As marriage equality continues to advance in the states and before the Supreme Court, policymakers are increasingly demonstrating an interest in lesbian, gay, bisexual, or transgender, or LGBT, families and how marriage equality can impact the health of children. Experts recognize that “it is in the best interest of children that they be able to partake in the security of permanent nurturing and care that comes with the civil marriage of their parents, without regard to their parents’ gender or sexual orientation.”

Despite the fact that our current focus is mostly on marriage equality and relationship recognition, there is much more to the story than that. Bullying, family rejection, and homelessness are also real threats to the health and well-being of LGBT young people. Every day, thousands of LGBT youth in the United States face injustice in schools, danger in their homes, or uncertainty on the streets.

But these threats are not inevitable, and they are not unstoppable. Policies and programs that have been proposed in Congress can help reduce the devastating impact of these dangers to LGBT youth and they are the key to ensuring that these children and young adults can grow up free of the discrimination and danger that currently threaten them.

Below we detail three preventable threats to the health of LGBT youth across the country—and the public policies that can reduce their harm.

Bullying

All too often, schools are not the safe spaces they should be for LGBT youth, who experience bullying and harassment at alarming rates. Studies show that between 78 percent and 86 percent of LGBT students experience verbal harassment in their schools because of their sexual orientation or gender identity. Nearly a quarter of LGBT students report being physically attacked in school. These acts of bullying were not only student-to-student incidents: In a national survey, nearly a third of transgender respondents reported being verbally harassed by teachers or staff in a K-12 school, 5 percent reported being physically assaulted by these adults, and 3 percent reported being sexually assaulted.

Some of the health implications of the harassment these students face are seen at the time of the incidents. Bullying can directly and immediately result in physical injury and significant emotional distress.

But the health effects of bullying also extend well beyond the time of the harassment. LGBT youth who are victims of bullying are at increased risk for depression and anxiety, and studies show other negative health outcomes as well. In a national survey of transgender adults, the long-term consequences of severe bullying were among the most alarming findings of the study. Nearly one-sixth of respondents who were out as transgender faced bullying so severe that it led them to leave school in grades K-12 or in higher-education settings. Of these individuals, nearly half reported experiencing homelessness, and the HIV infection rate in this group was eight times higher than the rate found in the general population. Worse still, more than half of transgender people who faced harassment or violence in schools because of their gender identity reported attempting suicide, and this rate increased for individuals who faced physical or sexual violence from teachers or staff.

With the bleak outcomes of bullying brought to light, it is clear that policymakers must act to protect LGBT youth in their schools, and a bill introduced this year would do just that. The Student Non-Discrimination Act would provide protections against bullying and harassment for LGBT youth, as well as meaningful consequences—including loss of federal funding and a legal cause of action for victims—for discrimination in public schools based on sexual orientation or gender identity. The positive health effects of passing this legislation have been noted by the American Psychological Association, which says that the law would “make critical progress toward protecting the psychological and physical health of [LGBT] youth.” If lawmakers are truly dedicated to the well-being of American students, protecting them in schools and passing the Student Non-Discrimination Act would be an excellent start.

Family rejection

Unfortunately, many LGBT youth not only face danger in the classroom, but also lack support in their own homes. Half of LGBT youth experience a negative reaction from their parents when they come out of the closet and disclose their sexual orientation or gender identity. Young people who come out to their parents are vulnerable to rejection and are at an increased risk of victimization with significant long-term health consequences.

Family rejection is correlated with increased depression, suicidal behavior, substance abuse, and HIV risk in LGBT youth. LGBT young adults who lack family support are more than eight times more likely to attempt suicide, nearly six times more likely to report high levels of depression, and are more than three times more likely to use illegal substances or engage in unprotected sex. What’s more, homeless LGBT youth frequently report that family conflict or rejection is the primary reason for their homelessness.

Family acceptance and rejection is a two-way street. Studies have shown that even in the face of significant institutional barriers to health and well-being, family acceptance has a protective effect against adverse health outcomes for LGBT people. Families that stand by their LGBT children insulate them from many health risks, including HIV infection and suicidal ideation. The connection between family rejection or acceptance and the health of LGBT youth is unquestionable, and yet this critical aspect of family support is largely left unaddressed in federal policy.

Some members of Congress have sought to address family rejection head-on. In May 2011 then-Sen. John Kerry (D-MA) introduced the Reconnecting Youth to Prevent Homelessness Act, a bill that would provide federal support for programs aimed at improving family relationships and reducing homelessness for LGBT youth. These programs would include concrete, research-based interventions and family-focused educational tools to help identify LGBT youth at risk for family rejection, to provide behavioral interventions to promote family acceptance, and to help families understand the importance of supporting their children. This bill has not been reintroduced in the 113th Congress, but the implementation of programs aimed at promoting acceptance could make a world of difference for LGBT young Americans and their families.

Homelessness

Harassment at school and family rejection all too often combine with failures of our social safety nets to contribute to a third threat to the health of LGBT youth: homelessness. Between 20 percent and 40 percent of homeless youth are LGBT, meaning that hundreds of thousands of LGBT children and young adults are living on the streets each year. Homelessness disrupts the lives and development of these young people and can lead to significant negative outcomes in mental and physical health, lower educational attainment, and economic instability. In short, lack of a stable home presents barriers to a healthy and productive adulthood.

These youth face more than just the significant risks associated with a lack of shelter—they are also exposed to dangers that can follow them for the rest of their lives. Homelessness can take a toll on the mental health of LGBT young people: Studies show that gay and lesbian homeless youth are more likely to be experiencing depression and post-traumatic stress disorders than heterosexual homeless youth. LGBT homeless youth also report higher rates of unprotected sex and HIV infection than non-LGBT homeless youth.

Living without shelter and adult protection leave these children and young adults vulnerable to exploitation and abuse. As many as 58 percent of LGBT homeless youth in some parts of the country report being sexually victimized, and a significant number also engage in survival or transactional sex to meet their basic needs. Most alarmingly, 62 percent of LGBT homeless youth have attempted suicide—a rate more than twice as high as heterosexual nontransgender homeless youth.

As with bullying and family rejection, homelessness is an issue that can be tackled through smart public policies. The Runaway and Homeless Youth Act has existed in various iterations since 1974 and is intended to provide services and interventions for out-of-home youth. These programs, however, are not currently administered in a way that specifically addresses the needs of the LGBT youth. Congress has the opportunity to meet the needs of this population by including nondiscrimination protections in the law and by requiring grant applicants to include LGBT youth in their programmatic plans to qualify for federal funding. Ensuring adequate funding for these services is also vital. The Runaway and Homeless Youth Act is up for reauthorization this year, but Congress has not yet acted on the opportunity to provide funding for the programs that are lifesaving for homeless youth or to address the dire needs of LGBT young people who are forced out of their homes and schools.

Conclusion

For thousands of LGBT youth in the United States, daily life is fraught with perils that no child should have to face. Severe harassment in school, rejection from family, and the prospect of not knowing where they will sleep at night all significantly harm the health and well-being of these youth.

If policymakers are truly concerned with family values and the future of American children, they must do more than ensure the future of marriage equality. They must also acknowledge the terrible realities faced by LGBT youth and act on policies that can save their lives and ensure that all of America’s children have a fair chance at a better tomorrow.

Andrew Cray is a Policy Analyst with the LGBT Research and Communications Project at the Center for American Progress.