On September 25, 2023, the Biden-Harris administration announced it would invest $200 million in the youth mental health crisis. Since youth mental health was declared a national emergency in 2021, many experts, including the US Surgeon General, have cited social media and the COVID-19 pandemic, among other things, as causal factors.

But what hasn’t been discussed to the same extent, is how anti-Black racism is fueling the mental health crisis among young people. Racism has a significant 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 witnessed the depressive, even suicidal effects of racism on Black youth. The kindergartener became depressed and withdrawn for weeks after his white classmates said his skin was too dark to play with them. The fourth grader who said he wanted to die because his white neighbors told him his black skin was ugly. The wealthy high schooler who is hospitalized after attempting suicide because he is rejected by his peers and overly punished by the teachers at his predominantly white prep school. Each time, I was the only participating mental health clinician to discuss the significant contribution of anti-Black racism to their mental health assessment. Interpersonal experiences of anti-Black racism play a large role in the mental health of Black youth, and the current crisis in mental health among young people, but they are largely absent from the conversation in the mental health field.

The truth is that the effects of racism on the mental health of Black Americans begin even before birth. The stress of racism experienced by Black mothers is linked to low birth weight babies, which puts the babies at greater risk of developing depression and other child mental health issues. Prenatal anti-Black racism can also have other lasting effects. Maternal reports of racism affect the socio-emotional development of Black children in their first year of life, with links to negative emotionality.

Another indication that distinct experiences of racism in America affect Black birth outcomes in ways that do not apply to other racial minority groups: Foreign-born Black mothers who experience better birth weight outcomes lose the “healthy immigrant effect” after a generation, according to a 2020 study published by Princeton University, while foreign-born Hispanic mothers has remained in it for generations.

In fact, black children and teenagers are suffering at unprecedented rates, and have been for more than 20 years. Black youth die by suicide at rates that are growing faster than any other racial or ethnic group: Black children younger than five years old are 1.8 times more likely are more likely to commit suicide than their white peers. Suicide rates among other ethnic groups, except for Latinx and American Indian/Alaskan Native youth, remained the same or declined, even from 2019 to 2020 at the height of the pandemic.

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By preschool age, black children have their own experiences with anti-Black racism, in addition to that of their mothers and families. A study shows that anti-Black racist beliefs emerge by the age of four. In particular, white children were found to have more negative attitudes toward Black peers and preferred white over Black children as playmates. Black children experience racism from adults, as well, and are more harshly disciplined in schools from an early age. Black preschoolers, especially Black boys, are more likely to be expelled than their white peers. This is not surprising given that teachers complain more about the behaviors of Black boys and white adults see 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 is associated with low self-esteem, symptoms of depression, and even suicide.

These “zero tolerance policies” in schools have led to children, especially black children, being expelled, suspended, or even arrested by the police in schools. This also puts them at greater risk of being funneled into the juvenile detention system, a racist phenomenon known as the school-to-prison pipeline, and is linked to higher rates of depression among Black males. Many of these children have learning problems and struggle from abuse and neglect. In other words, they need psychiatric, not punitive, measures.

The harsh punishment of Black children is linked to the phenomenon of “maturity,” the perception of Black children as older and more mature than they are. Adultification has anti-Black racist origins dating back to slavery, and is a major contributor to Black children not only being 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 as 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 in turn increases the risk of depression, stress, and suicide.

As black children age into adolescence, like all children, their social and cognitive abilities improve, including abstract reasoning. This development made them more attuned to experiences of anti-Black racism—which, on average, they reported experiencing five times a day. However, even children in the preadolescent age range, from ages nine to 12, report more suicidality with experiences of anti-Black racism and more experiences of racism in general compared to non-Blacks. young people. In young adulthood, at ages 18 to 25, experiences of anti-Black racism continued to be predictive for depressive symptoms and suicidal ideation.

The racist mutigenerational wealth gap also continues to harm Black youth and families, playing an undeniable role in the decline of Black youth’s mental health. (It’s tied to suicide, as well.) But poverty isn’t the whole story. Higher socioeconomic status was associated with greater depressive symptoms among 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 is true; A 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, independent of socio-economic status, and solutions are urgently needed to adapt mental health treatment to Black youth. Research funding is needed for additional studies examining the impact of anti-Black racism on child mental health across development. The topic remains understudied and underfunded, especially among 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 with expertise in providing anti-Black racism-focused care. Some organizations already exist, such as the AAKOMA Project, Therapy for Black Girls, and the National Black Child Development Institute, but not enough.

Standardized medical education does not teach the mental health effects of anti-Black racism, so traditionally trained psychiatrists are not prepared to help Black children navigate these harmful complexities. Curricula for psychiatrists that specifically address anti-Black racism are very limited, with only a few published in the literature. I was fortunate to study under one of them, the Social Justice Health Equity Curriculum at the Yale Department of Psychiatry. The landscape is gradually changing, with more and more medical schools working to educate students and residents about the effects 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 only the beginning; accountability is also necessary. Mental health clinicians cannot provide anti-Black-racism-informed care to children if they themselves engage in racist behavior. Leaders of mental health institutions, such as hospitals and clinics, must play an active role in ensuring that, when black children 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 important that leaders ensure that anti-racist practices hiring and reporting systems are in place to recruit and retain staff. When racist behavior occurs, leaders must hold mental health staff accountable, even if it means punishing dearest colleagues or best friends.

The youth mental health crisis will not end until the mental health of all children is strengthened. I refuse to let Black children be left behind—and that means facing anti-Black racism head on.