LGBTQ+ Crisis Services in the United States
The rise and fall of the 988 “Press 3” option.
Posted May 14, 2026 | Reviewed by Devon Frye
In the United States, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) history is a tangled web of civil rights battles, mental health challenges, and political warfare. Psychoanalysts and other early- and mid-20th-century students of the mind considered queerness a disease or something to be fixed. Homosexuality was classified as an illness in the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) until 1973. Less frequently discussed is that language pathologizing queerness remained explicit (e.g., “ego dystonic homosexuality” or “marked distress about one’s sexual orientation ”) until the publication of the DSM-5 in 2013 (McHenry, 2022), and the pathologization of queer identities has still not disappeared entirely, with gender dysphoria remaining a diagnosable condition to this day. Alongside the use of pathologizing language in psychology and psychiatry , LGBTQ+ individuals faced pervasive and dangerous threats to their health and well-being, from the devastation of the Stonewall Uprising in the late 1960s to the AIDS epidemic in the 1980s and the Don’t Ask, Don’t Tell policy of the 1990s.
Nevertheless, resiliency flourished in the LGBTQ+ community, with the creation of organizations like PFLAG (originally Parents and Friends of Lesbians and Gays), the Human Rights Campaign, and the Trevor Project. These organizations recognized the need for community support and resources to address the physical, mental, and social challenges that queer individuals, and particularly youth, face every day, not least of which is an increased risk of suicidal ideation, behaviors, and attempts (Wallace et al., 2024). As the 21st century has progressed and societal views on queer civil rights have shifted in a generally positive direction (Minkin et al., 2025), there has come added awareness of the need for queer-focused resources, particularly those focused on suicide prevention and intervention.
One manifestation of this recognition has been the development of targeted crisis intervention services designed specifically for LGBTQ+ individuals. In 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) partnered with the Trevor Project to provide specialized subnetwork services for LGBTQ+ youth, a three-digit hotline to simplify access to mental health crisis support across the United States. After calling the 988 Suicide and Crisis Lifeline, LGBTQ+ callers could “Press 3” to access trained volunteers with specific knowledge and skills to assist queer youth. Evidence indicates that such population-specific hotlines increase help-seeking by providing culturally sensitive care (Zabelski et al., 2023 ).
Although usage of the “Press 3” option steadily increased (Sciacca, 2025), SAMHSA discontinued it July 17, 2025, citing exhaustion of allocated federal funding for the LGBTQ+ youth subnetwork and a desire to “no longer silo” services by demographic group. Eliminating this opportunity was worrisome to advocates, public health experts, and legislators, given the help-seeking barriers LGBTQ+ youth face (McDermott et al., 2018), and the responses were swift. In January of 2026, MacKenzie Scott, a well-known American author and philanthropist, made a historic $45 million donation to The Trevor Project. This contribution demonstrated both the provision of a practical lifeline for LGBTQ+ youth and symbolic affirmation that their safety and well‑being matter. The Trevor Project launched an Emergency Lifeline Campaign emphasizing community support, urging direct contributions to specialized services outside of the 988 infrastructure.
Several state governments took steps to ensure continued LGBTQ+ youth access to affirming crisis support. Illinois announced efforts to preserve or expand LGBTQ+-competent crisis support (Illinois Department of Human Services, 2025; California Health and Human Services Agency, 2025) while California ordered training for 988 operators to provide tailored support to LGBTQ+ callers and facilitate warm hand-offs to The Trevor Project. Others invested in training, community partnerships, and funding mechanisms to maintain specialized crisis support locally (Nath et al, 2025). As adaptive as these responses have been, they highlight uneven access depending on state resources and political will. However, large foundations and individual donors are increasingly filling funding gaps left by public divestment, illustrating the shift in funding for specialized crisis services from the public domain to private donors.
It is imperative that support for LGBTQ+ suicide prevention and services that explicitly provide queer-affirming resources continue in the absence of the dedicated 988 pathway. Individuals and community members can signal safety and affirmation through visible cues, such as pride flags, accurate pronouns, and explicit LGBTQ+-affirming language, regardless of the setting (Zullo et al., 2021; Szkody et al., 2025). Community members can engage in direct suicide prevention through open questioning about suicidal thoughts, reducing access to lethal means, and offering or volunteering for resources such as the Trevor Project, local hotlines, and affirming services like gender - sexuality alliances, TrevorSpace, and online groups (McDermott et al., 2024; Morris-Perez et al., 2023) to buffer against isolation and suicidality (Zullo et al., 2021; Madireddy & Madireddy, 2022; Wilson & Cariola, 2019; McDermott et al., 2024; Worrell et al., 2022).
Clinical providers can provide explicitly affirming care, use chosen names/pronouns, validate identities, and post LGBTQ+‑affirming symbols in clinics (McDermott et al., 2021). Providers can incorporate LGBTQ+ risk into suicide‑prevention trainings and attend continuing education on suicide risk within the LGBTQ+ community (Madireddy & Madireddy, 2022; DelFerro et al., 2024; Morris-Perez et al., 2023). Key protective factors can be addressed by fostering family support, offering gender‑affirming care and safe exploration of identity , and providing alternatives to 988 (e.g., queer‑specific hotlines, community resources) on clinic websites and discharge paperwork (Ream & Peters, 2021; Wallace et al., 2024; Zullo et al., 2021; Szkody et al., 2025; Agrawal et al., 2023).
Clinical researchers can build and assess queer‑specific interventions (e.g., affirmative cognitive behavioral therapy , peer‑driven models, digital help‑seeking programs) and implement intersectional, youth‑rights frameworks centering youth voices and rights in service design. Clinical advocates can include LGBTQ+ youth in policy advocacy and advocate structurally by promoting evidence‑based suicide prevention strategies and LGBTQ+‑affirming policies in schools, healthcare, and legislation (Wilson & Cariola, 2019; Marraccini et al., 2022; Williams et al., 2021; Morris-Perez et al., 2023).
Despite innumerable obstacles, the LGBTQ+ community and its allies have shown incredible resilience . It is up to us as individuals, providers, researchers, and advocates to continue to show up in meaningful ways now that those we support cannot simply “Press 3.”
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Williams, A. J., Jones, C., Arcelus, J., Townsend, E., Lazaridou, A., & Michail, M. (2021). A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PloS One , 16(1), e0245268.
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