Save the Children

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Jason Johnson: This is a word, a podcast from Slate. I’m your host, Jason Johnson. For decades. Many of us viewed mental health and suicide as white people problems. But in recent years, there’s been a disturbing rise in suicide rates for black young people and even children as young as the age of five.

Speaker 2: Long before they’re 14, 16. They’re already getting signals from society pretty regularly that their life is not as valued.

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Jason Johnson: What’s behind the rising suicide rates for black kids and what can we do to stop them? Coming up on a word with me, Jason Johnson. Stay with us. Welcome to a word, a podcast about race in politics and everything else. I’m your host, Jason Johnson. It’s September. And with schools around the country welcoming students back. We’re going to spend this month focusing on education and other issues affecting young people. And we’re beginning with a really difficult conversation. We’re talking about rising suicide rates among African-American children and youth. Look, before we go any further, if you or anyone you know are in crisis, you can contact the National Suicide Prevention Lifeline any time by calling nine, eight, eight or by going to nine, eight, eight Lifeline Talk. We’re talking about this issue today because this problem has become a crisis.

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Jason Johnson: According to research published in the Journal of the American Medical Association, self-reported suicide attempts among black adolescents rose by 80% over the last two decades. And among very young suicide victims, black children between the ages of five and 12 are twice as likely to kill themselves as their white counterparts. So what’s behind these troubling numbers and what can we do to save our children? Joining us to talk about this is Dr. Kevin Simon. He’s a child and adolescent psychiatrist and the chief behavioral health officer for the city of Boston. Dr. Simon, welcome to a word.

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Speaker 2: Thank you for having me, Jason.

Jason Johnson: So I said at the beginning that for a long time suicide was seen in the black committee as a white people problem. What I mean by that, because of historic and current suppression and oppression of black people, systematic racism and education and health care and economic and educational opportunities, we’ve sort of become tough. Right. And white people, the ones who commit suicide, white people, the ones that when they face difficulties, they take their own lives. But we suppose they can push through it. That, of course, was never true, but it was sort of a self-perpetuating stereotype that we sort of placed on ourselves, I guess, to sort of lift ourselves up.

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Jason Johnson: My question is. What has led to this increase in youth suicides in the last 20 years?

Speaker 2: The best evidence that we have right now is just identifying that this shift has happened in terms of the cause. We’re not able to delineate a 1 to 1 causation, but there are a number of factors that we could surmise are reasons why black youth are identifying suicide as an unfortunate option.

Speaker 2: And so before getting to the, quote unquote, mental health services, all the things that happened in society, when you look at black youth, particularly black males. Mm hmm. Even from grade school and pre-K. So where my son is, there’s evidence that there’s discriminatory action that happened to black youth and black males at a higher rate than their peers long before they’re 14, 16. They’re really getting signals from society pretty regularly that their life is not as valuable. They’re not afforded the opportunity to make mistakes, to have failures and bounce back from set failures.

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Speaker 2: And so oftentimes the youth that I’ve met that are black and brown and have thought about suicide or attempted suicide, there’s a sense of hopelessness or that there isn’t someone that is paying attention, wants to pay attention, wants to listen to them. It ends up being that the suicide attempt can be, again, a very bad signal, but like the largest way in which they can. Drastically get somebodies attention. And unfortunately, as we’re seeing a number of them complete suicide and aren’t revived or saved. And so the causation is very difficult to say. This is the specific thing. Right. But the accumulation of disparities that exist for black youth, I think that combination may be the kindling. That is what we’ve seen since 2000.

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Jason Johnson: Dr.. SIMON So we’ve got kids going back to school. That can mean stress. Bullying them, being on the receiving end of violence. What role can the beginning of the school year play in sort of suicidal ideation and suicidal thoughts amongst young people?

Speaker 2: Yeah. So going back to school can be an extremely stressful time for a number of students, let alone black and brown students. And it is particularly important for the school environment. That’s from the headmaster or the principal superintendent all the way down to the teacher. How we engage with students and the environment that we create in the school and the class cannot be punitive if someone makes some kind of mistake. If you think that youth is acting in a certain kind of way, you might want to ask the youth about their potential behavior that you’re seeing in the classroom and or make space and time to ask about if other things are going on.

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Speaker 2: Right. Because unfortunately, particularly for black and brown youth, there is strong evidence that even when they’re engaging in the similar behaviour as their non-black peers, there’s a perception that their behaviour is deviant and they get expelled or detention at a higher rate and they’re actually not doing anything different is just the perception of that behaviour is foul play. I would say school administrators just have an open stance of okay, let’s be understanding and try to make an environment where the youth can feel comfortable bringing anything. If there is a concern to us that we don’t want them to be hiding that inside themselves and succumbing to a negative outcome.

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Jason Johnson: We’re going to take a short break. When we come back, more on black youth suicide. This is a word with Jason Johnson. Stay tuned. You listening to a word with Jason Johnson. Today we’re talking about rising suicide rates among black youth. Our guest is psychiatrist Kevin Simon.

Jason Johnson: So. Dr. Simon, one other thing that I think about is suicide prevention programs. They’re usually targeted at high school level. If it’s anything right, it’s high school level. Maybe when you go into college. The reason this really strikes me is because, again, a five, six, seven, eight or nine year old, you may still be explaining the idea of death to them. Right. Like you might have to explain to your eight year old grandma’s gone. This is what that means. So. How do you target suicide prevention programs against a population where concepts of life and death are still relatively new? Or is that just something we haven’t done? And that’s one of the reasons we’ve seen this increase.

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Speaker 2: So suicide prevention for the younger population is best acknowledge and best programmatically by talking about mental health awareness. Right. Being able to give five, six, seven, eight year olds the language about what they’re feeling is the actual prevention. When you think about the books that describe little Johnny, Little Kevin is upset, is mad. You should be having that conversation with your youth or also when they’re upset themselves. Yes, you might want to put them in the timeout, but actually engaging them in what are you feeling and layering it for them.

Speaker 2: Right. So my daughter is going to be turning four and I’ll say, baby, are you mad? Are you frustrated? And she said, Yes, I’m frustrated because I want ice cream. And you’re telling me is bedtime. So I understand that you’re frustrated. But it is bedtime. But tomorrow we can have ice cream. Right. But I’ve given her that language to say frustrated. And she’s going to pick that up. Are you mad? Are you scared? I am anxious.

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Speaker 2: Right. So there’s a lot of language that we can actually give youth that they don’t have. And oftentimes when you’re thinking about a person’s youth or otherwise, it have things like depression. One of the challenges is they’re unable to describe what it is that they feel. And so there’s this emptiness and feel. And so sometimes they will engage in self induced behavior to feel something. So again, if we’re able to do mental health awareness programs at the grade school level where it is a psychologist, a psychiatrist like myself, a clinical social worker, goes into a school and talks with the teachers, talks with the students about here the whole host of emotions that you could be feeling that actually can help. Because then when someone feels down or feels unusual, they might be able to express it to somebody else.

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Speaker 2: Oftentimes in the black community, we were thinking about older individuals, and this is where the cultural competency in context is important for providers. Different things that culturally individuals that are Caribbean. So my parents are Haitian. My mother’s not going to say she’s depressed. That is not the language that she would use. She might say she’s tired and say it in such a way that’s like, Oh, you’re tired not just because late, but you’re tired during the day.

Speaker 2: Okay, let me ask more questions about this. Oh, how is your energy? Oh, it’s low right now. If parents aren’t able to recognize their own sets of emotions, then it’s going to be obviously hard to describe that to youth. But that’s what we have to do in terms of mental health awareness, which can then be suicide prevention because. Yes, suicide prevention. Call nine, eight, eight. Please do. If you’re feeling a crisis, please call nine. But we have to actually have more than call this entity when you’re in a crisis, because the idea is we need to prevent the crisis from. Right. How do we do that? Giving that awareness and that language.

Jason Johnson: So you said that the data has shown there’s been an increase in adolescent suicide in the black community. But you said you guys haven’t been able to sort of pinpoint causality. Right. And that makes sense. That’s sort of difficult to assess. Have you found any patterns? Are black adolescents who commit suicide, are they more likely from the south? Do they come from broken homes? And by broken, I mean inconsistent parenting figures, regardless of if it’s single or grandparents or whatever it is. Are there adults in their lives who have also had suicidal tendencies? Are there any environmental factors? May not be causes, but at least are the beginnings of a pattern that we might see about the environments that these young people are coming out of.

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Speaker 2: So you’re talking about what are the risk factors? Yes. So before putting into the context of single home substance use, the number one risk factor for a suicide attempt is a prior suicide attempt. So we always x. Have you ever thought about suicide in the last six months? Have you engaged in some form of self interest behavior, i.e. cutting, which is letting you start to feel more comfortable of the idea of pain, more comfortable the idea of self induced behavior? Now outside of that, we start to look at the individual familial and societal factors. Yes. On an individual basis. Okay. There’s genetics. Is there a history of suicide in the family? Often times we don’t know.

Speaker 2: Right. Because it’s not talked about in certain communities. Right. So that’s a problem to things like depression, anxiety. Substance use disorders are genetic. There are genetic components to it. And so you got to ask, has mom. Experience anxiety. Has Dad had depression? Has your first aunt or uncle? So risk factors for mental health conditions are important individually. Then we will look at the familial side in terms of like peers, right? So who are the peer that you’re hanging around with? Persons who engage in substance use be that cannabis nicotine again in this early age range, that there are youth that do this very early on, they’re more susceptible to experiencing negative emotions and they’re more susceptible to engaging in that kind of behavior and in society in terms of access to resources and access to treatment.

Speaker 2: Yes, unfortunately, both rural America and urban America, there are not enough youth mental health providers. And one of the more recent studies that’s very interesting identified that states which seem to have anti-racism at a higher clip. Psychotherapies are less effective for black youth in those states. Hmm.

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Jason Johnson: Interesting.

Speaker 2: Yeah. So this comes from Dr. Maggie Price out of Boston College. So. Again. Her group identified ways of measuring anti-racism within a state and said, okay, let’s look at the randomised trials that have been done in that state specifically for psychotherapy and then say, oh, let’s look at the outcomes, black and brown youth or stigmatized youth versus non stigmatized youth and non stigmatized youth. There was no issue in terms of effectiveness of treatment for stigmatized youth. If you’re in a state that seems to have more anti-racism rhetoric policies, the psychotherapies are less effective.

Jason Johnson: Interesting.

Speaker 2: So to your question about have we been able to identify, you know, regionally? Where is that happening? Mm hmm. We don’t say, oh, youth in the South have more versus youth in the Northeast that we don’t do. But this paper is one of the first papers to identify something that exists outside the person. What’s the state look like?

Jason Johnson: We’re going to take a short break. And we come back more about preventing suicide among black youth. This is a word with Jason Johnson. Stay tuned. You’re listening to a word with Jason Johnson today. We’re talking about youth suicide prevention with Dr. Kevin Simon. So let’s talk a little bit about finding help as a community. There’s been an elite focus, right, on self-care. Highly educated, highly online, financially capable. Black folks are like, yes, self-care and therapy. And black men do therapy, bcom, blah, blah, blah. That’s all cute. But that’s all adults who have access to information and everything else like that.

Jason Johnson: And that’s also very class based. What do we need to be doing for people who aren’t necessarily able to be in these sort of elite spaces? What do we do for a police officer and a schoolteacher? They’re not Beyonce. They’re not home all day talking about self-care and everything else like that. And their children are not necessarily getting access to those messages. So what’s one of the steps that we can take as a community to make sure that these ideas about the importance of therapy for children are actually trickling down to non-elite kids?

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Speaker 2: You know, so this is a great point. And I think that this is where I’ll be specific to Boston, where we’re trying to partner with our larger public school system and say, okay, how can we get resources and experts into the school and be able to have conversations and dialogues with teachers? So that way teachers understand when they should or shouldn’t disclose information that they receive from students. Because that happens often, a student says, I’m never going to tell again because I told someone in confidence. Now here it is. I’m reading it in the emergency room. Like, I understand you don’t want to end up this way.

Speaker 2: Perhaps we can have a conversation about what is the appropriate response to hearing some information. There are often community health centers that can be better funded to provide that broad based public health perspective. Because you’re correct, individual therapy is expensive and there is evidence that group therapy can work and there is evidence that communication campaigns can be helpful. It’s just the communication campaigns tend not to be in the spaces that we need them to be, but we can think about a corollary disease. HIV communication campaign is what drives people to say, Oh, wait a minute, let me get tested. Let me get tested. Oh, let me wear a condom. Let me wear a condom. It’s on the bus. It’s everywhere. Right. At least when I grew up in New York City, you can see it everywhere.

Speaker 2: Oh, yeah. That same kind of level and intensity of messaging regarding mental health, regarding talking to someone, and then also having funding and creating what I would call therapeutic landscape, i.e. not the traditional. You come to Dr. Simon in my office because oftentimes people don’t want to get to the office. It’s how do I make the football field or how do I make the art space a place where you can feel comfortable talking to someone that’s an adult, right? And share something that might be somewhat softer or emotionally related. That’s what we need to be doing. And oftentimes in a lot of the communities that we’re talking about right now, those spaces may not actually exist. And so locally, the community organizations, we’re trying to say, okay, who’s doing the work? And is there a way that we can partner? And so you can scale the type of work that you’re doing.

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Jason Johnson: So I don’t want to take the focus away from the kids, but it’s another sort of idea for parents if you’re a parent, right, and you’re black parent and you’re like, all right, I’ve listened to this podcast with Dr. Simon and Dr. Johnson. I feel like there’s been a. Change. And my son or my daughter? Who can they go to that they trust? Because, look. Institutional racism is everywhere, right? Black folks call the police and the cops come and arrest us. Right. Right. I’m calling the cops for my neighbor. And the police, you know, they take me downtown. I call Child Protective Services or I call the school and say, hey, I think my son or daughter may have suicidal tendencies. And Child Protective Services blames me. Takes my kid away. Right. And I’m the one trying to make sure that he or she is okay. So what are some things that parents need to think about on who they reach out to on this issue so that they actually can be a part of the process and don’t get blamed?

Speaker 2: Yeah. So one of the spaces that parents should feel comfortable bringing up questions, let alone that they actually have overt concern, questions are to their kid’s pediatrician. Are most kids have a pediatrician and pediatricians oftentimes are the gatekeeper to. Oh, wait a minute, I know Dr. Simon or I have clinical provider that’s in my office. And people actually feel very comfortable going to the pediatricians office. And so there are systems that exist where there is what we would call collaborative care, i.e., you go to the pediatric office. Oh, but wait a minute. There’s a counselor there. Mm hmm. And so it becomes that you can have a warm hand-off because, like, oh, you have this concern. Do you have an extra 15 minutes? I have someone that you can talk to specifically about this particular type of issue.

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Speaker 2: Another thing that exists here in Massachusetts that I know exists in some other states, we have a consult system where if someone comes in, you recognize there’s an issue here, they can dial or put a page out and they might get me to call their office. And I can talk to the pediatrician when I say, tell me what you’re hearing.

Speaker 2: Mm hmm. Okay, here’s what I would do as a bridge to. Yes, the long wait list that they’re going to have to try to get to me. You can continue to use this service and get a doctor assignment or get another child psychiatrist. And that’s something that exists. And again, funding for that kind of programming to be expensive would be very helpful. So the pediatrician would be one of the core anchoring points that I would go to as a parent the next. Your clergyperson or your faith based community. Again, there are now organizations and churches and synagogues that are getting better educated about what are the resources that are available in my community because people are coming to their places of faith.

Speaker 2: The other place, particularly for black males, it’s particularly unique here. We did this in Atlanta. I used to go to the barber probably twice a month. Right. Far more often than I would go to my primary care provider. How can I get a conversation going at the barbershop? There’s already a conversation going at the barbershop. But how can I just introduce some idea? So we had some funding. Basically, you come, you talk, you hear us. You get a free cut. Right. So there are ways to infuse, again, mental health awareness in the community where it doesn’t feel so overt that, oh, I’m talking about my child’s problem or I’m talking about my own problem. So there are innovative ways that we can do this as a larger collective in larger society. There just has to be funding to support it.

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Jason Johnson: So there are a lot of black therapists out there if you’re in the right city. Right. If I’m in Atlanta, I can get a black therapist. If I’m in D.C., if I’m in New York from in Baltimore, I can get a black therapist. It may be harder for me to get a black therapist in Austin, Texas. It may be harder for me to get a black therapist in Bloomington, Indiana. Right. You start getting to secondary cities and everything else like that. Even if you have to operate with a white therapist for your son or your daughter. We’ve always heard about cultural competency. You have to find one that’s culturally competent. But you’ve also got this term called cultural humility. What is that? How does cultural humility differ from cultural competency? And how is that something you should look for in a potential therapist dealing with your child?

Speaker 2: This is a very great point and I’ll use personal anecdote. So I myself, since 2015 have gone to therapy. Yet because of who I am and what I look like. I often know all the other black therapists, so I can’t go to them. So when I’m with the providers that I’ve been with and the two that I’ve been with, neither is black. Mm hmm. How they inquire about things that they don’t know. If I bring it up, let me know. Okay. At least you’re comfortable saying. Wait, Kevin, can you just explain that to me?

Speaker 2: Mm hmm. And that’s cultural. Really not suggesting that you seem to know everything or the biases and the stereotypes that you see on TV is going to bring into the room. If the woman says she’s fatigued. You just actually, when you say 58, is it plain that for me or is there some cultural phrase that said, but can you help me understand it? And the reality is that happens as a provider myself. I’m only black, I’m not Asian, I’m not Latina. So if I have an Asian patient, I have to actually just that to me. I don’t understand that you want to feel like your provider is a place where you can go and you don’t feel judged and is also a place that you can go. And if they ask you a question, you don’t feel like they’re probing in a way to be demeaning, but they’re probing in a way to help you as well as help themselves understand.

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Speaker 2: That’s what the humility is in terms of culture, because the reality is it’s going to be impossible to try to pair every person of color with a provider of how could you just aren’t enough providers that are diverse? So you’re going to have to engage with individuals. And I say this to my colleagues. You’ve got to engage with people that don’t look like you. It’s not possible to send every kid that’s 16 like basketball. To me, it just can’t happen.

Jason Johnson: So, you know, Dr. Simon, I always like to end the show on sort of, I guess, an optimistic note or a call to action. Let’s say right now someone hears this podcast or it’s been shared with them or something else like that, and there’s an eight or nine year old in their life or a friend’s kid or a student or some kid who comes in for regular dental appointments. And they seem different. They seem changed and they seem sad. What are some steps that you can take right now if you have that child in your life to to sort of head off the possibility that this could be heading down that path. What is the number one thing you want that parent to know from this podcast about what they should do next?

Speaker 2: Yeah. So one, kids are very perceptive. Do not think that just because you move to a better situation that it’ll just be okay. You should set time. And I say this as young as six. As young as five. You should set TIME weekly for your child to be able to just talk to you where you listen to a call listening session. It doesn’t have to be long. The older they get, the longer you can extend it. But it’s really just they get to tell you about anything that’s happened to them in their day.

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Speaker 2: You have to fight the reflexive parental response of let me put in an action to make it better, and you yourself have to be able to sit with some of that discomfort. But what that actually does is you mirror that for your child and you let them see. Wait a minute. Oh, yes, I can tell mom or dad I’m sad because you want your kid to come to you when they’re feeling not well. Mm hmm. Oftentimes, parents might say it, but how did they tell you all this stuff?

Speaker 2: Mike, I just listened. I asked the question. I just listened. Parents can do that. We’re in a society where we move really, really fast and it’s like hard to actually just be still and present and grounded and just listen. But honestly, setting aside listening sessions in the week, Thursday, you choose the time. It could be the drive from school to home, but to train right from school to home when they know that those are the youth, that when something comes up or they’re getting peer pressured in this way, they come and tell the parents.

Speaker 2: And so that’s one of the things that the parents that I engage when they start to do that, they actually do start to notice a particular difference in how much their child does want to share. It comes from just being open and receptive. Outside of that, if it seems to be something that extends beyond what you feel is your capability, yes, your pediatrician should be kind of like your first line to the pediatrician, then has the ability to access higher level of resources. Even if you’re in a low resource area. The pediatrician generally would know.

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Jason Johnson: Dr. Kevin Simon is a child psychiatrist and the chief behavioral health officer for the city of Boston. Thank you so much for joining us today.

Speaker 2: Thank you for having me.

Jason Johnson: If you or anyone you know are in crisis, you can contact the National Suicide Prevention Lifeline anytime by calling nine, eight, eight or by going to nine, eight, eight Lifeline Talk. Thank you very much. And that’s a word for this week. The show’s email is a word at Slate.com. This episode was produced by Jonny Evans. Ben Richmond is Slate’s senior director of operations for podcasts. Alicia montgomery is the vice president of Audio. Our theme music was produced by Don Will. I’m Jason Johnson. Tune in next week forward.