How Could Medical Racism Fuel Soaring Black Youth Suicide Rate? Answers and Solutions

240404_Conversations_CalhounArmah_01.mp3

Speaker 1 [00:00:04] Black youth are at a higher risk for depression, anxiety and other
mental health struggles than their non-black peers. Our guests are sounding the alarm and
sharing important ideas for addressing the crisis.

Speaker 2 [00:00:18] We'll be talking about actually our youngest patient of this series, a
nine year old girl named Penny, who basically comes to the hospital because she wants to
kill herself because of the racism she's experienced from her peers. So, it's going to be a
heavy, heavy story. But, basically, you know, we present a narrative, we present the case
just like a normal clinical case conference. So you get all the background in the history and
everything.

Speaker 3 [00:00:42] Doctor Amanda Joy Calhoun is the chief resident at Yale University's
integrated adult child psychiatry program. Doctor Tatyana Sharma is the chief psychiatry
officer and the vice president of behavioral health at Community Health Center. She also
serves as president of the Connecticut Psychiatric Society.

Speaker 4 [00:01:01] Black children ages 5 to 12 have suicide rates that are nearly double
that of their white peers right now. And the suicide became the second leading cause of
death in black children ages 10 to 14 as of 2018. And that's. It was around 2017 that I
really started to see this and get really alarmed from all of the statistics that were coming
in.

Speaker 3 [00:01:25] This is conversations on health care.

Speaker 1 [00:01:36] Well, Doctor Calhoun and Doctor Armah, thank you for joining us in
conversations on health care.

Speaker 2 [00:01:42] Thank you for having me.

Speaker 4 [00:01:43] Yeah, I think it's great.

Speaker 1 [00:01:45] You know, we read, we were taken back by this New York Times
headline which asked, why are more black kids suicidal? In fact, the suicide rate for black
youth is rising faster than any other racial or ethnic group. What are. We can start with
asking each of you to provide your perspective on the crisis.

Speaker 4 [00:02:09] Absolutely happy to. And thank you. Thank you for bringing further
light to this topic, because it really is such a, a frightening, a frightening thing that we're
seeing. So it's true. I think it's really helpful to understand, the gravity of that when you
think about the numbers in terms of the ages. So black children ages 5 to 12 have suicide
rates that are nearly double that of their white peers right now. And the suicide became the
second leading cause of death in black children ages 10 to 14 as of 2018. And that's
because around 2017 that I really started to see this and get really alarmed from all of the
statistics that were coming in. And I think that really a number of things that have, that are
playing a role and contributing to that one being, dealing with this incessant and daily
discrimination that wears down on them. And I just want to note that it has both a physical
effect as well as as a emotional impact. And, you know, I'm sure you've had guests on
before are talking about the process of weathering, but they've been able to see and
document that children who are dealing with more racial discrimination had really early
levels of, markers of this weathering effect, where the DNA is actually, getting, getting beat

up. And, and we have already seen that that has a huge impact on our, our mortality. So at
very young ages, we're already seeing that it's having a huge impact. We're hearing it not
just physically but also emotionally. And and in addition to that, it's not just the
interpersonal discrimination. There's also an environmental level of discrimination that's
going on. These children have less access to green spaces, less access to healthful foods.
They have a fear of even going outside. And I'm not talking about children who are, you
know, who live in, in what we would call the hood. Right. Who are living in places that are
just, so economically disadvantaged. I'm even talking about children who are coming from
affluent families. People who are children, who have a doctor for a mother and a business
man for a father. I have one child who I know, a teen. He didn't want to learn how to drive.
This is like the rite of passage right in suburban Connecticut. He didn't want to learn how to
drive because he he wanted to stay alive. He was fearful of even learning how to drive. So
just thinking about the wear and tear of that one, the emotional well-being. And then
there's other things. Like, once you realize that there's a problem, being able to get care
that's culturally humble care from someone who respects you, who's going to give have
high expectations for you and, and, and racially concordant, care as well. So, there's
plenty more I'm going to stop because I know Doctor Calhoun has a lot to say as well.

Speaker 1 [00:05:19] Yeah, great. Thank you.

Speaker 2 [00:05:21] I mean, I echo all the things that Doctor Sharma is saying. And, I
also have to say that I just feel so honored to be speaking with Doctor Armor because she
is, just a close mentor of mine. And so I just feel really honored to be here today. You
know, I echo all the things she she's saying. So I mostly see kids right now. I see a lot of
kids. I see very young kids. And we know there's, mounting evidence that shows that,
experiences of anti-Black racism affect children before they're even born. So we know in
utero, if black women, mothers, you know, are experiencing reporting experiences of anti-
Black racism. So racial discrimination, etc., they are more likely to have babies, that have
lower birth weight. And when we think about what that means and psychiatry and mental
health, we know that lower birth weight is also tied to greater risk of mental health issues,
later on in childhood and even beyond in adulthood. There have also been studies that
have shown that maternal experiences of anti-Black racism even lead to negative
emotionality in the first year of life. So we're talking about, effects and strikes against black
children before they're even born. And then when you look at very young children, a lot of
whom I see studies that are coming out that anti-black racist beliefs start to becoming rain
by the age of four years old. Some experts would argue younger. So black children are
going to preschool, and they are already experiencing racism from white peers, from non-
black peers who are ingesting this racial hierarchy that we have in this country. They're
also experiencing racism from their teachers. I mean, we know that it's not just the, you
know, the school to prison pipeline is the preschool to prison pipeline that black children
are more likely to be. Attended, arrested in school, you know. And when we look at child
psychiatry, unfortunately, that excessive punishment continues. I was, coauthor on a
recent study that came out in Jama Pediatrics that showed and this was in New England,
across multiple emergency departments, that black children were the most likely to be
physically restrained in emergency departments, the most likely. And so when we think
about all of these different things, which is what Doctor Sharma brought up, not only are
they experiencing racism out in the world, but then they are coming to us. They're coming
to seek mental health care and they're being inappropriately and excessively restrained.
They are being given care that is not optimal. That is not the standard of care. Of course
they're going to have increasing suicidality. Of course they're going to have poor mental
health outcomes. And so the data is not at all surprising to me, but I'm just glad that it's
getting out there that people are talking about it.

Speaker 4 [00:08:02] You know, I could I just say Amanda is so spot on because you have
people who are traumatized, getting traumatized, even from them by the people are
supposed to help them. So it just.

Speaker 3 [00:08:14] Yeah. Well I want to thank you both for the powerful framing that you
gave to that and the fact that it starts almost from birth. And I think you'd probably both
agree with me. We can imagine actually probably some epigenetic trauma from their
parents experiences as well that come to play here. And obviously so important that we do
something about it. And along those lines, Doctor Calhoun, I understand you organized an
event that brought together over 300 health care providers for a black youth mental health
clinical case conference. Clinical case conferences can be very powerful. And I'd like you
to tell us about the clinical case that you presented and the discussion that followed.

Speaker 2 [00:08:56] Sure. I would love to. So, you know, I really wanted to create a
space in, in medicine to talk about these issues. That doctor, an eye doctor, and I have
mentioned because, you know, in a typical clinical case conference, we mostly focus on
the problematic behavior of patients. Or we talk about, you know, a strange side effect
that, you know, that happened or, you know, we found out a new medicine was helpful,
you know, but usually clinical case, common series. None that I have seen or heard. I've
never talked about. What if one of the primary problems that has led to the lapses in care
of this black child is the medical racism of the of the the medical, the racist behavior of the
medical team. And so you can't talk about those cases even though they're happening all
over the country. Because if you present that case, then you often get retaliated against,
you know, there's a lot of fear, rightfully so, about coming forward. And so what I chose to
do is I interviewed, black mental health care professionals from around the country, and I
said, tell me about your case. And then out of my case, obviously, where you felt like the
racist behavior of the medical team led to poor care. And I chose six, that I then, wrote out
into, a case presentation and also a narrative. So I basically infuse the feelings and the
emotions that the mental health professional was telling me and wrote it into a story. So
they're it's, they happen every month from January to June. So we've had three and we'll
have three more. Our next one is actually next week, April 10th. And we'll be talking about
actually our youngest patient of the series, a nine year old girl named Penny, who basically
comes to the hospital because she wants to kill herself because of the racism she's
experienced from her peers. So, it's going to be a heavy, heavy story. But, basically, you
know, we present a narrative, we present the case just like a normal clinical case
conference. So you get all the background in the history and everything. It concludes with
the narrative. And then we have an expert discussant panel that comes in and weighs in
on the case, and we engage the audience. So I'm really excited about it. I hope that, a lot
of I know some people from CHC have already been there. And also Doctor Sharma will
be an expert discussant in May. So stay tuned for that. But I would love for people to
attend. And it's actually open to people even if they have no healthcare background. So a
lot of people have attended who are just, you know, mothers, friends, you know, teachers,
who really want to understand what is happening and how do we form solutions to fight
against it.

Speaker 1 [00:11:28] Well, I want to just pull the thread on that because, Doctor Calhoun,
not only you are a leader in the mental health area, but you're also a trendsetter. Because
the case conference series is, as you just noted, is open to anyone. And you really don't
need to be a health care provider. I think it's so, so powerful, to bring these groups
together and, and, and really, each presentation gets delivered in a narrative style and
again, not using clinical language. And Margaret and I know as part of the community

health center world, that the majority of our board of directors are our patients. And so, you
know, get rid of all the other language and, you know, acronyms that you're using. Just talk
to people directly. And so we say Bravo. And tell us why you made this choice.

Speaker 2 [00:12:17] So, you know, I think similar to what you said, you know, let's get rid
of all the jargon, you know, and I didn't want to continue just sort of saying the same thing
to a bunch of psychiatrists. I mean, I love psychiatry, I like psychiatrist. That's great. And,
you know, I've done some of.

Speaker 1 [00:12:32] My best friends are psychiatrist.

Speaker 2 [00:12:35] Yeah, I love psychiatrist. They're great. You know, my dad's
psychiatrist. So, Doctor Robbins, it's like. I mean, I love psych, but but, you know, if we're
truly to generate solutions right about our patients that we see, they don't just see a
psychiatrist. In fact, most of them will never see a child psychiatrist like me. And so I
wanted to hear from people who are patients who are, you know, so there are youth that
that, that attend these conferences as well that are in this age group. I wanted to hear from
mothers who have had children that they have taken for mental health care and all. I
wanted them all to understand what happens when a black child comes to the hospital and
sort of break it down in a way that's very digestible. And, you know, people like stories. I
mean, everybody likes a good story. I think everybody storytelling is so powerful and it
brings people into the world of psychiatry because people don't know what happens
inside. I mean, psychiatry is somewhat of a mystical field. People don't even really know
the difference between a psychiatrist and a psychologist. So it's important to really break it
down and bring them into the eyes of mental health professionals to say, at the end of the
day, we're here because we want to take care of black children, and here are the things
that we're seeing that make us concerned. And I can say that. But to show you that with a
story I think is just so powerful, and I think it's resonated with so many people from, you
know, there have been policymakers who have attended, there have been people who,
you know, are, like I mentioned, or teachers, principals, you know, clergy. So I just think
we're going to need a multidisciplinary approach, and we need the expertise from our
patients and families if we're going to move the needle on this.

Speaker 4 [00:14:09] And and if I can just say the power of these sessions is incredible.
You know, I've tried to attend every session that happened, even if I had to be in two
places at one time at one point, because that very first one, the over 300 people online,
there were people in person listening to the stories really brought the human side of what
is happening from the patient's perspective. Right? So not only does Amanda bring out
what the provider was experiencing and what they saw and, and their challenges and
struggles, but she also brought out what the with the children had to say. And what were
their words in in quotes. And when I tell you, I don't think that anyone who could have
listened and not had some tears in their eyes about what was going on, and I know I did,
and I deal with this every day and have done so for, you know, over a really now two
decades. Right. And it, it brought that to me. So I think that's the piece that's important that
allows people to really recognize what's happening when you can hear it, that human
piece of it.

Speaker 3 [00:15:20] Well, let me ask you to answer, this question, and I had a pretty
good sense. The the first answer is no. Is the mental health field, as it's currently set up,
equipped to care for black children. And if the answer is no and happy to hear if that's the
wrong answer. But if the answer is no, what are the levers that we need to press to change

things? What what specifically do you think needs to change? When we think about the
whole mental health field? And Doctor Armah, why don't you start and then we'll move on.

Speaker 4 [00:15:59] Sure. Thank you. So. The answer I would say right now is no. I think
that efforts like what Amanda Doctor Calhoun is doing. Those are the kinds of efforts that
can move the needle forward, because I think often times, over the course of the years, we
really, as Amanda said, Doctor Calhoun, as you said, really, it wasn't necessarily receptive
environment to help people, to learn what needs to be learned so that we can give better
care. Often times, children are being misdiagnosed, underdiagnosed, over pathologized.
All of those things are happening. And those this is not news. This is what we learned back
when, with the unequal treatment, the Institute of Medicine's, report that came out when I
was going into medical school. Lots of, if not all of what was going on then is going on
now. People are not getting adequate care, and it's unequal and race is a huge factor. I
would say one, the the conversation needs to happen. And then we also need to think
differently. If we think about how our fields were created, they were created with not with
black people in mind. And so we do have to look at, what necessarily relates to some of
the, some of our, our cultural norms and, and our roots. How are we doing things? We're
very sort of social. Right. We. Community was so important in the black community. But to
say, okay, you're just going to go to this one person who's not from your community, and
you're going to tell them all your deep, dark secrets when you can't even trust your next
door neighbor who doesn't look like you is is far fetched. So being able to help people
learn how to give more culturally humble care and to be able to relate to, to, to their
patients, I think is a huge, a huge factor. I think there are a number of things we can do,
but I think, again, to move that needle forward, things like what Doctor Calhoun is doing is,
is really necessary so that you can end up having someone who treats you, who you can
trust, who respects you and has high expectations of what you can do and what your care
can actually be perfect.

Speaker 3 [00:18:17] And, Doctor Calhoun, I'd like you to answer, the same question.
What do you think needs to change or what levers would you press? Are they in training
and policy? In just, attitude and approach or any other levers that you would like to see
pressed to change the way things are today?

Speaker 2 [00:18:37] Yeah, I think it's a great question. I'm also going to echo doctor and
say, no, not equipped to optimally care for black children, I mean, youth. I think that it's sort
of I kind of think about it sort of as a double pronged solution. So, yes, education. And I
think, being able to understand what even is culturally responsive care is important. And I
think you need to first understand how does how do experiences of anti-Black racism
impact the mental health of black children? I mean, right now there's no standardized
medical education that teaches you that, you know, as a as a trainee, as a health care
professional. And I just think if you're in the mental health field and you're going to be
caring for black children, that training should be mandatory. So as far when we think about
policies, you know, Academy and a number of leading national medical organizations
recently came forward last week and supported Dei policies in medicine and health care.
So we need more than that. We also need, you know, mandated training in education. And
I think the other side of it is also accountability. So, as I mentioned, it's not safe right now
to report when racist behavior is happening largely in medicine. So, people are afraid, you
know, so people are afraid to come forward and, and report these things. And there's no
there's little to no protection when you do report these things. And so we need a robust,
you know, we need a robust reporting system that actually is well staffed by a group of
experts who are trained at anti-Black racism, who are trained to look out for what is
retaliation look like after you report a racist incident? Who, you know, so that people

actually feel like they can come forward and have a voice because even though, you
know, a recent Commonwealth Fund report came out, I think it was in February or, that
basically said that nearly half of healthcare workers have witnessed, racism inflicted on
patients. The other half are saying they didn't see it. And some people in health care still
don't believe racism is a problem. And so you've got people who are saying, I'm seeing
this a lot, it's a problem. And then you have some people saying, well, I think it's great. I
think we're doing great. And so that therein lies the problem. So for you to take a stand
and say, I don't agree with your behavior, you have to sort of confront your colleagues.
And I think for many people that's very scary. And it doesn't come without risk. And in
medicine, we don't really create a space where we can do that.

Speaker 1 [00:21:07] Well, speaking, I don't want to talk to the doctor arm about,
confronting your colleagues. And I want our listeners cross country to know that among
your many accomplishments and there are many, is that you really highlighted racial
disparities in mental health, physical health. Back in 2011 as an American Psychiatric
Association Yale minority fellow. And this was at a time when many continued to deny
these gaps existed. I I'll talk a little bit about the resistance that you faced in the past. And
why has it not improved?

Speaker 4 [00:21:41] Yeah. Thank you. And I. I think that tying into one of the things that
probably should also be said with that last question, I'll tie it into this question, which is one
of the other pieces that needs to happen is that we have to have more of us in, in the
mental health field that are black. If we are seeing this racism against black children. And
that's why experiences like the American Psychiatric Association having these minority
fellowships is is important. I was, really happy to get a chance to do that. I didn't even
know that it existed. A colleague of mine reached out a week before the application was
due and said, this is this is for you. You need to go and do this because this is all the stuff
that's important to you. And so during that year, I was able to, get $40,000. That helped to
do things like bring Doctor David Williams, who a huge voice in, the mental health care
disparities, mental health care disparities, dialog and is prolific writer. I think only maybe
Amanda's only second to Doctor David Williams in, prolific writing. But in that I was able to
take, an opportunity to set aside time to learn for myself about the mental health care
disparities and then also some of the extra layers uncovering bias and being able to teach
my own colleagues. At the time, we didn't have a really formalized system or didactic
around what was happening in health care, all these racial disparities. And so, you know,
Doctor Robert, who was our then program director, said, hey, why don't you teach it? Go
learn it in teacher. And so I taught it to my, fellow fourth years as well as our second year.
And what grew from that as I left and just would, help to, support the other residents,
teaching residents was a growing system of looking at health care disparities, looking at
social equity. And, and, and, social justice. And what drew from that was a group, a small
group of professors who all able to come together and say, okay, what does this look like
all throughout the years of Yale residency? Where are we looking at social justice? Where
are we looking at health equity? Let's bring it together and let's make it cohesive. And now
they have an entire social health equity, social justice and health equity track. And you
know, I want to really.

Speaker 1 [00:24:15] I want to just talk a little bit about, the, the numbers of, of psychiatrist
psychologists we have in Margaret. You remember we had Doctor Louis Sullivan on
former HHS secretary. He told us the story of that back in 1950 when he started medical
school. There were 2%, black, residents along with himself, and that today there were 5%.
And, you know, the American Psychological Association report found that only 4% of
psychologists in the United States were black, even though black people represented 13%

of the population. A similar disparity exist among social workers and psychiatrist Doctor
Aamodt and Doctor Calhoun. I wonder if you could share with us your role in training that
next generation of mental health care providers, especially efforts to involve all
communities.

Speaker 2 [00:25:09] Yeah. So I can start. So, you know, as a fellow, still, it's kind of funny
to me to think that I'm mentoring others, but, I had a lot of, you know, medical students and
undergraduate students reach out to me, wanting help, wanting support, wanting
encouragement. I think it's a heavy burden to bear to go into medicine as, a black, a black
American. It is, especially because the younger generation, which I'm so glad about, is
more and more aware of what they're getting into and, the racism that exists. And so for
me, taking out the time to, mentor people who want to come into medicine, encouraging
them to come into psychiatry and letting them know that it's okay to take a break and care
for yourself. And make sure that, you know, you know, the burden that you're taking on,
but at the same time, how how much needed you are. So I think that for me, really, you
know, mentoring others and also, you know, programs like, what Doctor Ahmed
mentioned, I also was, in the minority fellowship program. So, you know, going back, I'm
supposed to go back and speak to current minority fellows in SAMHSa about, their
experiences and my experiences. So I try to to carve out time to speak to future,
physicians and really encourage them, especially, black physicians, to, you know, to stay
the course because we really need we really need more black physicians. We really need
more physicians, period, who are compassionately and empathetically caring for black
people. So I also carve out time to mentor people who are not black, but have read about
my work and want to know. I don't want to, you know, I don't want to perpetuate racism. I
don't want to be part of that. I want to take a stand and be different. I want to be an ally. I
want to support you all. And so for me, taking the time to to show it, to tell them, you know,
you don't have to be black to empathetically care for black children. You know, you just
have to be an empathetic person that takes the time to learn and unlearn the things that
you have learned in this country. And so for me, taking out that time to speak to those
people, I think means a lot to me and I hope means a lot to them as well.

Speaker 3 [00:27:14] Well, I'm going to I'm sure we're running out of time here, but I got to
get a question in about research. Three years ago, the National Institute of Health issued a
public apology for, quote, structural racism and biomedical research. We know that we
need research. We know that research is key to unlocking answers and changing the
future. But I'd like to ask each of you to just maybe comment briefly. Are we making
progress in dismantling structural racism in research?

Speaker 2 [00:27:43] There are some optimistic, parts to that. So I will say, you know, we
have seen, a little bit, of an improvement in sort of, seeing who's getting who's getting
some funding. But then we also have seen dips as far as who's getting funded. So right
now we know that black researchers, you know, researchers who are doing work into
health disparities are less likely still to get funded. And then if you think about, you know,
across generations, because it's been difficult to get funded in the past, if you are a young
researcher who is trying to research health disparities, your mentors, you May 1st of all,
you may not have a mentor around you who's doing that work. And second of all, if you do,
they have less money because they were less likely to get funded. So that impacts your
work. So for me specifically, my research is in the mental health effects of anti-Black
racism in children. And I really had to pull doctor ami knows this because she's one of my
mentors, but I had to pull mentors who didn't necessarily have NIH funding, quote
unquote. Because, you know, they should have NIH funding, but, you know, they weren't
able to get it or, you know, they decided they didn't want to go down that route. But I had

to pull mentors who had expertise in the field beyond that. And I did receive an A funding,
actually. I received, the loan repayment program award. But I have a lot of concerns about
whether I will continue to be funded because based on, you know, what we've seen, it's
just it's very difficult to be funded as as a black person and especially a black person who's
studying racism. So I think we have a long way to go.

Speaker 4 [00:29:11] I think that we have to think about is, you know, everything the
doctor, Calhoun said is spot on. And and that's at this, the far end. There's a much earlier
point in which we have to address it. Right. So we have to create opportunities and
exposures at youth. For, especially for folks who are, black because we were talking about
just the low levels. It should be at least 14, at least 10%. Right. Who are black?
Residents? Who are the people who are going to be seeing the patients who are going to
be doing the research? So you've got to give them the exposure to the research early on.
There are all these wonderful programs, and oftentimes they are only available to small
swaths of the community. Sometimes only the lowest of the lowest of the lowest income.
But there is a larger we're not monolithic as black people. So we really have to make
opportunities available to the youth so that they would even be going down that path to
ever end up in the point where they're applying for this funding. So that's that's what I
wanted to point out.

Speaker 3 [00:30:12] Do we have time for one more question or two?

Speaker 1 [00:30:14] Unfortunately, I think they're giving us the hook, but I did want to just
acknowledge the leadership that Doctor Armah has played and tell us psychiatry, and her
advocacy, around not only in the state but across the country to make sure this vital
service exists. And we want to thank her for that.

Speaker 4 [00:30:33] Thank you so much is another matter of equity. So, definitely to keep
the eye on that.

Speaker 3 [00:30:40] Well, doctor Tatyana Ahmad. Doctor Amanda Calhoun, we so
appreciate you joining us on conversations. And thanks to our audience for being here.
Please be sure to subscribe to our videos on YouTube, find us on Facebook and with our
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Thank you both so much for joining us today.

Speaker 4 [00:31:08] Thank you for having us.

Speaker 3 [00:31:13] This copyrighted program is produced by Conversations on
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