Addressing Disparities in Youth Suicide Prevention Is Key, Researchers Say

NEW ORLEANS — Using a framework that consists of the effects of racism occurring at four levels — cultural, institutional, interpersonal, and intrapersonal — may help to identify disparities in mental health care in key settings, such as schools or health services, researchers proposed.

The Structural Racism and Suicide Prevention Systems Framework also offers suggestions for interventions that could reverse these biases, such as culturally relevant clinical training and more robust research on how structural racism affects suicide risk and prevention, said Kiara Alvarez, PhD, of Massachusetts General Hospital and Harvard Medical School in Boston, at the American Psychiatric Association annual meeting.

Existing suicide prevention strategies do not adequately support high-risk adolescents from minority communities by failing to account for structural biases. Several studies have shown that minority youth at risk for suicide were less likely to receive mental health care compared with white youth, Alvarez and colleagues noted in a review published in the American Journal of Psychiatry.

In one study, only about a third of Black youth who lost a parent or loved one to suicide were receiving mental health treatment, despite prior research showing that up to 90% of suicide decedents had a psychiatric disorder.

Alvarez and colleagues attributed these disparities to biases inherent in the systems designed to help these kids, noting that mental health professionals should take action to address these issues.

“The takeaway is that addressing individual behavior and experiences is an important component of suicide prevention … but it does not address the structural problems,” Alvarez told MedPage Today. “So, it can’t be engaged in isolation. For youth in particular, it’s important to think about how youth and their family experiences really are shaped by multiple systems.”

One area of particular concern, the researchers said, is how Black youth are engaged when they do receive health services, highlighting one study that showed that Black kids presenting to the emergency department experienced higher rates of physical restraint compared with white kids.

Moreover, other research has shown that individualized therapy is less effective for Black youth in some areas.

“Regardless of what the individual therapist was doing, their work was actually impacted by the social context,” Alvarez said. “Youth are generally not accessing the mental health service continuum. The systems are interconnected and mutually reinforcing.”

Alvarez and colleagues stressed the need to separate mental health care, both ongoing and acute, from other institutions not designed to properly treat these conditions, such as law enforcement and school discipline systems.

To that end, Ned H. Kalin, MD, of the University of Wisconsin School of Medicine and Public Health in Madison and the editor-in-chief of the American Journal of Psychiatry, echoed the need for psychiatry as a whole to address these racial biases inside and outside of mental health care systems.

“As far as I’m concerned, the journal is a great vehicle to move the field in the right directions in relation to these issues,” Kalin said. “I see the journal as being the voice of American and international psychiatry, and I see our role as really shaping the field. This is one of our, if not our highest priority, one of our highest priorities.”