Oct. 14-- Suicide attempts that were self-reported by black teens have spiked since 1991, even as their peers in other groups have experienced a downward trend or remained unchanged, according to a new study that raises concerns about mental health outreach for black youths.
The study, which was published online by the American Academy of Pediatrics, underscores the importance of equitable access to mental health care and prevention initiatives in schools, social workers and mental health advocates said. It also highlights the lack of data and the understudied nature of suicide in the black community, experts said.
"It's well documented that black youth access mental health treatment less," said Michael Lindsey, author of the study and executive director at the McSilver Institute for Poverty Policy and Research at New York University. "Stigma plays a huge role. They may mistrust mental health providers."
The researchers examined more than 20 years of data collected by the Centers for Disease Control and Prevention based on surveys from nearly 200,000 students in all 50 states from 1991 to 2017. The Youth Risk Behavior Survey, conducted every two years by the CDC, asks ninth through 12th graders to respond anonymously to questions about whether they had suicidal thoughts, or had planned or attempted a suicide in the past 12 months.
The study's authors conducted an analysis of the data that took into account the various increases and decreases each year over the 26-year period and found that black teenagers increasingly reported having attempted suicide while such reports declined or remained unchanged for white, Hispanic, Asian/Pacific Islander and American Indian/Alaska Native teenagers. Further, the study found that there was an increase in reports from black boys about sustaining an injury from a suicide attempt.
In 1991, 5.9% of black teenagers who responded to the survey reported attempting suicide, Lindsey told the Tribune. In 2017, more than 10% of of black teenagers said they had attempted suicide, he said.
The study's authors say the results challenge a pervasive bias that suicide mostly affects white communities. Overall, suicide deaths occur at higher rates among white youths, but experts said the results of the study indicate that the issue of suicide attempts among black youth merits more research.
"You have a well-deserved cultural mistrust of professional services in African American communities. White providers for years have been racist, oppressive, dismissive, have misdiagnosed (illnesses)," said Jonathan Singer, a professor of social work at Loyola University Chicago and president of the American Association of Suicidology. "The same counselor, because of their bias, might see an emotionally disregulated white kid and think, 'I wonder if this kid is struggling with suicidal thoughts,' but not think the same thing of a black kid because of their bias."
For Lindsey, who is also a professor of social work at NYU, the study raises questions about whether black teenagers are receiving equitable mental health care in schools. He said the results indicate the need for social workers and counselors to be increasingly staffed in schools.
"Unfortunately in communities that are impacted by high rates of poverty, that tend to be black and brown, there is a relative dearth of appropriate mental health counselors," he said.
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The Chicago Teachers Union has asked for more social workers in Chicago Public Schools, maintaining that schools are thinly staffed and overburdened. Mayor Lori Lightfoot and CPS CEO Janice Jackson in August announced that schools will be staffed by hundreds more nurses and social workers over the next five years.
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In Chicago's black communities that have faced a lack of resources, clinicians and nonprofit groups are working to bridge gaps in access to mental health care, especially as students may struggle to receive it in city schools.
Domonique McCord, a licensed clinical social worker who works with people impacted by gun violence, is heading up a new project that brings licensed clinicians into the homes of people at risk for gun violence. McCord is the director of behavioral health services for Metropolitan Peace Initiatives, which works to reduce violence in Chicago and is spearheading the initiative.
The clinicians do short-term work with clients, and then help connect them with ongoing mental health treatment that is available in the community.
McCord said she was not surprised to learn about the results of the study, noting the barriers to receiving consistent and ongoing treatment for those that express suicidal thoughts. Her project seeks to expand access to mental health care.
"Experiencing trauma, generational trauma and community violence increases risk factors that make people vulnerable to depression and suicidal ideation," McCord said.
Singer said schools need to do a better job of tracking their own data on suicide, suicidal thoughts and suicide attempts, rather than waiting on national studies such as this one. They should also be regularly screening students for risk of suicide, then referring students at high risk for services.
"This could be the job of a suicide prevention coordinator for each school district or school level," Singer said.
One Northbrook-based organization provides area schools with a free program for education and screening of students, but a lack of school social workers to help with screenings may hinder equitable access to such programming.
Elyssa's Mission, a nonprofit founded by the mother of a Northfield teenager who died by suicide in 2004, provides an evidence-based program to nearly 250 schools in the region, which includes education on suicide prevention and a screening that triggers a follow-up with students deemed at risk. The program has referred more than 5,000 students to some sort of support or counseling, said Jodie Segal, director of education at Elyssa's Mission.
Segal said the program is difficult to administer at schools that don't have enough social workers to handle the results of the screening and follow up with students deemed to be at risk, though she said the nonprofit helps schools find a way to make it work, sometimes reducing it to a pilot program that handles fewer students.
"Unless schools have that level of staffing in the building, the program is not going to be effective," Segal said.
Usually, about 15% of students screened for suicide risk through the program are referred for a follow-up, Segal, said, though that number is usually higher in lower income schools with more risk factors for depression and suicide.
"It shows us how essential screening is for all students," Segal said.
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