African American teens face mental health crisis but are less likely than whites to get treatment
This article originally appeared on The Conversation.
Black youth in the U.S. experience more illness, poverty, and discrimination than their white counterparts. These issues put them at higher risk for depression and other mental health problems. Yet Black youth are less likely to seek treatment. About 9% of them reported an episode of major depression in the past year, but less than half of those – about 40% – received treatment. By comparison, about 46% of white youth who reported an episode were treated for depressive symptoms.
Instead, some turn to suicide, now the second leading cause of death among Black children ages 10 to 19. That rate is rising faster for them than any other racial or ethnic group. Data from the Centers for Disease Control and Prevention show the rate of suicide attempts for Black adolescents rose 73% from 1991 to 2017.
With schools nationwide grappling with how to offer instruction to students, principals and teachers need to be reminded that Black children have endured a distinctive kind of trauma since the pandemic began. They have had a different experience. The shootings of George Floyd and Ahmaud Arbery – and what happened afterwards – are just two examples.
As an expert in child and adolescent psychology, I know that a multitude of barriers keep Black children, and their families, from receiving that treatment. They need help to deal with the pervasive poverty and racism that surrounds them.
The ‘crazy’ label
Studies suggest Black youth and their families may be less likely to identify their own mental health symptoms. If they do receive referrals for care, they may follow up less often than whites. Delays in seeking care can lead to negative consequences, including emergency psychiatric hospitalizations and non-compliance with treatment recommendations. These youngsters may then become adults with mental health issues that remain unaddressed.
Parents and caregivers should encourage treatment. But interviews with them done as part of one study revealed they sometimes obstruct the process. Many feared their child would be labeled “crazy.” Those caregivers, sensitive to social stigma, also relied on others in the community when deciding to pursue treatment for their sons. Sometimes they would receive support from those they spoke with; other times, they would not.
Because of discrimination and abuse, Blacks have good reason to distrust the mental health system. Health care disparities exist there just as they do in other health care domains. Black adolescents are less likely than white teens to be treated with beneficial psychiatric medications, and more likely than white teens to be hospitalized involuntarily. Other reports suggest Black youth with psychiatric disorders are more likely to be referred to the juvenile justice system, while white youth are more often referred for mental health treatment.
That same study found that schools were also pivotal, in both positive and negative ways. Some parents and caregivers said school staff validated their concerns and provided support. Others felt forced to seek services only because they believed their son would be expelled.
Stigmatizing mental illness
Researchers have found that Black adults, exposed to a police killing of an unarmed black citizen through media or word of mouth, had worse mental health. This includes an increased fear of victimization, diminished social trust and a revisiting of prior trauma.
Much the same seems true for Black adolescents. When a group of them aged 11 to 19 viewed traumatic events online – including viral videos of police shootings – they had higher rates of depressive and post-traumatic stress symptoms, including re-experiencing, avoidance, numbing, and hyperarousal. Experts have suggested that police violence be viewed as a public health issue, because each killing impacts individuals and communities both physiologically and emotionally. Each incident reminds Black youth that, in this country, their lives have been devalued.
One might consider the impact from the case of Ahmaud Arbery, a 25-year-old Black man shot to death in Glynn County, Georgia, last February. Three white men are charged in the killing. An attorney for one of them attempted to cast doubt on the character of Arbery, who reportedly had a previously diagnosed mental illness. The lead investigator in the case testified that Arbery suffered from hallucinations, though he was not undergoing treatment on the day of his death.
Hallucinations are actually relatively common in children and adolescents. Up to 13% of youth experience them. If Arbery had hallucinations, it appears they had little bearing on his killing, but those with mental health issues were further stigmatized.
With protests sweeping the nation calling for racial justice and defunding the police, I believe more funding to address disparities in mental health care for Black youth is critical. But merely investing in treatment is not enough. To support them and their families, we as a society must deal with stigma, cultural mistrust, systemic inequities and social supports.
Assistant Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University
This article originally appeared on The Conversation
How to Support Teens’ Mental Health During COVID and Beyond
Teens are struggling during the pandemic. Here's what they need from us right now.
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
It’s been more than a year since the COVID-19 pandemic changed life as we knew it. Many families across the country have been living in “survival mode.” Tweens and teens continue to experience a range of emotions, including sadness, anger, and fear. If left unresolved, these feelings can take a toll on health and well-being.
Parents of teens share similar struggles. According to Lauren, a mother of two teens in Woodland Hills, California, “My daughter has a hard time spending so much of her day on screens. She says having to do so makes her feel more anxiety than she already was feeling.” Nancy, a mother of two teen boys in Chevy Chase, Maryland, says, “Junior year is supposed to be a key year in high school before college. But my son has shut down.” And Rafaela, whose daughter attends high school in New York City, says, “My daughter is completely stressed about having to go back to school in person because she worries she’s going to get coronavirus.”
Sound familiar? In a survey of more than 4,600 people in Canada last spring, more than a third of families said they felt “very or extremely” anxious about family stress resulting from the pandemic.
When it comes to teens’ emotional and mental health, they are experiencing a crisis, says Dr. Edith Bracho-Sanchez, a primary care pediatrician and assistant professor of pediatrics at Columbia University Irving Medical Center. Even before the pandemic, more than 16% of youth in the United States dealt with a mental health disorder, according to a 2019 study in JAMA Pediatrics.
Bracho-Sanchez, who often treats families in Latino and Black communities that have been disproportionately affected by COVID-19, says the pandemic created the perfect storm of emotional turbulence. “Families are experiencing a lot of stress. Many have lost jobs. They’ve fallen behind on rent. The rates of food insecurity have skyrocketed. All of these things are really hard for everyone in the family—teens included.” Add to these issues virtual schooling, fear of family members getting sick or dying from COVID, feeling isolated and disconnected—it’s no wonder doctors are seeing higher levels of anxiety and depression in teens.
As parents, we can’t control the course of the pandemic. But we can help teens by modeling good coping skills, encouraging healthy habits, and working to understand and relate to what they are going through.
Understand what teens are going through
The first step toward supporting young people through this challenging time is for caring adults to have empathy for the teen experience. And to work to understand how their developmental stage impacts their emotional well-being.
Adolescence is a time when tweens and teens are supposed to be stretching their boundaries and testing limits. That means getting out of the house and trying new things. Figuring out their place among peers and within their communities. Making mistakes and learning how to bounce back. But during the COVID-19 pandemic, as a matter of safety, tweens and teens are limited from many growth opportunities. And that flies in the face of typical teen development.
For teens, peer relationships are a big deal. Their brains are designed to feel rewarded when they socialize, in some ways more so than adults. Spending time with friends helps them discover their identities and gives them the courage to move away from the family and into the larger world. Being restricted from exploring this aspect of themselves may leave them feeling lonely and bored, and it goes against the messages their brain’s reward centers are sending.
And let’s not forget the missed milestones. From birthdays to graduations to religious or cultural celebrations of growth, adolescence is also a time of important rites of passage. But these celebrations didn’t happen or looked dramatically different in the past year. Teens feel a true sense of loss for missing out on important affirmations that remind them they’re growing up.
On top of all that, the pandemic has diminished teens’ support systems or eliminated some altogether. Besides parents, teens often get support from other caring adults, including extended family and kin networks—grandparents, aunts and uncles, cousins, and others. Caring connections may also stem from teachers, coaches, after-school staff, or religious leaders. In normal times, schools also play an important part in providing mental health services for adolescents; research finds that just over a third of teens who get mental health services get them only at school. With these support channels disrupted, parents have an even bigger role to play in supporting teens’ mental health
Strategies to support teen coping
Start with yourself. One of the most important strategies for parents looking to help their teens is too often ignored: self-care. Parents must take care of themselves. You know, the whole “put your oxygen mask on first” concept. When parents show teens the hard but productive work it takes to cope with stress, they’re teaching them how to face challenges.
Children haven’t fully developed the ability to regulate emotions, so they need to co-regulate with the important adults in their lives. They look to see how their parents and other trusted adults are coping to figure out how they should react. They “borrow” our calm and gain a sense of safety by watching us. But they can just as easily “borrow” our frenzy or catastrophic thinking.
Dr. Ken Ginsburg, director of the Center for Parent and Teen Communication, cautions it’s not as simple as just acting calm around your kids. “Looking like a duck calmly gliding on water is not actually the answer. While it may lend stability, it doesn’t teach strategy. As parents, we want to look like the duck moving through the water but also let our children see that our feet are paddling quickly underneath to help us stay afloat.”
Bracho-Sanchez says when she’s working with teens, she often first considers where the parents are in their own mental health and self-care journey. “I think we sometimes forget that until the parent has enough food, a safe place to live, a stable income . . . it’s really hard for them to help in a way that is sustainable. And until we have provided the parents with resources to care for their own mental health, it will be difficult to create the healing environment that we so badly want for all of our kids.”
Ways for parents to model good self-care for their teens include spending time with others (in a safe way), healthy eating, exercising, getting enough sleep, and making time to relax. Consider relaxation techniques such as meditation, yoga, reading a book, listening to calming music, or enjoying a hobby. Encourage your tweens and teens to de-stress and take part in self-care routines, as well. Let your teen know these are important tools to take back control of their bodies and minds.
Check in with teens. Amid all the changes and chaos stemming from the pandemic, how do parents learn how their teens are really doing? Ginsburg stresses the importance of listening and taking cues from what teens are saying. And if they’re not saying much, ask open-ended questions that show you care about their well-being. For parents struggling to find the words, try saying, “This is a tough time. I want to know how you’re experiencing this. What are you finding that’s helping you get through it? How can I support you?” Parents don’t have to offer immediate solutions—sometimes kids just need a sympathetic ear.
Re-establish routines. My daughter is in high school, but during the pandemic it has felt like she (and many of her friends) have adopted more of a college-age lifestyle. Staying up late, talking to friends at all hours, sleeping in, snacking throughout the day instead of eating at regular mealtimes. There’s been a loss of structure. Social media and blog posts confirmed my suspicion that parents across the country are witnessing similar things happen with teens in their homes.
It’s essential for our teen’s mental health to get back some structure. Routines offer a sense of order that is calming in the midst of uncertainty. Help your teen re-establish bed- and wake-up times. Encourage them to get dressed in the morning, eat regular meals, and spend time away from screens.
Set the tone. Parents and caring adults can adopt an attitude that is honest, future-oriented, and hopeful. This doesn’t mean denying problems exist. These may be challenging times, but it is also an opportunity to demonstrate how to manage uncertainty. A time to find creative ways to re-connect. And a chance to build resilience.
While it may be difficult to keep a positive mindset, focus on what you can control and remind your children things will get better in the future. Part of this viewpoint includes looking at the reality of the situation and teaching them to believe that their actions (or inaction) make a difference. For example, if watching television news about the pandemic all the time is adding to your teen’s stress, remind them that while they can’t control what appears on the news, they can determine how much they watch. Choosing to turn it off, watch less, or vary the source of programs can impact their ability to maintain a more positive outlook.
Don’t forget joy. As the number of vaccinations continues to rise, Bracho-Sanchez has been encouraging families to (safely) find joy in their lives once again. “Families have been in survival mode for a while now. And when you’re just surviving there’s so much that you don’t allow yourself to do and feel. Families have so much culture and tradition that they can bring to their young people.” She focuses on joy because it’s a powerful emotion for getting through hard times.
For example, my daughter and I have been enjoying putting our own spin on old family recipes. Quincineras, bar and bat mitzvahs—often large, extended family celebrations—are alternatively being enjoyed with immediate family at home as friends and other family members take part “virtually.” Some families are creating new rituals. A friend now works with his kids to come up with “reflection and gratitude” prompts that they write down on slips of folded paper. They open one at dinner to start conversations about things they have to be grateful for and happy about.
Seek help. Sometimes it’s beyond our ability to help teens improve their emotional and mental health. Seeking help from others is an act of great strength. If parents feel unstable or if their own mental health is challenged, there is power in seeking help for yourself and modeling that “I don’t deserve to feel this way. I want to take the steps needed to feel better,” says Ginsburg.
There are many places to reach out for professional help. Find a psychologist near you from the American Psychological Association or ask your personal doctor for local counseling service providers. There are also professionals trained to help children and teens get through tough times. The family pediatrician or a school counselor is a good starting point. You can also reach out to someone you trust in the community for local resources.
Moving toward a new normal
As the pandemic wanes, Ginsburg, who is also author of Building Resilience in Children and Teens: Giving Kids Roots and Wings, says there’s a real opportunity for families and communities to better support teens’ emotional well-being.
Many parents wonder what’s going to happen to this group of teenagers after living through these unprecedented times. What they want to hear is that kids are resilient and will bounce back to normal in no time.
But Ginsburg has a slightly different answer. He says adults first must intentionally work to ensure teens have the support systems in place to help manage the enormous amount of stress they are still under. He adds, “I hope things don’t go back to the way they were before the pandemic. Every generation is shaped by what it’s exposed to during adolescence, and this generation has been exposed to an understanding that human beings need each other. This could be the greatest generation ever if they are shaped by this essential truth.”
Award-winning journalist, writer, and blogger
Executive producer and director of digital content at the Center for Parent and Teen Communication at Children’s Hospital of Philadelphia
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.