The youth mental health crisis disproportionately affects Black adolescents. We spoke with Brandon Johnson, MHS, MCHES, a Public Health Advisor for the Substance Abuse and Mental Health Services Administration (SAMHSA), about Black youth suicide prevention. We also reflect on a conversation from our 2020 conference with Dr. Alfiee Breland-Noble (Dr. Alfiee), Founder of the AAKOMA Project, about how behavioral health technology can help address mental health concerns in the Black community. Both conversations highlight the unique challenges and recommendations for Black youth mental health and what tools are available to help.

Current State of Youth Mental Health

As of 2018, the National Institute of Mental Health (NIMH) reported that death by suicide was the second leading cause of death in Black children (10-14) and the third leading cause of death for Black adolescents (15-19). In fact, the death rate by suicide for Black youth is increasing faster than any other racial/ethnic group. Brandon explains, "we've seen the suicide rate of young African Americans, for ages 5 to 12, double in the last thirteen years, and we've seen this rate decrease with their white counterparts."

The suicide rate is further exacerbated by unique stressors that Black youth face, such as discrimination and violence, which leads to a higher risk for mental health problems. Additionally, Black adolescents are less likely to receive care for depression due to many barriers to treatment, such as structural inequalities, stigma, and mistrust of healthcare providers. 

Unique Challenges and Concerns

One factor that may be contributing to the increased suicide rate is that Black youth are experiencing an access problem to mental health resources. As Brandon explains, they "may not have the ability to go and find a mental health support or mental health professional to be able to engage with them. [Another issue] is also how is the system built for our young people to be able to find the support that they need?" 

Unfortunately, our mental health system is challenging to navigate, and on top of that, there is a tremendous lack of mental health providers of color. Only 4-5% of Child and Adolescent Psychiatrists are people of color, and less than 2% of American Psychological Association members are Black or African American. The lack of representation can lead to Black youth not seeking treatment due to fears of cultural competence. The lack of providers of color is a problem that will take many years to address. In the meantime, it requires non-Black providers to be genuinely curious about the experiences of the youth that present for treatment.  

Next Steps

There must be a multi-pronged approach to begin to address the rise in suicide attempts in Black youth. Five factors can help protect against suicide:

• Familial support
• Spiritual engagement
• Community/social support
• Personal aspects (i.e., self-esteem, emotional well-being)
• Environmental factors such as family housing

Brandon Johnson emphasizes the importance of including the family unit in any interventions, explaining that "young people don't have the ability to do everything on their own, the family unit has to be part of the support that we give to our young people." 

When building digital solutions to help Black youth, it's crucial to meet them where they are and include them at the very beginning of the design process. As Brandon Johnson explains, "if you want to engage the Black community in the services that you provide…make sure that they are there to influence policy, direction, experience, protocols, all of these things should have that community engaged in a meaningful way." 

Dr. Alfiee emphasizes that "there have to be unique ways in which we understand and then begin to try to address the unique mental health needs of Black people and people of color. And I think that behavioral health technology, when built with all these things in mind, can really be something that can move us along that path in the right kinds of ways." 

Both Brandon Johnson and Dr. Alfiee mention the notOK app as an example of a digital health solution getting it right. The app was built by two Black adolescents, and it has a digital panic button to connect adolescents to their trusted contacts when they are in need. Dr. Alfiee explains, "because it has been developed by people of diverse backgrounds, it already has [cultural competency] built into it. It's not an afterthought. It's not an add-on. We don't have to do an adaptation to get to the cultural piece. It's baked in." 

Reminders

‍1. Include the Black Community and People of Color from the Beginning

If you are building a mental health solution, you need BIPOC involvement from the beginning, not as an afterthought.

‍2. Mental Health Providers Need to Focus on Cultural Competency‍

It will take many years to increase the number of mental health clinicians of color. In the meantime, all mental health clinicians need to become genuinely curious about the lived experience of youth of color.

3. We Need to Talk about Suicide

As Brandon Johnson explains, "I know the topic of suicide and suicide prevention can be intimidating, and it can feel scary. But our young people are talking about it. They're having the conversations already, and so if we think that we're doing them a favor by not talking about it, we're not. We're just leaving them to figure some of these things out on their own. We want to be a safe place to land for our young people." 

The 988 Suicide and Crisis Lifeline is 988 and is available 24/7 for support, and the Crisis Text Line is available by texting "HOME" to 741741. Please see here for warning signs and how to support your loved ones.

There is so much more to discuss on this topic, and you can hear these conversations and more in our video library. 

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