# “We Want Our Therapist to Talk With Us About Sexuality and Gender Diversity”: Qualitative Perspectives of Adolescents and Professionals in Youth Mental Health Care

## TL;DR

Adolescents in mental health care want to discuss sexuality and gender identity, but professionals often hesitate due to barriers like discomfort and cultural concerns.

## Contribution

The study reveals a disconnect between the importance of discussing sexuality and SOGI and their actual integration into youth mental health care.

## Key findings

- Youth view discussions about sexuality and identity as essential to their well-being.
- Professionals face barriers such as discomfort and cultural sensitivity when addressing these topics.
- Youth desire professional-initiated, confidential conversations about sexuality and medication side effects.

## Abstract

Youth receiving mental health care often face challenges related to romantic relationships, sexuality, and sexual orientation and gender identity (SOGI). Although widely recognized as relevant, these topics are infrequently addressed in youth mental health care. This study explored how youth and mental health professionals experience discussions about sexuality and SOGI in clinical practice.

In-depth interviews were conducted with 21 youth aged 15–22 years receiving psychiatric care, alongside three focus groups with 20 mental health professionals, at a youth mental health center. Data were analyzed using thematic analysis.

Youth described romance, sexuality, and identity as a normal part of life and closely linked to their well-being, while mental health difficulties often complicated relationships and identity processes. Professionals reported hesitation in raising these topics due to practical and personal barriers. Cultural and religious contexts shaped experiences, particularly for LGBTQ+ youth. Both groups emphasized the importance of addressing sexual side effects of psychotropic medication.

This study highlights a gap between the recognized relevance of sexuality and SOGI and their discussion in everyday practice. Youth want these topics addressed in mental health care conversations. Bridging this gap requires proactive, youth-centered and culturally sensitive communication, supported by training and institutional attention.

Youth is a stage when young people explore relationships, sexuality, and questions about sexual orientation and gender identity (SOGI). These experiences are central to well-being, but for youth with mental health conditions they can be more difficult. Symptoms and medications may affect intimacy, and LGBTQ+ youth may face stigma or rejection, especially in cultural or religious settings. Despite their importance, these topics are rarely addressed in youth mental health care. This study explored the perspectives of adolescents and mental health professionals (MHPs). We interviewed 21 youth (15–22 years) in psychiatric care and held three focus groups with 20 MHPs (26–55 years) at a youth mental health center in Amsterdam. We analyzed their views on sexuality, gender, and communication in treatment. Youth said romantic and sexual experiences could boost confidence but also cause insecurity or harm, especially without consent. Mental health problems often made it harder to form healthy relationships. LGBTQ+ youth described added stress from stigma and lack of acceptance. Several reported sexual side effects from medication that were not discussed with them. Cultural and religious influences could be either challenging or protective. Conversations about sexuality and gender identity were strongly desired by youth. Both groups agreed that professionals, not patients, should initiate them, in private and with clear explanations. Barriers included clinician discomfort, parents in the room, and uncertainty about language. Facilitators included trust, training, and supportive environments. Respectful, confidential conversations about sexuality, gender, and medication side effects should be a routine part of youth mental health care. Professional-initiated dialogue can build trust, improve engagement, and better support.