Taking Pride in Preventing Suicide: Advocating for LGBTQ+ Suicide Prevention with AFSP’s Alison Kwok

Meet Alison Kwok (they/them), the American Foundation for Suicide Prevention’s Manager of State Policy and Advocacy. In addition to their primary role in AFSP’s Policy & Advocacy Office, they are the Co-Representative of AFSP’s Pride Employee Resource Group (ERG), which brings together AFSP LGBTQ+ staff to ensure our collective voices are reflected both within our organization and in communities across the country. 

For Pride Month, we asked Alison some questions about LGBTQ+ suicide prevention, and what fuels their passion for this work.

Alison, could you tell us a bit about yourself and why this is important to you? 

LGBTQ+ suicide prevention means everything to me because, like many queer and transgender kids of color, I could not see a future for myself that was worth living. Now, as an out, proud, and loud-about-it adult, I get to shape meaningful conversations and public policies that save lives.

As AFSP’s Manager of State Policy & Advocacy and Pride ERG Co-Representative, I get to combine my lived experience, public mental health research and policy expertise, and grassroots organizing background to make a difference. Through this holistic approach, I help guide AFSP chapters nationwide (I support nearly 30 states), as well as colleagues internally, on how we can advocate for public policies, research, and programs. I am proud to be presenting a virtual national offering of AFSP’s new education program, Pride Pathways: Suicide Prevention for LGBTQ+ Communities and Allies, at the end of June in honor of the Stonewall Uprising.

What do we know about the impact of suicide on LGBTQ+ people?

It’s the sad truth that every LGBTQ+ person I’ve ever met has either lost someone to suicide, knows another LGBTQ+ person who has struggled, or has personally struggled with thoughts of ending their life.

We advocate for LGBTQ+ mental health and suicide prevention because saving lives and ensuring access to evidence-based mental health care are public health priorities, not political issues. Advocating for policies, research, and programs that affirm LGBTQ+ people is part of community care. Being a kind neighbor means we do not and should not have to go through this world alone. 

LGBTQ+ people are not inherently at higher risk of suicide because they are LGBTQ+. In reality, it is the harmful experiences that LGBTQ+ people face in society, such as discrimination and hate, that can increase an individual’s suicide risk.

I’ll rattle off some statistics:

• LGBTQ+ people are at higher risk of attempting suicide compared to cisgender heterosexual (straight) people.
• Transgender people experience even higher risk. Almost half (42%) of trans adults in the U.S. have attempted to kill themself at least once in their lifetime.
• 1/3 of young queer folks and almost a half of young trans folks don’t think they’ll live to 35. LGBTQ+ youth of color were more likely to think they wouldn’t live that long, compared to LGBTQ+ white youth.

Due in part to suicide, homicide, and other health inequities, LGBTQ+ people have shorter lifespans on average, especially Black trans women. I want LGBTQ+ people to have a normal lifespan. I want us to not only survive, but live and thrive. 

What are some things you’d like more people to understand about the impact of suicide on the LGBTQ+ community?

LGBTQ+ people are beautiful, not broken. 

For thousands of years and across many cultures, people have lived and thrived outside of the gender binary (man or woman, nothing else) and straight-ness (man and woman, nothing else). Variation in gender and sexuality is part of human nature. 

How a culture reacts to that natural variation can affect how safe and valued an LGBTQ+ person feels, which can then affect their mental health and risk of suicide.

Even through the current onslaught of physical, psychological, and institutional harm, we persist. Even with people creating a culture of fear and legislating against our civil rights and our existence in public spaces, like where we can legally pee, I want every LGBTQ+ person to know they are loved and deserve joy. 

In a world where people are punished and killed for living authentically, existence is resistance.

We have always existed and we will always exist.

Are distinct demographics within the LGBTQ+ community impacted differently by suicide?

Yes, being LGBTQ+ is one facet of someone’s whole person, so other combinations of demographic factors can also affect their risk of suicide. 

For example, autistic people are more likely to be LGBTQ+, which can mean a double whammy of discrimination and misunderstanding if someone is both, like a lot of my besties.

Personally, I have lived a fairly atypical experience as a neurodivergent, mentally ill, second-generation Hong Kong Chinese American who also happens to be queer and transgender nonbinary. When I was a teenager, my mother warned me against falling into the “fad” of being gay. She said, “Woman and man are yin and yang, that is what is natural, and that is how it is supposed to be.” It made me feel like a freak of nature. I carried so much shame. It took a long time for me to reframe this cautionary tale: that the ancient Taoist concept of yin/yang is not so binary. There is a little piece of each color within the other, and the curves are ever-evolving, which all sounds pretty queer to me.

Later, as I became more authentically myself as a trans person, along with love from my chosen family and little sister, I decided to come out to my parents. 

We are doing better now. Sometimes it’s still rocky, but their correctly using my pronouns is not just a language adjustment. It’s a sign of respect: respect that you don’t know me better than I know myself. You do not have to understand someone’s experience to respect them. When I remind you that my pronouns are they/them, that means I trust that you care enough to see me for me: nonbinary and proud. Plus, using gender-affirming pronouns for LGBTQ+ youth lowers their risk of attempting suicide by half. Respecting someone’s pronouns may seem inconsequential, but this small act can help save someone’s life.

What are some key risk factors for suicide among LGBTQ+ people?

• Interpersonal and systemic hate, violence, prejudice, and discrimination.
  • In a single year, I visited the same inpatient psychiatric center for three different queer friends of color after suicide attempts. One of my friends was taken away in handcuffs, and we waited in the hospital all night until she could finally get seen. Since police are not typically trained in mental health crisis response and she came from an immigrant family, we were especially worried this already fraught situation would be worsened considering the many cases of violence inflicted on people of color and LGBTQ+ people. During a mental health crisis, I want to know my loved one will be safe. I don’t want to be worried they will be treated like a criminal, detained, deported, or worse.
• Lack of access to health care, both physical and behavioral: not just gender-affirming or culturally competent, but also in general.
• Family rejection, which can lead to child abuse, homelessness, survival sex work, and other risks.
• Efforts to change another person’s sexual orientation or gender identity, or “conversion therapy”:
  • One friend of mine got kicked out of the house after “failing” so-called “conversion therapy.” Their family completely disowned them, so they were unhoused for years. Even I was surprised that this abusive, fraudulent, and discredited practice still happens. As part of the Ending Conversion Therapy Coalition, AFSP lets everyone know that LGBTQ+ people do not need to be fixed. We are not trash that needs to be thrown away.
• A lifetime of internalizing guilt and shame:
  • For me, “coming out” as queer and transgender has felt a lot easier than “coming out” as a suicide attempt survivor. Maybe it’s because there is more outspoken pride in being LGBTQ+, but I still fight internalized shame around the stigma of mental illness.  

However, being able to openly explore the nuances of feeling suicidal with my LGBTQ+ family of color; working at AFSP in a culture of bringing hope to those affected by suicide; and years of therapy, medication, and time have all helped empower me to tell my story.

What are some key protective factors against suicide among LGBTQ+ people?

• Chosen family
• Legal protections and easing legal administrative burdens: changing birth certificate, etc.
• Gender-affirming care: physical health, behavioral health, medical procedures, vocal training, and more.
• Safe spaces: home, community, school, work (like our Pride ERG), everywhere.
  • Keep in mind that probably someone you know is LGBTQ+: almost 1 in 10 people in the U.S. Being a visible and vocal ally to the LGBTQ+ community could be as simple as wearing one of our AFSP rainbow pins or a sticker with your pronouns even if you’re not trans. That helps signal that it’s safe to be their true self with you.

Just a few weeks ago, at our annual Advocacy Forum, I spoke to over 200 of our Volunteer Advocates about my lived experience as a member of the LGBTQ+ community and as a survivor of suicide loss and personal attempts. Afterwards, two volunteer advocates separately told me how inspiring it was to see me share my story, especially because each was a parent to a trans kid. One of them told me, “I took a picture of you on the stage to send to my kid. I want them to see what it looks like to see another nonbinary person thrive!” 

I sobbed, of course. If sharing my journey helps a single person hold onto the bit of hope that’ll keep them around, I will never shut up.

What are AFSP's policy priorities related to LGBTQ+ individuals and populations? Why is it important to advocate for these policies?

Advocacy can seem scary. You’re vulnerable, pouring some of the worst moments of your life out to a stranger in a fancy suit. I still grapple with imposter syndrome, and this is my actual job. 

I got into public policy by accident. My personal and professional interests have always been in mental health and behavioral sciences, but as a researcher. I didn’t think of myself as someone with a voice, that I had things to say that people would care to hear –– but realizing my queerness empowered me tremendously. I realized that presenting my research at the International Summit on Suicide Research in Barcelona went hand-in-hand with advocating in the Alabama State House. There are endless ways to make a difference!

No matter what your life experience is, you can advocate for suicide prevention. You also don’t have to be LGBTQ+ to advocate for LGBTQ+ suicide prevention, and policies that support LGBTQ+ people can also benefit everyone.

AFSP advocates for policies that support LGBTQ+ people — and more recently, we have unfortunately had to oppose policies that harm LGBTQ+ people, like denouncing the Supreme Court’s decision (on Transgender Day of Visibility) to allow mental health professionals to practice abusive “conversion therapy”. 

There has been an ebb and flow in public support for disproportionately impacted communities. Most recently, anti-transgender legislation has been increasing year on year. Last June, during Pride Month, the federal administration announced the end of the 988 “Press 3” LGBTQ+ youth specialized services. We have been fighting this decision ever since. AFSP supported the introduction of several bipartisan federal bills, including the 988 LGBTQ+ Youth Access Act, to protect the lifesaving line. On the state level, we helped to secure over $1 million in Washington’s state budget and advocate for protection of LGBTQ+ youth in several other states during our Advocacy Action Days. While the “Press 3” option is not yet available again to answer calls and texts, in April, the administration committed to restarting the specialized services soon. AFSP remains dedicated as ever to preventing LGBTQ+ suicide.

What are some things you love about LGBTQ+ people?

• I love that we self-create. Choosing to go through puberty for a second time is no joke, but it’s so worth it.
• We refuse to be caged in by or assimilate to traditional views of gender or sexuality. I love embracing the chaos of going beyond the default.
• We can still cultivate peace and happiness, even when others try to take it from us. Their fear, void of empathy, or hate will not end us. We still honor those we’ve lost every Transgender Day of Remembrance and by living with as much queer joy as we possibly can every day.
• I have a community wherever I go. Places to belong even if I’ve never been. There is a shared understanding about mutual respect, being open to differences, thinking outside the box, and radical community care.
• We have a long history of advocating for our rights. We’ve been resilient through it all, from epidemics to political assassinations, and now it’s our turn to keep up the fight. Everyone can help to prevent suicide in the LGBTQ+ community.
• I love the process of questioning everything, and not accepting things for how they are, how they have been, or how we’ve been taught or socially conditioned.
  • “Are you the way you are because you want to be or because you were told to be?” Be who you want to be. It’s never too late to become more yourself. 

I've lost friends and community members to suicide. I almost lost myself. I've dedicated my life to suicide prevention because I don't want anyone to ever lose anyone else.

Whether in the streets or on Capitol Hill, we can create a world in which everyone feels they have a life worth living.

With hope, from a recovering cynic, 
Alison P. Kwok, MPH (they/them)