Warning: this article discusses suicidal ideation.

Roughly 40% of youth experiencing homelessness in Canada identify as lesbian, gay, bisexual, transgender, queer, questioning, or two-spirit (LGBTQ2S+) (Abramovich & Shelton, 2017). Not enough people appreciate how high that number is, according to Dr. Alex Abramovich, Independent Scientist at the Centre for Addiction and Mental Health (CAMH) and Making the Shift Network Investigator. He and a team of researchers are conducting a study supported by Making the Shift: Youth Homelessness Social Innovation Lab that investigates the mental health impacts of COVID-19 on LGBTQ2S+ youth in the Greater Toronto Area.

“I think it’s very important to look at specific subpopulations who are over-represented or who are at higher risk of contracting COVID or experiencing homelessness,” Dr. Abramovich says.

The study seeks to understand the specific challenges, coping strategies, and mental health responses for LGBTQ2S youth at risk of, or experiencing, homelessness during the COVID-19 pandemic. The team is administering secure and easily accessible online surveys three times over six months, which include a number of standardized measures that assess suicidal ideation, self-harm, depression, anxiety, and alcohol and substance use. They are also conducting in-depth interviews with a select number of youth and Key Informants from youth-serving organizations to expand on the quantitative data and find appropriate, evidence-based support strategies.

It has been harder than usual to recruit LGBTQ2S young people into the study, who were already difficult to reach because many avoid mainstream services, such as shelters, due to safety concerns, and stay with friends’ families or couch surf.

Before the pandemic, Abramovich’s research team would host information sessions at drop-in centres and other places LGBTQ2S+ youth frequent to create a connection. “In the past, I would have an opportunity to meet youth during recruitment and share a bit about my program of research and about myself, for example, I would share that I am trans, which makes a big difference for youth because people want  to see themselves reflected in the programs they attend and the research they participate in.” Dr. Abramovich says.

Unfortunately, many regular drop-in programs offered to LGBTQ2S+ youth have been cancelled until further notice due to public health measures. Now, the team cannot recruit this way, and these vital community centres are not able to support research like they used to. One way the team has been able to recruit participants into their study is through Instagram’s targeted advertisements. Using Instagram has helped improve recruitment, though it also meant adjusting to new challenges, like working with their online survey company to block cyber scammers who had learned how to sign up en masse for paid research studies.

Despite these setbacks, the team is making headway. So far, the study’s findings are worrying.

Participants are experiencing significant levels of anxiety and depression. Out of 55 youth surveyed thus far, 45 hurt or injured themselves on purpose without wanting to die, known as non-suicidal self-injury, since the start of the pandemic. 47 out of 55 youth reported that they thought they would be better off dead; and 45 out of 55 youth reported that they have thought about attempting suicide. All 55 reported experiencing anxiety; of these, 46 scored very high with severe anxiety. All 55 also reported experiencing depression, 49 of whom scored moderate or moderately severe depression.

A number of youth participants interviewed have mentioned the City of Toronto’s hotel program. To reduce the spread of COVID-19 within the shelters, the City of Toronto leased a number of hotels and relocated people to these spaces.

Dr. Abramovich and his team want to know if the spaces that youth access are inclusive and safe for LGBTQ2S young people: “Are you asking about their gender identity, for example, the pronouns that they go by? And are you ensuring that they don’t get misgendered? Because that’s a big problem for a lot of youth. They say, ‘Oh, the staff refer to me as she but I actually go by he, and they just keep getting it wrong.’ And so that creates a situation for youth where it makes it very difficult for them to be in a shelter or housing program.”

For these reasons, a lot of LGBTQ2S+ youth avoid shelters and end up couch surfing or staying at a friend’s house or sleeping in a park. But lockdown measures have made that kind of arrangement untenable, even illegal. As a result, a lot of youth had to return to abusive situations in their home. “So that’s something that is very important for us to look at: what is happening to those youth who are now forced into an abusive household,” Dr. Abramovich says.

The team has also heard from staff in the homeless sector that there is a lack of knowledge about COVID-19 and its risks. Service providers have said that even youth who have been infected with COVID-19 don’t always believe it is real. Dr. Abramovich thinks this is because current public health messaging is not addressing youth overall, and especially not LGBTQ2S youth.

“For so many LGBTQ2S people, their chosen family is very important to them. And a lot of the messaging around family and the family bubble, you know, it doesn’t always translate well; it really doesn’t work,” says Dr. Abramovich. “A one-size-fits-all approach doesn’t work. And we have to be a bit more flexible in the way that we communicate these types of things, the way that we design, you know, interventions and public health measures. My hope is that this study will help inform some of those decisions.”

As a scientist and activist who faced his own challenges as a queer person coming out, Dr. Abramovich’s research is about making change. He sits on the Government of Canada’s poverty reduction council and is working with all levels of government to help shape policy on poverty reduction.

Despite the severity of mental health issues among LGBTQ2S youth during the pandemic, he has noticed a change in attitudes and is hopeful about the future. “I do believe there is more empathy and understanding. If we talk about youth and children, for example, the government can start to understand things through the eyes of a child, how does a child experience poverty? What is it like to come from a family experiencing poverty?” he says.

Dr. Abramovich anticipates that the impacts of COVID-19 study on LGBTQ2S youth will be complete by autumn 2021. In addition to publishing their research in academic journals, the team will create evidence briefs and recommendations, including public health messaging specific for LGBTQ2S+ youth guided by an advisory board.

If you or some you know is struggling with depression, anxiety, or are experiencing suicidal thoughts there is help. Call the Canada Suicide Prevention Helpline at 1-833-456-4566, send a text to 45645, or visit https://www.crisisservicescanada.ca/en/. You can find more resources at http://www.camh.ca/en/suicide-prevention/get-help.

The Research Team
Research Coordinator – Nelson Pang, MSW
Research Analyst – Amanda Moss, MSW

Co-Investigators: Dr. Carmen Logie, University of Toronto
Dr. Hayley Hamilton, Centre for Addiction and Mental Health (CAMH)
Dr. Sean Kidd, Centre for Addiction and Mental Health (CAMH)
Dr. Michael Chaiton, Centre for Addiction and Mental Health (CAMH)

References
Abramovich, A. & Shelton, J., editors (2017). Where am I going to go? Intersectional approaches to ending LGBTQ2S youth homelessness in Canada & the U.S. Toronto: Canadian Observatory on Homelessness Press. Retrieved from https://www.homelesshub.ca/WhereAmIGoingtoGo