Between 1991 and 2017, suicide attempts among black adolescents increased by 73%, while attempts among white youth decreased, according to an analysis of more than 198,000 high school students nationwide (Lindsey, M.A., et al., Pediatricsopens in new window, Vol. 144, No. 5, 2019). Other studies have shown an elevated risk of suicide among African American boys ages 5 to 11 (Bridge, J.A., et al., JAMA Pediatricsopens in new window, Vol. 172, No. 7, 2018).
In response to these startling findings, psychologists are boosting their efforts to address suicide by diagnosing and treating its precursors — such as trauma, depression and anxiety — and raising awareness of the crisis.
“When we have people of the same racial or ethnic group experiencing a disparity for something as tragic and awful as suicide, everybody should be concerned,” says Alfiee Breland-Noble, PhD, founder and board president of the African American Knowledge Optimized for Mindfully Health Adolescents Projectopens in new window, a research and outreach nonprofit based in Arlington, Virginia.
Psychologists are taking action by designing interventions for schools and faith-based communities, crafting messages to encourage help-seeking and training community leaders to recognize signs of mental illness in children and teens. And in 2018, Breland-Noble and other psychologists joined a working group alongside the Emergency Taskforce on Black Youth Suicide and Mental Health, commissioned by U.S. Rep. Bonnie Watson Coleman (D-N.J.) and the Congressional Black Caucus, to probe the worrying trend.
The working group identified major gaps in research, service providers and prevention programs focused on mental health and suicidality among black youth, as well as a lack of funding for future efforts (Ring the Alarm: The Crisis of Black Youth Suicide in America [PDF, 1.5MB]opens in new window, 2019). In response to the group’s findings, Watson Coleman introduced the Pursuing Equity in Mental Health Act of 2019 (PDF, 362KB)opens in new window in December, which proposes more than a billion dollars for research, treatment and prevention efforts.
“It’s a watershed moment because in the 23 years that I've been doing this work, very few people will name and attend to the unique mental health needs of black children,” Breland-Noble says.
Risks for black youth
Across the board, mental health problems such as depression, anxiety and post-traumatic stress disorder put youth at risk for suicidal thoughts and attempts. But many African American children and adolescents face additional challenges, including exposure to violence and racial discrimination, that may further increase their risk, says Sherry Molock, PhD, associate professor of psychology at The George Washington University in the District of Columbia and a member of the working group.
Black youth are also less likely than their white peers to receive care for depression — and when they do enter treatment, it’s often through the juvenile justice system. Breland-Noble says that white children with behavioral problems such as irritability and belligerence are often diagnosed with mood disorders, while black children exhibiting the same behaviors are seen as disruptive and requiring discipline.
“Where we fall down as a field is that we look at the same types of behaviors in white and African American children but diagnose them differently,” she says.
To address such gaps in diagnosis and service utilization, Molock created Helping Alleviate Valley Experiences Now (HAVEN), a suicide prevention approach for faith-based communities (Suicide and Life-Threatening Behavioropens in new window, Vol. 38, No. 3, 2008). The program trains congregants to recognize warning signs of depression and anxiety; works with clergy members to incorporate messages about mental health and help-seeking into Bible study lessons, Sunday school classes and sermons; and aids churches in developing mental health resource directories. Molock has even helped several churches establish on-site counseling centers staffed by licensed mental health professionals.
Others are studying barriers to mental health services in black communities that prevent suicidal youth from getting the support they need. Concrete barriers, such as the cost of care, lack of health insurance, unreliable transportation and a dearth of providers are a big part of the problem, says Inger Burnett-Zeigler, PhD, clinical psychologist and associate professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine.
But psychological factors — including mistrust of the mental health-care system, doubt about the effectiveness of medical treatment and shame around help-seeking — also play a role (The Journal of Behavioral Health Science & Researchopens in new window, Vol. 45, No. 1, 2018; International Journal of Geriatric Psychiatryopens in new window, Vol. 29, No. 2, 2014). To overcome some of these barriers, Burnett-Zeigler leads “Mental Health 101” training seminars in black communities. She helps teachers, youth leaders and other community members learn to recognize signs of depression and trauma and the benefits of turning to mental health professionals in such circumstances.
“Black youth will touch hands with many, many people before they get to a mental health provider,” she says. “It's critical that these folks have the information they need to do a warm handoff.”
Psychologists are hopeful that the proposed Pursuing Equity in Mental Health Act of 2019 (PDF, 362KB)opens in new window, the first national bill to address mental health in black youth, will garner attention for the growing crisis and stimulate progress in research, prevention and treatment. The bill aims to allocate $650 million for research on health disparities, $100 million for patient and community-based research and $250 million to improve culturally competent mental health care in schools. It would also increase the authorized funding level for the APA Minority Fellowship Program. Additional funds are intended to improve cultural competence and diversity among providers, who are still primarily white (APA Center for Workforce Studies, 2018).
APA endorsed the measure, and future APA efforts will involve advocacy for specific provisions and attempts to gain bipartisan support for the bill in both houses of Congress. These activities will become part of a comprehensive health equity advocacy strategy that APA’s Advocacy Office is crafting.
“In all the years I've been doing this research, I've never seen legislation like this,” Molock says. “It’s refreshing that the Congressional Black Caucus is not only bringing attention to the topic — but also putting action behind it.”
The three-digit number 988 has been approved by the Federal Communications Commission as a nationwide suicide prevention hotline number, which will soon redirect callers to the National Suicide Prevention Line, 800-273-TALK (800-273-8255).
Further Reading
- Opinion: Young Black People Are Killing Themselvesopens in new window
Burnett-Zeigler, I., New York Times, 2019 - Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
APA, 2019 - If You Don’t Know, Now You Know: Mental Health Stigma in the Black Communityopens in new window
The Daily Show, 2019 - Addressing Racial and Ethnic Disparities in Youth Mental Health
APA Resource
