Original article written by Annie Ma for AP News.
This story is part three of an AP series examining the health disparities experienced by Black Americans across a lifetime.
To her students who need the most support, India Strother is rarely just “Ms. Strother” — she’s a family figure they call “Mom,” a trusted guide as they negotiate their teenage years.
They open up to her about their dating lives. About pregnancy scares. About their fights with their parents, about the trauma they experience outside school. She keeps a mental list of those at risk of self-harm or suicide, and checks to see how they are doing. It's just part of the job of being a counselor at any American high school.
But at predominantly Black schools like the one in Columbus, Ohio, where Strother works, students’ mental health is further tested by pressures and discrimination they endure because they are Black, as well as poverty and violence in some communities that have faced years of disinvestment.
“Anytime you deal with African American mental health, you’re not dealing with one thing,” Strother said. “It is several things. It is trauma that has not been addressed.”
The drivers of the mental health crisis for Black children begin early and persist through a lifetime. Black children’s first encounters with racism can start before they are even in school, and Black teenagers report experiencing an average of five instances of racial discrimination per day. Young Black students are often perceived as less innocent and older than their age, leading to disproportionately harsher discipline in schools.
Black adolescents are far less likely than their white peers to seek and find mental health care. In part, that’s because Black families often distrust the medical system after generations of mistreatment — from lack of access to care to being subjected to racist practices and experimentation like the Tuskegee Study. The country also has a shortage of providers who understand the roles that racial identity and racism play in shaping young Black people’s mental health.
Research and health surveillance data point to a growing mental health crisis among Black youth over decades. Between 1991 and 2019, Black adolescents had the highest increase among any racial or ethnic group in prevalence of suicide attempts — a rise of nearly 80%.
About 53% of Black youth experience moderate to severe symptoms of depression, and about 20% said they were exposed to racial trauma often or very often in their life.
These disparities and lived experiences have systemic roots, including discrimination in housing, education and health care, and they have led to Black people experiencing higher rates of poverty and being underinsured. But financial stability does not shelter Black youth from the toll of racism on their mental health, said Dr. Alfiee Breland-Noble, a psychologist and founder of the AAKOMA Project, a mental health nonprofit focused on youth of color.
“Socioeconomic status adds another layer to it, but that’s not the thing that’s driving a lot of the behaviors that our young people are experiencing,” she said. “It’s the fact that people make assumptions about Black kids, based purely on their stereotypes.”
As young as 4 to 6 years old, children of color begin to experience race-based traumatic stress, said Dr. Steven Kniffley, a licensed psychologist and senior associate dean for diversity, equity and inclusion at the University of Cincinnati College of Medicine.
Racism affects mental health on multiple levels. Besides direct hostility and microaggressions, experts said seeing people of color subjected to racist violence also takes a toll. Called vicarious racism, research has found it can result in greater symptoms of depression and anxiety.
“When we think about our young folks specifically, because of the strong influence of social media on their lived experience, they’re constantly inundated and really overexposed to all the bad things that are going on in our society,” Kniffley said. “You see a police shooting, and they’re retraumatized over and over again.”
In the Columbus area, the killing of 16-year-old Ma’Khia Bryant brought the feeling close to home for Black girls in the city. Bryant was holding a knife during a confrontation with a woman at her foster home when police shot the teen. But Bryant’s family later revealed it was Bryant who had called for police to come to the scene, saying she was being attacked and needed help.
The shooting made Fran Frazier, founder of the Columbus-based Black Girl Rising, want to do something for Black girls in the city, who she said felt denied of their girlhood and “adultified” — viewed as older and less innocent. She bought time on a radio station and asked Black women in the area to read love letters to Black girls on the air.
“Our girls have the assumption that, ‘If we don’t look like you think we’re supposed to look, then you can address us as adults,’” Frazier said. “‘You’re not thinking about us as actual girls.’”
Frazier led a 2011 study into the lives of Black girls in Ohio that forms the basis of her work now with young Black women around mental health, leadership and resilience.
Through the Black Girl Think Tank, Frazier said participants identified six key areas affecting Black girls’ mental health: colorism, bullying, body shaming, lack of conflict resolution skills, depression and LGBTQ+ issues.
While nearly all the girls who responded said they liked being Black, and liked being a girl, they felt they had been treated unfairly for being both.
“When you are walking around every day, being reminded that you are a female, that you are a female of color, and nobody in the world actually likes you, that helps you see what the future could be like,” Frazier said. “Our girls have a lot of hope, but not necessarily what they need to get there.”
Suicides for all Black youth between the ages of 5 and 17 climbed between 2003 and 2017 — but the increase was sharpest for girls and 15- to 17-year-olds. A Centers for Disease Control and Prevention survey found that 22% of Black youth had considered suicide in the past year. For Black youth who are also LGBTQ+, that number was 44%, according to the Trevor Project, a suicide prevention and crisis intervention organization.
Individually and systemically, barriers to accessing mental health care disproportionately deter Black teens from getting the support they need.
The cost of care — sometimes hundreds of dollars for a single therapy session if providers don’t take insurance, and many do not — can make services inaccessible, but poverty and insurance rates do not fully explain the disparate outcomes.
The fear of being misunderstood or even mistreated by the medical establishment is not without foundation. Most mental health care providers are white — only 4% of psychologists are Black, according to the American Psychological Association. And 80% of mental health providers are not trained in treating race-based trauma, said Kniffley, the psychologist.
Racist treatment of Black people in medical care dates to slavery, and psychiatry and psychology are not exceptions. In 1851, physician Samuel Cartwright hypothesized that mental illness was what drove enslaved Black Americans to escape to freedom. Termed “drapetomania,” the belief was rooted in the idea that slavery was such an improvement to Black peoples’ lives that only those who were mentally ill would wish to escape.
And in 1968, psychologists Walter Bromberg and Franck Simon developed the theory of “protest psychosis,” the idea that Black male participation in the Civil Rights Movement caused violent, schizophrenic symptoms.
“That legacy has contributed to a mistrust that Black and brown folks have where their experience has been pathologized,” Kniffley said. “They’ve been overlabeled with behavioral challenges and learning challenges that have very real-world consequences in terms of what type of schooling you get, what type of jobs are accessible to you, how people treat you.”
Psychologists have taken steps to acknowledge their profession’s history. In 2021, the American Psychological Association issued a public apology and resolution noting psychology’s roots in eugenicist and racist ideas and the negative impact that the field has had on communities of color. The resolution called for prioritizing training and policies meant to address these inequities.
Though Black parents, activists, clinicians and teens said in interviews that while they feel the stigma of mental health has lightened overall, individual experiences are still shaped by pressure to keep personal struggles private.
A distrust of formal systems still lingers among Black Americans in response to decades of medical mistreatment, said Dr. Michael Lindsey, professor of social work at New York University. In response, families may seek support through informal systems in their communities such as churches, Lindsey said, rather than speaking of their personal affairs to people outside the family.
Society still treats those struggling with mental health differently, Lindsey said. And for people of color who are already marginalized because of their identity, admitting they are struggling with their mental health adds a “double consequence,” he said.
Counselors and therapists must overcome those hesitations with young people before they open up about their needs. But in schools — often the only places where many teens can access mental health support — social workers, psychologists and counselors are frequently overwhelmed by the number of students in their caseloads.
One time, Strother, the counselor, recalled looking up from her desk and seeing 10 students in her office, hoping to talk to her about something on their minds.
“You have that happening with 100 students, 200 students, who always want to hang in your office because you’re their safe space in the school,” she said.
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