Behavioral and Mental Health: A National Crisis Impacting Black Youth

July 2023

Behavioral and Mental Health: A National Crisis Impacting Black Youth

Tashia Roberson–Wing, John R. Lewis Social Justice Fellow

Youth today are facing increased mental health crises. Among the most vulnerable are Black youth. In the wake of social media, televised killings of Black people at the hands of police officers, gun violence, bans on AP African American studies, and anti-trans and anti-LGBTQ laws, Black youth experience daily challenges that can lead to adverse behavioral and mental health conditions. They have unique risk factors that can onset behavioral and mental health conditions, such as the experience of racism, discrimination, poverty, health coverage disparities, and traumatic events.1

Behavioral and mental health conditions impact and influence how one learns, behaves, controls emotions, and ultimately shows up in the world.2 Access to behavioral and mental health services is vital for overall well-being. The Centers for Disease Control and Prevention reported that between 2018 and 2021, suicide rates among Black youth between the ages of 10 to 24 years old increased by 36.6 percent.3 A study that surveyed around 34,000 lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth ages 13 to 24 throughout the United States indicated that 1 in 4 Black transgender and nonbinary youth attempted suicide in the past year.4 Mental health conditions have been recognized as common in society and have led to government entities taking steps to expand mental and behavioral health resources. Though policymakers, industry professionals, and society recognize the need for behavioral and mental health services, Black adults, and youth face disproportionate barriers to accessing behavioral and mental health care services.5 This policy brief explores trends linked to Black youth’s behavioral and mental health, current efforts to expand behavioral and mental health services, and ways to continue expanding services.

Background:

What is Behavioral and Mental Health?

The terms mental health and behavioral health are sometimes used interchangeably.6 However, the terms have two different definitions. Mental health concerns one’s state of mind, feelings, and thoughts and refers to an individual’s emotional, psychological, and social well-being.7 Mental health is housed under the umbrella of behavioral health.8 Behavioral health focuses on actions and behaviors in connection to one’s state of mind, body, and spiritual health.9 Physical symptoms that are stress-related, stressors and crises associated with daily life, mental health, and substance misuse disorders are generally referred to as behavioral health.10

Health conditions where one may notice changes in emotion, thinking, or behavior (or a combination) may be referred to as mental illnesses.11 Mental illnesses can also be linked to distress or functioning issues concerning social, work, and family activities.12 Disorders such as generalized anxiety, schizophrenia, and depression are associated with mental health.13 Disorders such as substance abuse, self-injury, and eating disorders are associated with behavioral health.14 While all mental disorders fall under behavioral health disorders, not all behavioral health issues are categorized as mental health issues.

Source: Georgians for a Healthy Future

• Depression

• Anxiety disorders

• Schizophrenia or other psychoses

• PTSD

• Attention hyperactive disorder (ADHD)

• Etc.

Contributing Factors and Trends in Mental Health Outcomes for Black Youth/Young People

Mental health conditions such as anxiety disorder, depression, attention deficit hyperactivity disorder, and eating disorders are common among adolescents.15 According to the World Health Organization, the leading causes of illness and disability among adolescents are associated with depression, anxiety, and behavioral disorders.16 In reference to the 2021 U.S. Surgeon General’s Advisory Report, Black youth were considered a group at higher risk for mental health challenges such as stress, anxiety, and depression due to the Covid-19 pandemic.17 During the pandemic, Black youth, compared to other youth, were more likely to experience a loss of a parent or caregiver to Covid-19.18 The loss of a parent or caregiver is a factor that can continuously impact a person’s mental and behavioral health. The report drew attention to other factors that could contribute to Black youth’s mental health, such as the deaths of Black people killed by law enforcement officers, including George Floyd’s death.19 The risk for posttraumatic stress disorder (PTSD) increases for over 25 percent of Black youth exposed to violence.20 The report also mentioned gun violence, polarized politics, and climate change as contributing factors to young people’s mental health.21

In 2021, the Center for Disease Control and Prevention (CDC) conducted an Adolescent Behaviors and Experiences Survey (ABES) of U.S. high school students. The survey revealed that racism is a threat to public health and impacts youth’s mental health.22 The survey also indicated that students experiencing the highest levels of racism were Black, Asian, and Multiracial students.23 Students experiencing racism were more likely to encounter poor mental health conditions. Daily disturbances such as poverty and hunger also play a role in a young person’s mental and behavioral health.24 Reports showed that Black students were more likely to go hungry during the Covid-19 pandemic.25

Serious mental conditions increased between 2008 to 2018 within the Black community amongst all ages.26 Between 2015 and 2018, major depression increased in Black youth ranging from 12 to 25 years of age.27 Black youth are dying at alarming rates due to poor mental and behavioral health conditions. Death rates linked to suicide are increasing faster among Black youth than other racial/ethnic groups.28 Suicide rates among Black youth ages 10–19 increased 78 percent throughout the years 2000–2020.29

Source: Pediatrics Nationwide published by Nationwide Children’s Hospital

Being a young Black person who identifies as LGBTQ+ can put an individual at a greater risk of experiencing serious mental and behavioral health conditions. The CDC’s Adolescent Behaviors and Experiences Survey showed that LGBTQ+ youth disproportionately experience suicidal behaviors and poor mental health conditions.30 Studies show evidence of higher rates of suicidal-related behaviors within the transgender and nonbinary community of young people but considering the intersection of being a young Black person and identifying as transgender or nonbinary, this population may be more open to undesirable experiences and chronic stress due to the intersectional marginalized social statuses.31

Barriers to Black youth accessing behavioral and mental health services also serve as a contributing factor to behavioral and mental health outcomes. Stigma, cost, lack of cultural care, shortages of industry professionals, systemic issues, and going undiagnosed are just some of the barriers Black youth face when accessing health care.32 Though Black youth might be more likely to experience higher rates of depressive mood disorders, they are less likely to use resources for mental health due to these barriers.33

Recent Federal Efforts to Expand Mental and Behavioral Services and Implications for Black Youth

On May 18, 2023, in honor of Mental Health Day of Action and Mental Health Awareness Month, the Biden-Harris Administration announced new action steps to address the nation’s mental health crisis.34 The actions included investing 200 million dollars towards the improvement of the 988 suicide and crisis lifeline while also investing in mental health services in schools.35 The announcement and action steps are centered around three objectives: strengthening the mental health workforce and system capacity, connecting more Americans to care, and creating a continuum of support.36

Strengthening the mental health workforce and system capacity objectively aims to increase the size of the behavioral health workforce and increase diversity in the workforce.37 One of the barriers to Black youth receiving care is the lack of diverse mental and behavioral health providers. Increasing the diversity in providers will allow Black youth the opportunity to access culturally competent care and receive services from individuals that look like them. The connecting more Americans to care objective is centered around making it easier for Americans to find help while creating more avenues for students to obtain mental and behavioral health services in school. 38 Expanding mental and behavioral services in schools brings the services to youth directly, which could be a significant step in Black youth receiving care.

On May 22, 2023, Congressman Seth Moulton (D-MA-6) introduced a bipartisan resolution, H.Res.434 - Declaring a mental health crisis among youth in the United States and expressing the pressing need for historic investments in mental health care for students. The resolution suggests that states, local agencies, schools, and community organizations support students impacted by mental health by improving training for educators (recognizing that some youth have mis- or undiagnosed mental health disorders) and working to understand the unique challenges of lower-income students.39

CO-SPONSOR OF THE RESOLUTION, CONGRESSWOMAN BONNIE WATSON (D-NJ-12) SAID

“One of our primary responsibilities as both parents and members of Congress is to protect the wellbeing of our children. While chairing the [Congressional Black Caucus] CBC’s Emergency Taskforce on Black Youth Suicide and Mental Health, I saw firsthand the devastating impact our mental health crisis has had on our nation’s youth and the loved ones of those suffering and those lost to suicide… We must take steps right now to help our young people and save lives.”40

The resolution impacts Black youth by acknowledging that youth around America are facing a mental health crisis and creating a call for action for investments to improve mental health conditions for youth. The resolution addresses that some youth have misor undiagnosed mental health disorders, which causes a lack of adequate support and resources for youth.41 Providers, caregivers, educators, and industry professionals at times fail to realize that mental and behavioral conditions may appear or be presented differently among youth of different races, backgrounds, and ethnicities.42 Black youth are mis- or undiagnosed when it comes to mental and behavioral health disorders due to the lack of cultural understanding. The resolution encourages agencies and governments to address mis- or undiagnosed mental health disorders, which in return would benefit Black youth.

Policy Recommendations

Though there are Federal efforts to address the national mental health crisis for youth, there is still work to be done to meet the mental and behavioral health needs of youth. Public policy can be a tool used to address the limited access to mental and behavioral health services in America. As policymakers work to address the mental health crisis hindering youth, they should include the following factors:

Improving structures that address having continuously available services, culturally appropriate services, and evidence-based early intervention/prevention services.

Providing more substantial mental health investments in Medicaid and private insurance.

Protect the existence of telehealth to ensure that there are options for accessing mental and behavioral services.

Expanding available life-affirming mental and behavioral services for Black LGBTQ youth. Services that indicate LGBTQ youth life has value.

Expanding and improving funding for current policies that support mental and behavioral health services within school systems.

Treating and creating access to mental and behavioral health services at the same level as traditional medicine and physical care.

Conclusion

Behavioral and mental illness is common within the United States of America, but millions of people go untreated. Behavioral and mental health conditions are impacting America’s youth at alarming rates. Black youth aren’t excluded from the impacts of mental and behavioral illness. Access to behavioral and mental health services is pivotal to ensuring a person’s well-being. Though the Federal government has acknowledged that the nation is facing a mental health crisis among youth, there is still a lot of work that needs to be done to keep youth safe. To be certain that youth are getting the services they need, policymakers and industry professionals must move away from one-size fits all approaches and use an intersectional lens to serve youth. Expanding behavioral and mental health services can be lifesaving for Black youth, especially Black trans and nonbinary youth.

A National Crisis Impacting Black

References

1 Gordon, J. (2020, September 22). Addressing the Crisis of Black Youth Suicide. National Institute of Mental Health (NIMH); National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/about/director/messages/2020/addressing-the-crisisof-black-youth-suicide

Rennie, L. (2022, March 30). APA shines light on Black youth mental health crisis. American Psychological Association; American Psychological Association. https://www.apaservices.org/advocacy/news/black-youth-mental-health

2 Substance Abuse and Mental Health Services Administration. (2023, April 24). What is Mental Health? SAMHSA; Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/mental-health

3 Stone, D. M., Mack, K. A., & Qualters, J. (2023). Notes from the Field: Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021. MMWR Morbidity and Mortality Weekly Report, 72 https://doi.org/10.15585/ mmwr.mm7206a4

4 The Trevor Project. (2023). Research Brief: Mental Health of Black Transgender and Nonbinary Young People https:// www.thetrevorproject.org/wp-content/uploads/2023/02/EMBARGOED_2.28.23_The-Trevor-Project-Research-Brief_BlackTGNB-Youth-Mental-Health.pdf

5 Rennie, L. (2022, March 30). APA shines light on Black youth mental health crisis. American Psychological Association; American Psychological Association. https://www.apaservices.org/advocacy/news/black-youth-mental-health

6 Salveo Integrative Health. (2021, March). What Is the Difference Between Mental and Behavioral Health? Salveo Integrative Health. https://salveohealth.org/what-is-the-difference-between-mental-and-behavioral-health/

7 Supra Note 3.

8 Agency for Healthcare Research and Quality. (n.d.). What is integrated behavioral health? | the academy. The Academy Integrating Behavioral Health & Primary Care; Agency for Healthcare Research and Quality.

9 Supra Note 7.

10 American Medical Association. (2022, August 22). What is behavioral health? [Public Health]. American Medical Association. https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health

11 American Psychiatric Association. (2022, November). What is Mental Illness? American Psychiatric Association. https:// www.psychiatry.org/patients-families/what-is-mental-illness

12 Id.

13 University of Massachusetts Global. (n.d.). Behavioral health vs. Mental health: Breaking down the differences. Psychology https://www.umassglobal.edu/news-and-events/blog/comparing-behavioral-health-vs-mental-health

14 Id.

15 World Health Organization. (2021, November 17). Mental health of adolescents. World Health Organization. https://www. who.int/news-room/fact-sheets/detail/adolescent-mental-health

16 Id.

17 Office of the Surgeon General. (2021). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-healthadvisory.pdf

18 Id.

19 Id.

20 Anxiety & Depression Association of America. (n.d.). Black and African American Communities. Anxiety & Depression Association of America. https://adaa.org/find-help/by-demographics/black-african-american-communities

21 Supra Note 18.

22 Centers for Disease Control and Prevention. (2022, March 31). Adolescent Behaviors and Experiences Survey (ABES). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/data/abes.htm 23 Id. 24 Id. 25 Id.

26 Substance Abuse and Mental Health Services Administration. (2018). 2018 National Survey on Drug Use and Health: African Americans. SAMHSA; U.S. Department of Health and Human Services. https://www.mhanational.org/issues/blackand-african-american-communities-and-mental-health

27 Id.

28 Supra Note 4.

29 Supra Note 27.

31 Supra Note 5.

32 Hill, E. (2023, February 22). To support black youth mental health, we must look to community-based solutions. The Jed Foundation. https://jedfoundation.org/to-support-black-youth-mental-health-we-must-look-to-community-basedsolutions/

33 Jon-Ubabuco, N., & Dimmitt Champion, J. (2019). Perceived mental healthcare barriers and health-seeking behavior of African American caregivers of adolescents with mental health disorders. Issues in Mental Health Nursing, 40(7), 585–592. https://doi.org/10.1080/01612840.2018.1547803

34 The White House. (2023, May 18). Fact Sheet: Biden-Harris Administration Announces New Actions to Tackle Nation’s Mental Health Crisis. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/factsheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/

39 H.Res.434—Declaring a mental health crisis among youth in the United States, and expressing the pressing need for historic investments in mental health care for students., H.Res.434, 118th Congress.

40 Moulton Leads Bipartisan Resolution Declaring National Youth Mental Health Crisis. (2023, May 23). https://moulton. house.gov/press-releases/moulton-leads-bipartisan-resolution-declaring-national-youth-mental-health-crisis

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