Black Adolescent Suicide Rate Reveals Urgent Need to Address Mental Health Care Barriers

Black adolescents are significantly less likely than their peers in other demographic groups to receive mental health care. This is due, in part, to systemic inequities, including racism and poverty, as well as deeply rooted stigma around mental health and well-founded cultural mistrust of the health care system.

A 2019 report to Congress put forth recommendations to address this crisis, including best and promising practices to improve how health care providers can better meet the needs of Black youth experiencing suicidality (the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of an elaborate suicidal plan). Three strategies include increasing cultural competency among health care providers, expanding the use of suicide screening tools, and conducting more research to understand risk factors, according to Dr. Michael Lindsey, Dean and Paulette Goddard Professor of Social Work at New York University’s Silver School of Social Work. Lindsey led the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health that produced the report.

Culturally competent suicide care providers

Mental health providers should be trained in implicit and unconscious biases and in identifying signs of depression and suicidal behaviors in different racial and ethnic groups. For example, research shows that Black youth may express symptoms of depression—a risk factor for suicide—differently than their White peers, including through behaviors such as anger, aggression, or irritability, as opposed to sadness or lack of interest in daily activities.

When providers do not share this understanding or are not trained to provide culturally competent care, such behaviors are too often misclassified and met with extreme or inappropriate responses, including inpatient (rather than outpatient) treatment or disproportionate disciplinary actions. The effect is a deepened cultural mistrust of mental health professionals.

“And when a Black child or their caregiver experiences this mistrust, it can delay or prevent treatment,” said Lindsey.

Use of suicide risk screening tools and interventions

Across all young people who die by suicide, research shows that only 32% had a mental health care visit in the year before their death, yet nearly 78% interacted with the overall health care system. Health care providers are uniquely positioned to identify and support adolescents experiencing suicidality, but among Black youth, symptoms of suicidality are often under- or misdiagnosed.

To identify suicide risk and help ensure that young people receive the care they need, the American Academy of Pediatrics issued a recommendation in 2022 that all pediatric providers screen patients 12 years old and older for suicide risk at least once a year. “For children and adolescents, screenings enable us to catch warning signs that parents, caregivers, or school personnel may miss,” said Lindsey. And while screening is a vital first step, connecting at-risk individuals to appropriate, accessible follow-up care and ensuring that they adhere to treatment is imperative to suicide prevention.

Yet many people are not receiving the care they need to reduce their risk of suicide. “We know that less than half of young people go on to outpatient treatment after being seen in the emergency department for deliberate self-harm, and that proportion is lower for Black youth than their White counterparts,” said Lindsey.

Research to improve understanding of risk factors

As Black youth suicide rates continue to climb, additional research is needed to better understand the risk factors and protective factors—circumstances that increase or protect against suicide risk—specific to this group. Authors of the 2019 report to Congress called for increased federal funding and resources for studies on risk factors such as stigma, protective factors such as a strong sense of cultural identity and connectedness to the community, and mental health care access and engagement among Black youth.

“I am heartened by the fact that since our report, the National Institute of Mental Health (NIMH) is allocating more research dollars to address the issue. Other advocacy organizations are stepping up to the plate with attention and resources as well,” said Lindsey.

With NIMH funding, Lindsey is now leading a study to assess how culturally adapted screening tools and prevention interventions in two New York City emergency departments can better connect Black youth who are experiencing suicidality to the appropriate treatment. Separately, he’s also leading a study that analyzes national survey data to identify additional risk factors associated with suicidal ideation (a range of contemplations, wishes, and preoccupations with death and suicide).

“Unfortunately, the rising rates of suicide behaviors in Black children and adolescents have continued since our original report,” said Lindsey. “We must gain a better understanding of this trend—and what risk factors we may be missing—to design effective suicide risk screening tools and interventions for this population.”

Farzana Akkas is a senior associate and Allison Corr is an officer with The Pew Charitable Trusts’ suicide risk reduction project.

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