As America works to adapt its healthcare services and public policy to meet the needs of children suffering from the current mental health epidemic, it is important that history does not repeat itself—with Black children being left behind.
The stakes are higher than ever. Suicide rates among Black children have increased faster than in any other racial or ethnic group in the past two decades. Many Black children’s earliest experiences with our modern healthcare system have been shaped by racism, microaggressions, lack of cultural understanding, limited trauma-informed care resources and fear, especially following the death of George Floyd on May 25, 2020. These experiences, compounded by historic healthcare inequities, have resulted in Black children being more at risk for depression, anxiety and stress.
A lifeline does exist for Black children: According to the World Health Organization, access to mental health services is one of the most important predictors of suicide risk. But a multitude of barriers stand between Black children and the care they desperately need. These hurdles include poverty, food insecurity and discrimination against families seeking quality, equitable care. Additional factors standing in the way include travel costs or other limitations, such as a parent or caregiver’s inability to miss work for their child’s appointments.
In addition, telehealth has also proven to be another discriminating factor. Now celebrated for its ease of access and its reach, telehealth has been widely used in mental health care. But recent research reveals that rural families are not as likely to use telemedicine for behavioral health needs. In many cases, large Black populations reside in rural areas where broadband service is unavailable and low-income families often cannot afford internet service.
As chief equity and inclusion officer at Children’s Mercy Kansas City, I’m intimately familiar with the barriers many children and their families face in our community. Missouri has a higher rural population than most of the country, with approximately one-third of the state’s residents living in a rural area.
I’m also aware that our local care experience is a microcosm of the national one. For the past two years, we have begun to chip away at these barriers through health equity-focused initiatives informed by research and an understanding of our organization’s culture and systems. One example includes the Physician/Provider Cross-Cultural Medical Assessment, which was given to our physicians and allied health providers, such as social workers, psychologists and advanced practice registered nurses. The assessment evaluated the extent of our providers’ formal training in cross-cultural medicine, their opinions regarding health disparities, and their self-assessed preparedness to treat a wide variety of people—such as racially and ethnically diverse patients, LGBTQ+ patients, immigrants, patients with limited English proficiency, deaf and hearing-impaired patients, and those whose health beliefs may be at odds with Western culture, potentially impacting treatment decisions. The assessment helped us to uncover areas within our health system that require improvement, which will ultimately lead to better health outcomes for our diverse patient population.
While physicians and institutions alike organize to confront a mental health crisis unlike anything we as providers have seen before, it’s critical to move forward with context for how Black children, in particular, have been affected by history, modern-day societal structures and the COVID-19 pandemic. We must not be afraid to look within our own systems to benchmark and identify equity gaps, so that we might address issues at their roots. Only then can we align to drive enterprise-wide change within our own institutions as well as our communities. Together we have the opportunity, but more importantly the responsibility, to serve and protect the lives of our Black children.
