Recommendations and Next Steps

Project SPARK’s two-year findings point to the need for multi-level strategies that reduce exposure to stigma-related harm while strengthening the supports that protect LGBTQ+ young people’s mental health. Schools, families, health systems, community organizations, and policymakers all have a role to play in making the places where LGBTQ+ young people live, learn, seek care, and build relationships safer and more affirming. This includes reducing discrimination, victimization, conversion therapy threats or exposure, gender-based exclusion, and barriers to everyday safety, while expanding affirming home, school, peer, and care environments. These priorities are consistent with research showing that family acceptance, social support, and affirming environments are protective for LGBTQ+ youth mental health and suicide-related risk (DelFerro et al., 2024; Nath et al., 2025; Russell & Fish, 2016; Ryan et al., 2010). They are also consistent with Project SPARK’s longitudinal findings showing that affirming home environments, family support, and gender euphoria were associated with lower likelihood of anxiety, depression, self-harm, and suicidal ideation over time. Because average family supportive action scores remained near 2 on a 4-point scale across all three time points, family-focused interventions — such as programs that help parents and caregivers move from tolerance toward active support — stand out as one practical area where meaningful change may be possible.

Suicide prevention for LGBTQ+ young people should extend beyond crisis response to address the social and structural conditions that shape risk over time. Project SPARK findings show that victimization, discrimination, conversion therapy, economic insecurity, and bathroom access barriers were associated with poorer mental health outcomes, self-harm, and suicidal ideation. These findings suggest that suicide prevention efforts should include reducing victimization and discrimination, protecting young people from conversion therapy, addressing housing instability and unmet basic needs, ensuring gender affirmation for TGNB youth, strengthening family support, and expanding access to affirming care — not only individual-level screening or treatment. The significant increase in past-year houselessness during the second study year — a period when many participants were aging into adulthood — highlights a vulnerable transition point, when some young people may be leaving family homes, schools, or other sources of support without stable housing in place.

Additionally, the finding that nearly one-third of participants experiencing suicidal thoughts sought help from no one further underscores the need to build systems that young people perceive as safe, trustworthy, confidential, and accessible before a crisis escalates. At the same time, the significant increase in helpline use during suicidal crises — the only source of support that grew over the study period — suggests that crisis services are reaching more LGBTQ+ young people and warrant sustained investment.

Two additional gaps deserve attention: help-seeking from doctors and general practitioners remained consistently low (4–6%), suggesting that primary care settings are an underused opportunity for suicide risk identification and support; and the strong association between recent mental health-related hospitalization and subsequent self-harm underscores the importance of comprehensive post-discharge follow-up and continuity of care. Continued investment in crisis services, peer support, and culturally responsive mental health care is especially important, but these services must be paired with broader efforts to reduce the conditions that place LGBTQ+ young people at risk. Additionally, because many LGBTQ+ young people turn to online spaces for information, connection, and support, digital spaces should be part of any suicide prevention strategy. Efforts to support LGBTQ+ youth should include both reducing online harassment and strengthening safe, affirming opportunities for online connection.

For TGNB youth, next steps should focus on protecting and expanding access to gender affirmation across social, legal, medical, and community settings. Project SPARK findings show that access to desired hormones, accurate identification documents, affirming home environments, and gender euphoria were associated with better mental health outcomes among TGNB participants, while bathroom access barriers were associated with greater mental health risk. These findings support the importance of policies and practices that help TGNB young people safely access transgender health care, identity documents, affirming schools, appropriate facilities, and tools related to gender expression or transition. The age gap in hormone access at the two-year follow-up (73% among those 18 and older versus 33% among minors) shows how sharply access can differ by age, and why younger TGNB youth may need particular support navigating consent-related, legal, and practical barriers. Prior research also shows that gender affirmation, including chosen name use and access to transgender health care, is associated with better mental health among transgender and nonbinary youth and young adults (Russell et al., 2018; Tordoff et al., 2022). In the current policy context, where restrictions on transgender health care, bathroom access, school participation, and legal recognition remain active areas of debate, protecting access to gender affirmation is central to supporting TGNB youth well-being (KFF, 2026; Movement Advancement Project, 2025, 2026a, 2026b, 2026c).

Mental health systems should also address both access and quality of care. Although most participants who wanted mental health care were receiving it by the two-year follow-up, and perceived helpfulness of care improved substantially over the study period, barriers such as cost, parent or caregiver permission, fear of discussing mental health, fear of not being taken seriously, and concerns that providers would not understand participants’ LGBTQ+ identities persisted. Notably, not wanting to seek a parent or caregiver’s permission was the most commonly reported barrier at the two-year follow-up (49%), underscoring the importance of confidential care pathways and, where legally and ethically appropriate, minor consent policies for mental health services. Moreover, these findings demonstrate that care must be affordable, developmentally responsive, and affirming of young people’s intersecting identities. Mental health providers and systems should be equipped to support LGBTQ+ youth experiencing stigma, family conflict, economic insecurity, suicidal thoughts, and gender-related stressors, while also recognizing positive identity-related experiences such as gender euphoria as part of well-being.

Future Project SPARK analyses will track how LGBTQ+ youth mental health evolves as participants grow older and navigate a changing social and political landscape. Subsequent data waves will clarify if declines in self-harm and suicide attempts persist, whether depression, anxiety, and suicidal ideation remain high, and how changes in risk and protective factors change mental health over time. Ultimately, these insights will help pinpoint where urgent support is needed, identify which protective factors are most effective, and inform how policies and systems can create safer, more affirming spaces for young people.

Project SPARK is an ongoing longitudinal study, and continued participation from participants is essential for understanding how LGBTQ+ young people’s mental health, experiences, and sources of support change over time. Engagement from participants will help ensure that Project SPARK continues to reflect the lives of LGBTQ+ young people as they grow, face new challenges, and build sources of support over time.