In April 2019, the Congressional Black Caucus (CBC) launched the Emergency Taskforce on Black Youth Suicide and Mental Health. The emergency task force was created to address startling findings from a 2018 research letter in the Journal of America Medical Association (JAMA) Pediatrics which reported, among other things, a 73% increase in the suicide rates of Black youth between the ages of five and 12. The findings debunked long held beliefs about suicide rates among Black youth in general.
Concerned about these findings and seeking additional information on what steps could be taken to address and reverse this trend, the Task Force formed a working group of social work and other mental health professionals chaired by Dr. Michael Lindsay, PhD, MSW, MPH, Executive Director of the NYU McSilver Institute for Poverty Policy and Research. The working group was charged with developing a comprehensive report on this complex issue, including preliminary solutions for families and providers.
The group’s report, Ring the Alarm: The Crisis of Black Youth Suicide in America, expands on prior research by exploring suicide and suicidal behaviors among Black youth, risk and protective factors, mental health utilization, treatment interventions, and recommendations. Black youth under the age of 13 are twice as likely to complete suicide than their White counterparts when controlling for age and sex.
One of the most troubling report findings is that attempts and injury from attempts have increased by 73% for all Black adolescents and 122% for Black adolescent boys, respectively, while suicidal thoughts and plans have trended downward. Black LGBT+ youth were more likely to report suicidal thoughts than their White LGBT+ youth due to higher experiences of rejection and isolation related to their sexual orientation. The deaths of 9-year-old Jamel Myles and 15-year-old Nigel Shelby, both of whom completed suicide following incessant, homophobic bullying, were shocking and terrifying and highlighted unmet mental health needs of LGBT+ Black adolescents.
Suicide rates among 10-19 years old youth was the second leading cause of death in 2017 according to data from the National Vital Statistics System. Overall, rates for youth aged 10-14 declined between 2000-2007 before tripling between 2007-2017.
The rates of completed suicide among Black youth are increasing faster than any other racial or ethnic group. The report identifies several risk factors that may contribute to this trend: mental health concerns, gender, being a part of the LGBTQ+ community, prior suicide attempts, bullying behaviors, socioeconomic factors, family dysfunction, exposure to suicide, and access to lethal means.
Further complicating this matter, Black adolescents who attempted suicide were less likely to have a mental health diagnosis. There are a variety of reasons for this disparity: depressive symptoms in Black youth may present in ways that differ from their White counterparts, under- or misdiagnosis due to a dearth of nuanced assessment tools, and lack of access to appropriate, culturally humble mental health providers.
This last point is of significant importance when considering the Black experience with healthcare providers, including mental health providers.There has long been a well-earned mistrust of healthcare providers among the Black community. Healthcare research over the years has identified implicit bias as a significant factor contributing to healthcare disparities.
More racially and culturally diverse providers, more providers who practice with a true understanding of cultural humility, and acknowledgement of and solutions for these continued disparities among those in healthcare leadership is necessary to help facilitate changes. Without these changes, Black youth may continue to have their mental health issues criminalized; being suspended instead of supported and being funneled to inpatient programs instead of being connected with providers in or near their communities, all of which may exacerbate or expand exposure of trauma.
Social workers should pay close attention to complaints about physical pain and interpersonal conflicts, as depressive symptoms in Black adolescents often manifest in these ways. Johnathan Singer, Ph.D., LCSW, President of the American Association of Suicidology and an NASW member, highlights some ways that social workers can be more effective in addressing adolescent suicidal thoughts and behaviors: know your role, know your students, know your community, know your tools, and know your resources.
Anti-bullying laws are in place in all 50 states. However, only 21 states have LGBTQ-inclusive protections. Research by the Williams Institute at the UCLA School of Law found that implementing LGBT-inclusive bullying laws leads to lower rates of teen suicide attempts.
Human Rights Campaign and the University of Connecticut’s 2019 Black and African American LGBTQ Youth Report found that only 35% of Black LGBT+ youth felt comfortable being themselves in school. Two-thirds reported being verbally assaulted because of their identify and one-third reported being physically threatened.In addition to practicing he cultural humility, mental health professionals should be open to discussing sexual orientation and gender identity, advocate for LGBT+ youth and provide educational resources for teachers, parents, and students.
The Task Force report identifies four broad goals to address the issue of suicide specifically and mental health in general among Black adolescents. The authors suggest:
- increased government funding for research through National Institutes of Health (NIH), National Institute of Mental Health (NIMH) or other funding sources to focus on this topic with this population;
- increasing population-level research grant awards;
- promoting the use of evidence-based interventions that have proven to be effective with Black adolescents among school personnel, clinicians, and other providers;
- collaboration between the Taskforce and the Working Group with other stakeholders through technical assistance, state and local government advocacy and public-private partnerships.
In December 2019, in conjunction with the report’s release, Rep. Watson Coleman (D-NJ) introduced the Pursuing Equity in Mental Health Act of 2019 (H.R. 5469). The bill proposes the following:
- $250,000,000 in funding to develop comprehensive school-based mental health programs to assist children in dealing with traumatic experiences, grief, bereavement, risk of suicide and violence
- Training students in the fields of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance abuse counseling in core competencies to address mental health disparities
- $20,000,000 in funding to Federally Qualified Health Centers to establish interprofessional behavioral health care teams that serve higher proportions of racial and ethnic minorities
- $10,000,000 to advocacy and behavioral health organizations to develop and implement outreach and education strategies to reduce stigma associated with mental health conditions
- NIMH and the National Academies of Science, Engineering and Medicine to conduct a joint study on mental health disparities, taking into consideration exposure to community violence, Adverse Childhood Experiences, and other psychological traumas
- $100,000,000 to NIH to build relationships with communities and conduct or support clinical research and $650,000,000 to NIMH to fund research on racial and ethnic disparities in mental and physical health
- Reauthorizes the Minority Fellowship Program with $25,000,000 in funding
- Establish the Commission on the Effects of Smartphone and Social Media Usage on Adolescents
- No Federal funds for conversion therapy or other pseudoscientific practices geared towards changing an individual’s sexual orientation
The National Association of Social Workers signed on to a letter of support for the Pursuing Equity in Mental Health Act endorsed by several mental health organizations. NASW continues to support efforts to prevent suicide and promote healthcare equity.
Prepared by Takia Richardson, LICSW, LCSW