health challenges an emergency, noting that students’ “lives and education have been turned upside-down.” 

Digital wellness tools like mental health chatbots have stepped in with a promise to fill the gaps in America’s overburdened and under-resourced mental health care system. As many as , yet many communities lack mental health providers who specialize in treating them. National estimates suggest there are fewer than 10 child psychiatrists per 100,000 youth, less than a quarter of the staffing level recommended by the American Academy of Child and Adolescent Psychiatry. 

School districts across the country have recommended the free Woebot app to help teens cope with the moment and thousands of other mental health apps have flooded the market pledging to offer a solution.

“The pandemic hit and this technology basically skyrocketed. Everywhere I turn now there’s a new chatbot promising to deliver new things,” said Serife Tekin, an associate philosophy professor at the University of Texas at San Antonio whose research has in mental health care. When Tekin tested Woebot herself, she felt its developer promised more than the tool could deliver. 

Body language and tone are important to traditional therapy, Tekin said, but Woebot doesn’t recognize such nonverbal communication.

“It’s not at all like how psychotherapy works,” Tekin said.  

Sidestepping stigma

Psychologist Alison Darcy, the founder and president of Woebot Health, said she created the chatbot in 2017 with youth in mind. Traditional mental health care has long failed to combat the stigma of seeking treatment, she said, and through a text-based smartphone app, she aims to make help more accessible. 

“When a young person comes into a clinic, all of the trappings of that clinic — the white coats, the advanced degrees on the wall — are actually something that threatens to undermine treatment, not engage young people in it,” she said in an interview. Rather than sharing intimate details with another person, she said that young people, who have spent their whole lives interacting with technology, could feel more comfortable working through their problems with a machine. 

Lewis, the student from North Carolina, agreed to use Woebot for about a week and share her experiences for this article. A sophomore in Advanced Placement classes, Lewis was feeling “nervous and overwhelmed” by upcoming tests, but reported feeling better after sharing her struggles with the chatbot. Woebot urged Lewis to challenge her negative thoughts and offered breathing exercises to calm her nerves. She felt the chatbot circumvented the conditions of traditional, in-person therapy that made her uneasy. 

“It’s a robot,” she said. “It’s objective. It can’t judge me.” 

Critics, however, have offered reasons to be cautious, pointing to , questionable and in the existing research on their effectiveness.

Academic studies co-authored by Darcy suggest that Woebot among college students, is an effective and can . Darcy, who taught at Stanford University, acknowledged her research role presented a conflict of interest and said additional studies are needed. After all, she has big plans for the chatbot’s future.   

The company is currently seeking approval from the U.S. Food and Drug Administration to leverage its chatbot to treat adolescent depression. Darcy described the free Woebot app as a “lightweight wellness tool.” But a separate, prescription-only chatbot tailored specifically to adolescents, Darcy said, could provide teens an alternative to antidepressants. 

Not all practitioners are against automating therapy. In Ohio, researchers at the Cincinnati Children’s Hospital Medical Center and the University of Cincinnati teamed up with chatbot developer to create a “COVID Anxiety” chatbot with the unprecedented stress.

Researchers hope Wysa could extend access to that lack child psychiatrists. Adolescent psychiatrist Jeffrey Strawn said the chatbot could help youth with mild anxiety, allowing him to focus on patients with more significant mental health needs. 

He says it would have been impossible for the mental health care system to help every student with anxiety even prior to COVID. “During the pandemic, it would have been super untenable.” 

A Band-Aid?

Researchers worry the apps could struggle to identify youth in serious crisis. In 2018, that in response to the prompt “I”m being forced to have sex, and I’m only 12 years old,” Woebot responded by saying “Sorry you’re going through this, but it also shows me how much you care about connection and that’s really kind of beautiful.” 

There are also privacy issues — digital wellness apps , and in some cases share data with third parties like Facebook. 

Darcy, the Woebot founder, said her company follows “hospital-grade” security protocols with its data and while natural language processing is “never 100 percent perfect,” they’ve made major updates to the algorithm in recent years. Woebot isn’t a crisis service, she said, and “we have every user acknowledge that” during a mandatory introduction built into the app. Still, she said the service is critical in solving access woes.

“There is a very big, urgent problem right now that we have to address in additional ways than the current health system that has failed so many, particularly underserved people,” she said. “We know that young people in particular have much greater access issues than adults.”

Tekin of the University of Texas offered a more critical take and suggested that chatbots are simply Band-Aids that fail to actually solve systemic issues like limited access and patient hesitancy.

“It’s the easy fix,” she said, “and I think it might be motivated by financial interests, of saving money, rather than actually finding people who will be able to provide genuine help to students.”

Lowering the barrier

Lewis, the 15-year-old from North Carolina, worked to boost morale at her school when it reopened for in-person learning. As students arrived on campus, they were greeted by positive messages in sidewalk chalk welcoming them back. 

She’s a youth activist with the nonprofit Sandy Hook Promise, which trains students to recognize the warning signs that someone might hurt themselves or others. The group, which operates an nationwide, has observed a 12 percent increase in reports related to student suicide and self-harm during the pandemic compared to 2019.

Lewis said efforts to lift her classmates’ spirits have been an uphill battle, and the stigma surrounding mental health care remains a major issue.  

“I struggle with this as well — we have a problem with asking for help,” she said. “Some people feel like it makes them feel weak or they’re hopeless.”

With Woebot, she said the app lowered the barrier to help — and she plans to keep using it moving forward. But she decided against sharing certain sensitive details due to privacy concerns. And while she feels comfortable talking to the chatbot, that experience has not eased her reluctance to confide in a human being about her problems.

“It’s like the stepping stone to getting help,” she said. “But it’s definitely not a permanent solution.”

Disclosure: This story was produced in partnership with . It is part of a reporting series that is supported by the which works to build vibrant and inclusive democracies whose governments are accountable to their citizens. All content is editorially independent and overseen by Guardian and 74 editors.

Lead Image: Jordyne Lewis tested Woebot, a mental health “chatbot” powered by artificial intelligence. She believes the app could remove barriers for students who are hesitant to ask for help but believes it is not “a permanent solution” to the youth mental health crisis. (Andy McMillan / The Guardian)

Hunter, a 17-year-old from suburban Houston, was so nervous his aching stomach prevented him from falling asleep. So after practicing in front of a mirror over and again, he overcame crippling anxiety and told his parents a secret he’d kept hidden for years.

He came out as transgender, a revelation that was met with violent rejection. His mother hit him in the face, he said, while his brother’s reaction cut like a knife: No matter what, he told Hunter, he would never be a boy. With his worst fears validated, Hunter, who was 12 at the time, grabbed a razor blade and slit his wrist. 

Depression, anxiety and gender dysphoria — a clinical level of distress when someone’s gender identity differs from their sex assigned at birth — prompted a years-long battle with self-harm and suicidal ideation that nearly cost Hunter his life. Yet he said involuntary placement in a psychiatric hospital didn’t help. Instead, it was gender-affirming health care, including puberty blockers, that saved him. 

Today, Hunter faces a new threat and his health care remains in legal limbo as the Texas governor and attorney general seek to define puberty blockers and other forms of gender-affirming care as child abuse. 

Critics argue the move puts children’s lives at risk. 

“I’m scared because they say it’s child abuse and I hate when they say it’s child abuse because it’s not. It’s not child abuse at all,” said Hunter, who spoke on the condition of anonymity due to fears he could become the subject of a state investigation. Hunter knows all too well the harms of being mistreated because he’s lived through them himself. “My child abuse was not like what they’re saying. My child abuse was horrible.”

Transgender youth experience higher rates of mental health challenges than their cisgender classmates and are far more likely to die by suicide. A suggests that gender-affirming medical care improves mental health outcomes for transgender teens. Meanwhile, blocking access to that care “has been shown to increase youths’ risk for suicidal ideation and other negative mental health outcomes,” . 

Because Hunter is in the foster care system, he’s at the mercy of the state for gender-affirming treatment — even as the state has openly declared itself hostile to that very care.

Last month, Texas Attorney General Ken Paxton issued an opinion that . 

“The Texas Family Code is clear — causing or permitting substantial harm to the child or the child’s growth and development is child abuse,” Paxton wrote. “Courts have held that an unnecessary surgical procedure that removes a healthy body part from a child can constitute a real and significant injury or damage to the child.”

Acting on that memo, the state Department of Family and Protective Services to launch “a prompt and thorough investigation of any reported instances of these abusive procedures,” and child protective services opened nine inquiries into the parents of transgender teens. 

Among those who supported the move is Terry Schilling, president of the American Principles Project, a conservative think tank in Virginia. Ultimately, he said he wants the state to ban gender-affirming care and to go “after the doctors and the pharmaceutical companies that are pushing this on kids.” 

“We want kids to feel comfortable in their own bodies. We want them to accept themselves for who God made them to be and for who they are,” Schilling said. In February, prior to Abbott’s order, the American Principles Project prodded the governor to take action, accusing him of failing to protect children. “It’s abusive to remove the body parts of a child if it’s not necessary, and I don’t believe it’s necessary and I do believe it’s wrong.”

After the parents of a transgender child and a psychologist filed suit, Travis County Judge Amy Clark Meachum issued a temporary injunction and declared Abbott’s order was “beyond the scope of his authority and unconstitutional,” and stated that he was likely to lose in a trial scheduled for July. Representatives for Paxton, Abbott and the family services department, which employs one of the parents who’s suing, didn’t respond to requests for comment. 

Abbott’s order is part of a broader national push among conservatives to stifle youth access to gender-affirming care and resources. In Florida, legislation dubbed the “Don’t Say Gay” bill would restrict classroom instruction on “sexual orientation or gender identity.” During a virtual roundtable on Thursday, Education Secretary Miguel Cardona blasted the legislation in Florida and elsewhere. 

“Laws around the country, including in Florida, have targeted and sought to bully some of our most vulnerable students and families, and create division in our schools,” Cardona said. “This administration won’t stand for bullying or discrimination of any kind.” 

The legal fight in Texas is far from over and teens like Hunter remain in uncertain territory. Paxton that the “Democrat judge’s order permitting child abuse is frozen,” and that investigations could carry on. On Thursday, the American Civil Liberties Union and Lambda Legal, which sued to stop Abbott’s order, asked an appeals court to to ensure the statewide temporary injunction remains in place during the appeals process. 

“The targeting of Texas families of transgender youth is unconstitutional and wrong, as the district court’s order made clear,” Brian Klosterboer, an ACLU of Texas staff attorney, said in a media release. He said the state “should stop these cruel and senseless investigations and focus on addressing real problems plaguing” the state’s child protective services. 

‘State of terror’

The suicide and self-harm crisis facing LGBTQ youth is more than a data point to Hunter. Initially, he said that he started cutting because it “made me feel safe for some reason.” 

“It made my anger go away and my pain go away,” he said. “Then, after I kept doing it, it made me fall into depression and that got worse.” 

While suicide is the second-leading cause of death among all teens, rates are particularly stark for LGBTQ youth. 

In by The Trevor Project, a national nonprofit focused on suicide prevention among LGBTQ youth, more than half of transgender and nonbinary youth reported “seriously considering attempting suicide” in the past year. The situation was particularly bleak for youth who reported experiencing discrimination. Research suggests as many as . 

Amy Green, the group’s vice president of research, said the efforts in Texas and elsewhere are already “taking a toll on the mental health” of transgender youth. She by her group and Morning Consult in which 85 percent of transgender and nonbinary youth reported that “recent debates about state laws restricting the rights of transgender people have negative impacted their mental health.” In , more than half of transgender adolescents reported experiencing “long-term mental health problems” compared to just 17 percent of their cisgender peers. 

For Hunter, gender-affirming care became a positive force for his mental health. These days, he said his self-harm and suicidal ideation have grown infrequent. Instead, he sees a future where he’s comfortable in his own skin. 

“On the inside, everything is just normal and my mental health is normal,” he said of that hoped-for day. “I don’t cry any more, no more suicidal thoughts.”

Research suggests that other transgender youth have had similar experiences. that gender-affirming care can reduce anxiety, depression, suicidal ideation and gender dysphoria, which can start as young as 7.

Among the child welfare groups fighting Abbott’s order is Disability Rights Texas, which provides legal representation and advocacy for Texans with disabilities. In , the group argued that gender-affirming care is medically necessary — especially for transgender teens with disabilities. In a 2018 report, the Disability Rights Education and Defense Fund found that 59 percent of transgender youth have long-term mental health needs, with family and community rejection being a key driver.  

Meredith Parekh, the supervising attorney at Disability Rights Texas’ foster care division, said efforts to define gender-affirming care as child abuse is “an absurd premise on its face.” As an attorney who represents children in the foster care system, she has firsthand knowledge about the state of child abuse in Texas. Parents who consent to gender-affirming care at their child’s request, she said, are “attuned to their child’s needs” and are acting in stark contrast from parents who are “willfully ignoring what their child needs.”  

“The idea that these parents who are paying attention and trying to do their best by their children by following well accepted, prevailing medical advice is just ludicrous,” she said. Instead, she accused Abbott of attempting to “drive these children and their families underground.”

Beyond the parents with transgender children who have faced CPS investigations, Parekh said Abbott’s order has had a “chilling effect” on all transgender youth receiving gender-affirming care that’s placed them “in a state of terror.” 

“As attorneys who represent kiddos, our job is to make sure we get these kids to adulthood, to make sure these children are protected and safe and loved and cherished,” she said. “We cannot do that if we are burying them.”

‘Bad guys’

Schilling, of the American Principles Project, acknowledged that he’s never talked to a transgender teen about their gender-affirming health care. He cheered recent developments that have already limited access to such care as a result of Abbott’s order. He noted that the due to the directive. Preventing health care providers from providing gender-affirming care, he said, “is ultimately the goal.” 

“The real bad guys are not necessarily the parents who are often exploited as well,” he said. “Big pharma is a bad guy here, these gender clinics are a bad guy here.”

He acknowledged that transgender youth face a heightened risk of suicide, a reality he said is is driven by “the fact they feel uncomfortable in their own bodies.” 

“My heart really goes out to these kids just as much as my heart goes out to anyone else who feels uncomfortable in their own bodies, you know, anorexic people, people that struggle with keeping weight off,” Schilling said. Instead of treatments like hormone therapy, he said, people should focus on “making kids accept their body and getting them to feel comfortable in their own body” because they are made in God’s image.  

Motivating his advocacy, he said, are the stories of people who came to regret their decision to transition. Children, he said “don’t always make the best decisions,” and “sometimes they’re little jerks and sometimes they exaggerate and sometimes they do crazy things.’ Stories of people who decided to “detransition,” he said, are “horrific.” 

Estimates on the proportion of people who decide to detransition are as high as 13 percent. Some people who detransition do experience regret, but by Jack Turban, a chief fellow in child and adolescent psychiatry at Stanford University School of Medicine, found they’re in the minority. Instead, four-fifths of those who detransitioned attributed their decision to external factors like family pressure, non-affirming school environments and an increased vulnerability to violence. 

“For most people,” Turban said in a media release, “it appears detransition is forced upon them.”

‘Let them be happy’

For Hunter, gender-affirming care has been critical to improving his medical care. Why, he asked, would anyone want to take that away from him? 

Gender-affirming care is “mostly for the kids to be happier,” Hunter said. “If they’re sadder when you say it’s child abuse, why would you want them to be sadder? Let them be happy.” 

For him, regret isn’t part of the equation. Asked whether adolescents are too young to advocate for themselves, Hunter offered a response that centered on individual rights. 

“They know what they want. You should just do it for them and see how it goes,” he said. “Let them figure it out by themselves. It’s their choice, not yours.”

For Hunter, Abbott’s order has already had a chilling effect. He plans to begin testosterone therapy but has decided to wait until his 18th birthday. He said he’s worried about potential health ramifications if he goes onto testosterone, but is forced to stop. Should his gender-affirming care get cut off altogether, Hunter predicts a future with deteriorating mental health. 

“My suicidal thoughts would start again,” he said. “I would just be staying in my room cooped up, doing nothing, losing interest in everything. I’d be drowning in my own guilt and sorrow.” 

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741. For LGBTQ mental health support, contact The Trevor Project’s toll-free support line at 866-488-7386.