Black Kids Face Racism Before They Even Start School. It’s Driving a Major Mental Health Crisis

To her students who need the most support, India Strother is rarely just “Ms. Strother” — she’s a family figure they call “Mom,” a trusted guide as they negotiate their teenage years.

They open up to her about their dating lives. About pregnancy scares. About their fights with their parents, about the trauma they experience outside school. She keeps a mental list of those at risk of self-harm or suicide, and checks to see how they are doing. It’s just part of the job of being a counselor at any American high school.

But at predominantly Black schools like the one in Columbus, Ohio, where Strother works, students’ mental health is further tested by pressures and discrimination they endure because they are Black, as well as poverty and violence in some communities that have faced years of disinvestment.

“Anytime you deal with African American mental health, you’re not dealing with one thing,” Strother said. “It is several things. It is trauma that has not been addressed.”

The drivers of the mental health crisis for Black children begin early and persist through a lifetime. Black children’s first encounters with racism can start before they are even in school, and Black teenagers report experiencing an average of five instances of racial discrimination per day. Young Black students are often perceived as less innocent and older than their age, leading to disproportionately harsher discipline in schools.

Black adolescents are far less likely than their white peers to seek and find mental health care. In part, that’s because Black families often distrust the medical system after generations of mistreatment — from lack of access to care to being subjected to racist practices and experimentation like the Tuskegee Study. The country also has a shortage of providers who understand the roles that racial identity and racism play in shaping young Black people’s mental health.

Research and health surveillance data point to a growing mental health crisis among Black youth over decades. Between 1991 and 2019, Black adolescents had the highest increase among any racial or ethnic group in prevalence of suicide attempts — a rise of nearly 80%.

About 53% of Black youth experience moderate to severe symptoms of depression, and about 20% said they were exposed to racial trauma often or very often in their life.

These disparities and lived experiences have systemic roots, including discrimination in housing, education and health care, and they have led to Black people experiencing higher rates of poverty and being underinsured. But financial stability does not shelter Black youth from the toll of racism on their mental health, said Dr. Alfiee Breland-Noble, a psychologist and founder of the AAKOMA Project, a mental health nonprofit focused on youth of color.

“Socioeconomic status adds another layer to it, but that’s not the thing that’s driving a lot of the behaviors that our young people are experiencing,” she said. “It’s the fact that people make assumptions about Black kids, based purely on their stereotypes.”

For 17-year-old Lillian, navigating a predominantly white school as a high-achieving Black girl wore heavily on her mental health. The AP is only publishing her first name to protect her privacy in discussing sensitive topics.

At its worst, anxiety isolated Lillian from her close-knit family. She sometimes went days without sleeping, kept awake by her schoolwork and the pressure she put on herself to excel.

All the insensitive comments and racial microaggressions felt relentless, and often came just as she was starting to become closer friends with someone. This school year alone, at least four people have tried without warning to touch her hair, which she loves wearing in puffs, braids and other natural styles.

Others told her she didn’t seem like what they expected, leaving her wondering what exactly they expected of Black girls like her. With few teachers who were people of color at her school, she often felt like she had to work harder to prove herself capable and deserving of the same opportunities and recognition that white students easily received. But in advocating for herself, she worried about coming across as too aggressive.

“I think in predominantly white spaces, we naturally code switch. We’re softer,” Lillian said. “I had to have this large patience for things that I wouldn’t normally have. Because it was my school, it’s like if I’m so aggressive, and it becomes known that I’m the aggressive Black girl, it’s gonna be terrible, and it’s gonna follow me.”

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As young as 4 to 6 years old, children of color begin to experience race-based traumatic stress, said Dr. Steven Kniffley, a licensed psychologist and senior associate dean for diversity, equity and inclusion at the University of Cincinnati College of Medicine.

Racism affects mental health on multiple levels. Besides direct hostility and microaggressions, experts said seeing people of color subjected to racist violence also takes a toll. Called vicarious racism, research has found it can result in greater symptoms of depression and anxiety.

“When we think about our young folks specifically, because of the strong influence of social media on their lived experience, they’re constantly inundated and really overexposed to all the bad things that are going on in our society,” Kniffley said. “You see a police shooting, and they’re retraumatized over and over again.”

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Suicides for all Black youth between the ages of 5 and 17 climbed between 2003 and 2017 — but the increase was sharpest for girls and 15- to 17-year-olds. A Centers for Disease Control and Prevention survey found that 22% of Black youth had considered suicide in the past year. For Black youth who are also LGBTQ+, that number was 44%, according to the Trevor Project, a suicide prevention and crisis intervention organization.

Individually and systemically, barriers to accessing mental health care disproportionately deter Black teens from getting the support they need.

The cost of care — sometimes hundreds of dollars for a single therapy session if providers don’t take insurance, and many do not — can make services inaccessible, but poverty and insurance rates do not fully explain the disparate outcomes.

The fear of being misunderstood or even mistreated by the medical establishment is not without foundation. Most mental health care providers are white — only 4% of psychologists are Black, according to the American Psychological Association. And 80% of mental health providers are not trained in treating race-based trauma, said Kniffley, the psychologist.

Racist treatment of Black people in medical care dates to slavery, and psychiatry and psychology are not exceptions. In 1851, physician Samuel Cartwright hypothesized that mental illness was what drove enslaved Black Americans to escape to freedom. Termed “drapetomania,” the belief was rooted in the idea that slavery was such an improvement to Black peoples’ lives that only those who were mentally ill would wish to escape.

And in 1968, psychologists Walter Bromberg and Franck Simon developed the theory of “protest psychosis,” the idea that Black male participation in the Civil Rights Movement caused violent, schizophrenic symptoms.

“That legacy has contributed to a mistrust that Black and brown folks have where their experience has been pathologized,” Kniffley said. “They’ve been overlabeled with behavioral challenges and learning challenges that have very real-world consequences in terms of what type of schooling you get, what type of jobs are accessible to you, how people treat you.”

Psychologists have taken steps to acknowledge their profession’s history. In 2021, the American Psychological Association issued a public apology and resolution noting psychology’s roots in eugenicist and racist ideas and the negative impact that the field has had on communities of color. The resolution called for prioritizing training and policies meant to address these inequities.

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