By Amanda Joy Calhoun
On Sept. 25, 2023, the Biden-Harris administration announced that it will be investing some $200 million in the youth mental health crisis. Since youth mental health was declared a national emergency in 2021, multiple experts, including the U.S. Surgeon General, have cited social media and the COVID-19 pandemic, among other things, as major contributing factors.
But what has not been talked about to the same extent, is how anti-Black racism is fueling the youth mental health crisis. Racism has a crucial impact on the mental health of Black youth, and the current mental health system is not equipped to address it.
As a child and adolescent psychiatrist, I’ve witnessed the depressive, even suicidal effects of racism on Black youth. The kindergartener who was sad and withdrawn for weeks after her white classmates said her skin was too dark to play with them. The fourth grader who said she wanted to die because her white neighbors told her that her black skin was ugly. The affluent high schooler who was hospitalized after a suicide attempt because she was ostracized by her peers and excessively punished by teachers at her predominantly white prep school. Each time, I was the only mental health clinician involved who cited the crucial contribution of anti-Black racism in their mental health assessment. Interpersonal experiences of anti-Black racism play a large role in the mental health of Black youth, and the current youth mental health crisis, but they are largely left out of the conversation in the mental health field.
The truth is that the effects of racism on the mental health of Black Americans start even before birth. The stress of racism experienced by Black mothers has been linked to low birthweight babies, which puts those children at greater risk for developing depression and other child mental health issues. Prenatal anti-Black racism can also have other persistent effects. Maternal reports of racism affect the socio-emotional development of Black children in their first year of life, with links to negative emotionality.
Yet another indication that the distinct experiences of racism in America affect Black birth outcomes in ways that do not apply to other racially minoritized groups: Foreign-born Black mothers who experience better birthweight outcomes lose the “healthy immigrant effect” after only one generation, according to a 2020 study published by Princeton University, while foreign-born Hispanic mothers retain it for generations.
Indeed, Black children and adolescents are suffering at unprecedented rates, and have been for over 20 years. Black youth are dying by suicide at rates increasing faster than any other racial or ethnic group: Black children as young as five years old are 1.8 times as likely to commit suicide compared to their white peers. The suicide rates of other ethnic groups, except for Latinx and American Indian/Alaskan Native youth, have remained virtually the same or declined, even from 2019 to 2020 in the height of the pandemic.
By preschool age, Black children have their own experiences of anti-Black racism, in addition to those of their mothers and families. One study showed that anti-Black racist beliefs emerge as early as age four. In particular, white children have been found to have more negative attitudes towards Black peers and prefer white over Black children as playmates. Black children experience racism from adults, as well, and are disciplined more harshly in schools from an early age. Black preschoolers, especially Black boys, are significantly more likely to be expelled than white peers. This is not surprising given that teachers complain more about the behaviors of Black boys and white adults view them as more dangerous than their white peers.
Although sometimes overlooked, Black girls are not spared, receiving harsher school discipline compared to white girls. This criminalization of Black students leads to poor grades and overall school performance, which have been associated with low self-esteem, depressive symptoms, and even suicidality.
These “zero tolerance policies” in schools lead to children, especially Black children, being expelled, suspended, or even arrested by cops in schools. It also puts them at greater risk of being funneled into juvenile detention system, a racist phenomenon known as the school-to-prison pipeline, and is linked to higher rates of depression in Black males. Many of these children have learning problems and are struggling from abuse and neglect. In other words, they need psychiatric, not punitive, measures.
The harsh punishment of Black children is intertwined with the phenomenon of “adultification,” the perception of Black kids as being older and more mature than they are. Adultification has anti-Black racist origins dating back to enslavement, and is a major contributor to Black children being not only criminalized, but also hypersexualized at an earlier age than their white peers. A 2020 Georgetown study found that Black girls as young as five and as old as 19, were viewed to be more knowledgeable about sex and less in need of nurturing and protection than their white female peers. This can lead to Black children receiving less emotional support than white children, which can in turn increase the risk of depression, stress, and suicidality.
As Black children age into adolescence, like all children, their social and cognitive abilities increase, including abstract reasoning. This development enables them to be increasingly attuned to experiences of anti-Black racism—which, on average, they report experiencing five times a day. But, even children in the preadolescent age range, from ages nine to 12, report increased suicidality with experiences of anti-Black racism and more experiences of racism overall compared to non-Black youth. In young adulthood, around ages 18 of 25, experiences of anti-Black racism continues to be predictive for depressive symptoms and suicidal ideations.
The racist mutigenerational wealth gap also continues to harm Black youth and families, playing an undeniable role in the declining mental health of Black youth. (It is tied to suicidality, as well.) But poverty is not the whole story. Higher socioeconomic status was associated with greater depressive symptoms in Black children living in predominantly white neighborhoods compared to those living in predominantly Black areas. For white youth, greater parental education was associated with fewer depressive symptoms. In Black youth, however, the opposite was true; one 2015 study found that Black youth with highly educated parents had higher depression and higher perceived lifetime discrimination scale ratings. These findings suggest that experiences of racism outweigh the protective effects of parental education.
Anti-Black racism is a driver of the Black youth mental health crisis, separate from socio-economic status, and solutions are urgently needed to tailor the mental health treatment of Black youth. Research funding is necessary for further studies examining the impact of anti-Black racism on child mental health throughout development. The topic remains understudied and underfunded, especially for very young children. We also need more funding for anti-Black racism-conscious mental health treatment tailored to Black youth—staffed by mental health clinicians who have expertise in providing anti-Black racism targeted care. Some organizations already exist, such as the AAKOMA Project, Therapy for Black Girls, and the National Black Child Development Institute, but there are not enough.
Standardized medical education does not teach the mental health effects of anti-Black racism, so traditionally trained psychiatrists are ill-prepared to help Black children navigate these harmful complexities. Curricula for psychiatrists that specifically deal with anti-Black racism are very limited, with only a few published in the literature. I was fortunate to study under one of these, the Social Justice Health Equity Curriculum at Yale Department of Psychiatry. The landscape is gradually changing, with an increasing number of medical schools working to educate students and residents about the impacts of racism. For example, an anti-racism curriculum tailored to child psychiatry, the first known of its kind, was piloted at UCLA in 2021.
But education is just the start; accountability is also necessary. Mental health clinicians cannot provide anti-Black-racism-informed care for children if they are engaging in racist behaviors themselves. Leaders of mental health institutions, like hospitals and clinics, must take an active role in ensuring that, when Black children do seek help, that their mental health is not further harmed by racism in medical care. Black children are more likely than white children to be diagnosed with stigma-laden disruptive mood disorders and physically restrained in emergency departments, so it is crucial that leaders ensure anti-racist hiring practices and reporting systems are in place to recruit and retain staff. When racist behaviors do occur, leaders need to hold mental health staff accountable, even if it means penalizing highly prized colleagues or close friends.
The youth mental health crisis will not end until the mental health of all children stabilizes. I refuse to let Black children be left behind—and that means facing anti-Black racism head on.
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