Intro
LGBTQI children and youth in Europe face unique challenges that disproportionately affect their mental health, access to healthcare, and their ability to receive inclusive sex education. These barriers, along with frequent experiences of discrimination within healthcare and education systems, make it difficult for these young people to fully exercise their right to health.
The Council of Europe (CoE) recently published an in-depth report that comprehensively examines the barriers LGBTQI people encounter in accessing healthcare. Developed by the Committee of Experts on Sexual Orientation, Gender Identity, and Expression, and Sex Characteristics (ADI-SOGIESC), this report is part of a broader series assessing how well member states have implemented Recommendation CM/Rec(2010)5, aimed at combating discrimination based on sexual orientation and gender identity.
IGLYO contributed vital data and insights for this report, drawing on years of work with LGBTQI youth in health and education. This brief summarises the most critical findings and data, focusing on three key areas affecting LGBTQI youth and children: Mental health, access to trans-specific healthcare for minors, and comprehensive sex education in schools.
1. Mental Health
High Mental Health Disparities
Mental health disparities among LGBTQI youth begin alarmingly early, with studies showing that even by the age of 10, LGBTQI children already face higher rates of mental health challenges compared to their cisgender, heterosexual peers. These challenges include increased levels of depression, anxiety, self-harm, and suicidal thoughts. The statistics are striking; transgender youth are six times more likely to attempt suicide than their cisgender counterparts, bisexual youth are five times more likely, and lesbian or gay youth are four times more likely.
Recent findings from the EU LGBTI survey by the European Union Agency for Fundamental Rights (FRA) revealed that over one-third of young LGBTQI people considered suicide in the past year, with trans, non-binary, and gender-diverse youth particularly vulnerable. Additionally, the “Our Europe, Our Rights, Our Future” survey of children aged 11-17, led by IGLYO and ILGA-Europe, found that 20% of respondents felt sad or unhappy “most of the time.” Among non-binary youth, this figure rose to 47%, and for LGBTQI children overall, it was 48%.
Intersectional Discrimination Compounds Mental Health Issues
For LGBTQI youth facing multiple forms of discrimination, such as those based on race, socio-economic background, or disability, the mental health impacts are even more severe. This report cites IGLYO's research, which shows that young people experiencing intersecting forms of marginalisation, including racialisation, migration status, religion, and economic hardship, report significantly higher rates of anxiety, depression, and isolation.
To address these compounded health disparities, Member States should develop and implement dedicated, devolved national strategies for LGBTI health. These strategies should cover mental health, sexual health, trans-specific healthcare, aged care, and the bodily autonomy of intersex children, ensuring that healthcare provision is inclusive, respectful, and responsive. Each strategy should include a monitoring group to oversee implementation and evaluate outcomes, helping these frameworks evolve to meet the needs of our communities through real-world data and lived experiences.
Bullying and Hate Speech
Bullying and hate speech are major contributors to the mental health struggles of LGBTQI youth and children. Schools, which should provide a safe and supportive environment, are often where LGBTQI students face the most intense bullying. The FRA survey shows that young LGBTI people experience more hate-motivated violence than other age groups, with much of this occurring in schools or being perpetrated by peers.
Shockingly, two-thirds of respondents reported being bullied, ridiculed, or insulted in school because of their LGBTQI identity. This is a significant increase from 2019 when 46% reported similar experiences. Such targeted hate speech leaves LGBTQI youth feeling isolated, which further deteriorates their mental health.
A survey of 17,000 young people across Europe found that half of LGBTI students experienced bullying in school at least once due to their sexual orientation, gender identity, or gender expression or variations of sex characteristics. Research has also shown a link between the mental health struggles of LGBTQI youth and the presence of anti-LGBTQI policies in their country. By contrast, LGBTQI young people living in more supportive environments or with access to gender-affirming spaces report better mental health outcomes.
Early intervention is key to supporting children and young people at risk of poor mental health. Additionally, addressing root issues like bullying, violence, hate speech, and the lack of proper support systems is essential to creating environments where LGBTQI youth feel safe and supported.
Promising Practices in Mental Health Support
Several community-driven initiatives and resources are proving effective in supporting the mental health and well-being of LGBTQI people:
- Community Support and Peer Groups: The Rainbow Support Service in Malta, run by the Malta LGBTI Rights Movement (MGRM), provides a vital community-based service that supports the mental health of LGBTQI individuals. Through one-to-one and group support sessions, as well as a youth group, it promotes self-help and community resilience.
- Toolkits:some text
- GAMIAN-Europe and IGLYO collaborated to produce a toolkit on LGBTQIA+ youth mental health and suicidality awareness, designed “for everyone.” This toolkit provides actionable recommendations for professionals, organisations, and policymakers, along with practical resources.
- Queer Futures 2: This UK study (2019-2023) identified effective early intervention mental health support services for LGBTQ+ youth. It produced a best practices checklist for LGBTQ+ mental health services and guidance for health service commissioners, offering a model for inclusive, supportive care environments.
2. Trans-Specific Healthcare for Minors
Access to gender-affirming healthcare remains one of the most pressing issues for trans youth and children across Europe. Many young trans individuals encounter significant challenges when seeking trans-specific healthcare (TSHC), such as lack of accessibility, affordability, and respect from healthcare providers. These issues are amplified by legal barriers and gaps in healthcare professionals' knowledge, as well as the absence of social support systems.
Legal barriers and access to hormone therapies
One of the primary issues transgender minors face in Europe is navigating the ever-changing legal landscape surrounding their access to healthcare. Many countries have introduced laws that limit access to vital treatments, such as puberty blockers and hormone therapies, for trans youth.
For example, in Italy, the Ministry of Health has inspected Careggi Hospital in Florence, which provides gender-affirming care to children and adolescents, potentially restricting minors' access to puberty blockers. In May 2024, the French Senate approved a draft law banning hormone therapies for those under 18 and imposing severe restrictions on the use of puberty blockers. Similar steps have been taken in other countries, NHS England announced in 2023 that puberty blockers would only be available to minors enrolled in clinical trials, and Sweden has recommended a similar approach. These developments have raised ethical concerns, as some argue that offering treatment exclusively through clinical trials could violate patients' rights, especially since minors may feel pressured to consent in order to receive the care they need.
Trans minors who also belong to other marginalised groups often face compounded challenges in accessing TSHC. For example, trans individuals with disabilities may be denied care based on their disability, those in prison or seeking asylum may have to interrupt their treatment, and others may be forced to pay for their care out of pocket while awaiting asylum decisions.
Waiting times
Even in countries where trans-specific healthcare is legally available to minors, young people often face prolonged waiting times. In the Netherlands and the UK, demand has far outpaced available resources, leading to delays that severely impact trans youth. In England, approximately 8,000 youth are on waiting lists for gender clinics, with waiting times averaging five years for a first appointment. Such long delays have a detrimental effect on trans youth's mental health and overall well-being, as they are left in a prolonged state of uncertainty during critical developmental years.
3. Comprehensive Sexuality Education
Challenges and Gaps
While Comprehensive Sexuality Education (CSE) is recognised as an essential component of inclusive education, significant gaps remain in its implementation across Council of Europe (CoE) member states. Although CSE has proven benefits, including reducing discrimination, promoting gender equality, and promoting respect for sexual and gender diversity, many countries still struggle to deliver CSE that fully addresses issues related to sexual orientation, gender identity and expression, and sex characteristics (SOGIESC). This lack of inclusivity affects both LGBTQI youth, who miss out on crucial support, and their peers, who miss the opportunity to develop empathy and understanding around diverse identities.
Research indicates that when CSE includes SOGIESC topics, the entire school community benefits. LGBTQI students are less likely to experience bullying and more likely to feel safe and accepted, while all students gain from an increased awareness of sexual diversity, prevention of intimate partner violence, and the development of healthy relationships. Yet, despite this evidence, only 12 CoE member states mandate SOGIESC-inclusive content throughout the entire curriculum. This inconsistency leaves LGBTQI students in most countries without the comprehensive support they need and contributes to a pervasive sense of exclusion and vulnerability within educational settings.
Political and Social Barriers to CSE Implementation
In some CoE member states, CSE has become a politicised issue, with efforts to restrict or reverse inclusive educational policies. For instance, in Poland, a proposed bill known as “Stop Paedophilia” seeks to criminalise the provision of sexuality education to minors, and in Hungary, laws enacted in 2021 restrict CSE content by requiring parental consent and banning material deemed to “promote homosexuality.” These actions, which are echoed in other countries such as Georgia and Italy, perpetuate stigma and harmful stereotypes and limit LGBTQI students’ access to accurate information about their identities and health. Educators, often uncertain of the legal framework or concerned about potential backlash, may avoid discussing topics related to SOGIESC issues altogether, leaving LGBTQI youth and children without essential resources and guidance.
Promising Practices in CSE
Despite these challenges, Civil society organisations (CSOs) have been instrumental in advancing inclusive CSE through innovative programmes, resources, and partnerships with educational institutions:
- Bilitis in Bulgaria: This CSO provides teacher training on LGBTQI issues, along with resources to create safer school environments. Bilitis also offers psychological support for LGBTQI students who experience bullying.
- COC Netherlands’ GSA Standard for Education: Launched in 2020, this tool helps Dutch schools evaluate their policies and practices on LGBTQI inclusion, promoting an environment of support for LGBTQI students.
- Väestöliitto in Finland: Finland’s Family Federation integrates age-appropriate CSE into early childhood education, covering essential topics around body autonomy, safety, and emotions.
- It Gets Better Portugal: This organisation developed guidelines to support teachers in delivering inclusive, supportive CSE that acknowledges the experiences of LGBTQI students.
Recommendations for Inclusive CSE
The CoE report recommends that member states take concrete steps to improve CSE inclusivity, urging collaboration with human rights bodies, national ombuds institutions, and CSOs to review and enhance existing curricula. Key recommendations include:
- Developing CSE Action Plans: Member states should establish action plans for all schools that explicitly include SOGIESC topics. The UNESCO framework for SOGIESC inclusiveness in CSE outlines key components, suggesting that education should be protective, sensitive, and transformative to meet the diverse needs of students.
- Mandatory Teacher Training on LGBTQI Topics: Teachers must be equipped to deliver CSE inclusively. Training programmes should cover SOGIESC topics, to ensure all educators have the skills to support LGBTQI students effectively.
- Curriculum Revision with Civil Society Involvement: Revising curricula in partnership with civil society organisations, equality bodies, and human rights institutions is essential for developing materials that reflect LGBTQI students’ lived experiences and combat discrimination in schools.
Conclusion
The findings in this report highlight a pressing need for practical actions to support the health and well-being of LGBTQI youth and children across Europe. Inclusive health strategies that focus on mental health, sexual health, and trans-specific care are essential to lowering the high levels of anxiety, depression, and isolation that so many LGBTQI young people experience.
Moreover, comprehensive sexuality education that openly addresses sexual and gender diversity, creates safer school environments, reduces bullying, and encourages respect and understanding. With stronger LGBTQI-inclusive policies, targeted teacher training, curricula revision, and close collaboration with civil society, member states can make sure LGBTQI youth and children have the resources, protection, and support they need to realise their right to the highest attainable standard of physical and mental health.
Read the original report here: https://www.coe.int/en/web/portal/-/report-highlights-inadequate-healthcare-access-for-lgbti-people-recommends-solutions
