Issue Category: Substance Misuse and Mental Health

Annual Deaths Due to Alcohol, Drugs or Suicide Exceeded 156,000 According to the Most Recent Data

Preliminary data shows COVID-19 crisis created higher rates of mental distress, substance use, and drug overdose; 2019 alcohol deaths were higher for every adult age group

(Washington, DC and Oakland, Ca) – May 18, 2021 – Newly released data show that 156,242 Americans died due to alcohol, drugs or suicide in 2019, a record number of such deaths in a single year.  Furthermore, the COVID-19 pandemic increased stress and related substance use for many Americans.

During 2019, alcohol and drug-induced deaths increased, while suicide rates were slightly lower. Over the last decade, 2009 – 2019, the number of alcohol and drug related and suicide deaths increased by 52 percent.  These data are part of a report releasing today, Pain in the Nation: Alcohol, Drug and Suicide Deaths, the latest in a series of reports tracking the nation’s deaths of despair crisis produced by Trust for America’s Health and Well Being Trust.

Americans dying due to drug-induced causes was five percent higher in 2019 than the previous year, for a total of 74,511 deaths. The data are also beginning to show changes in the most affected population groups.  For many years, the death rate for drug overdoses among whites was substantially higher than other racial groups, data are now showing dramatic increases in drug related deaths for certain populations of color. For the year, drug-induced deaths were up by 15 percent among Latinos and Blacks, 11 percent for American Indians and 10 percent for people of Asian descent. Among whites’ drug-induced deaths rose by 2 percent for the year.

For the first time since 2005, 2019 deaths rates from drugs for Black people was higher than that of whites.

Synthetic opioids, such as fentanyl, (up 16%), cocaine (up 8%) and other psychostimulants (e.g., methamphetamine and ecstasy) (up 28%) continue to drive drug-induced deaths higher. Natural/semisynthetic opioids (e.g., Prescription opioids) and heroin overdoses declined for the year.

In 2019, 39,043 Americans died from alcohol-related causes, up 4 percent over 2018.  It was the tenth year in a row that the alcohol death rate increased.  Alcohol deaths were highest among American Indians (31.9 deaths per 100,000 people), adults over 55 (28.3 deaths per 100,000 people) and males (15.2 deaths per 100,000 people). All groups, except children, had a higher rate of alcohol deaths in 2019 compared with 2018 and early 2020 data show that rates of consumption are continuing to increase.

One bright spot in the data is that for the year (2019), the age-adjusted suicide rate declined from 14.2 to 13.9 deaths per 100,000 deaths, a 2 percent decrease. Americans who died by suicide in 2019 totaled 47,511. This decline in suicide deaths was the first since 2005 and is statistically significant. Preliminary 2020 data show a further small decrease in suicides despite the COVID crisis.

States with the highest age-adjusted death rates from alcohol, drugs and suicide combined in 2019 were New Mexico (88 deaths per 100,000 people) and West Virginia (85.1 deaths per 100,000 people).

“These data underscore, yet again, the massive problem we have had on our hands in this country,” said Benjamin Miller, PsyD, Chief Strategy Officer, Well Being Trust. “The trends are clear we are going in the wrong direction. If we are serious about addressing mental health and addiction, we must invest in strategies that are comprehensive and integrated. Incremental tinkering will not change the course or direction sufficiently enough – it’s time for bold leadership to demand more.”

The Impact of the COVID-19 Pandemic

The COVID-19 pandemic impacted Americans in almost inconceivable ways including illness, the loss of loved ones, job loss, financial stress, food insecurity, social isolation, and learning loss and the interruption of school-based services for millions of children. These stressors are impacting rates of alcohol and drug use and drug overdose deaths as more people turn to substances to help them cope.

From March 2019 to March 2020, the number of calls to the Substance Abuse and Mental Health Services Administration Disaster Distress Helpline increased by 891 percent.  The U.S. Household Pulse Survey found that the number of adults reporting symptoms of anxiety or depression from April 2020 through March 2021 was triple the number who reported such symptoms in 2019. A June 2020 CDC study found that 13 percent of adults “started or increased substance use to cope with pandemic-related stress or emotions.”

“The drug, alcohol and suicide crisis has been growing for a decade and growing in uneven ways. The COVID crisis has increased stress on all Americans and has worsened the differential impact of health inequities on communities of color. While all Americans need support coping with the pandemic, people who are currently struggling with addiction or a mental health issue need urgent attention,” said John Auerbach, President and CEO Trust for America’s Health.

The report includes policy solutions and recommendations including:

  • Expand programs that support families and communities and reduce traumatic experiences, particularly in childhood.
  • Expand access to substance use prevention programs and mental health and resiliency programs in schools.
  • Tailor prevention and intervention programs for communities of color.
  • Strengthen crisis intervention programs and supports.
  • Increase access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act.
  • Reduce availability of illicit opioids and psychostimulants.
  • Limit access to lethal means of suicide.
  • Expand efforts to combat stigma about mental health issues.
  • Improve mental health data accuracy, completeness and timeliness.
  • Expand the mental health and substance use treatment workforce; promote diversity and culturally informed practices within the workforce.
  • Build community capacity for early identification and intervention with individuals who need mental health care.

# # #

 Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org. Twitter: @WellBeingTrust

 

 

 

 

 

 

 

 

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year.  Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019.  While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

 

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7
2019 70,630 21.6

 Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

 # # #

 

About Trust for America’s Health
Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

 

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

 

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

  • HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
  • FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

 Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration.  Ensure their meaningful engagement and participation by providing funding.

  • Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

  • Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
  • FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
  • All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

 

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

  • We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
  • Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
  • Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
  • Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
  • In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

  • Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
  • HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

 Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

  • CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
  • CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

# # #

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @healthyamerica1

 

New Data: Overdose Deaths Up Nearly 5 Percent; COVID-19 Creates Additional Stressors for Both Patient and Provider Community

(Washington, DC and Oakland, CA – July 20, 2020) – Last week, the Centers for Disease Control and Prevention (CDC) released preliminary data showing an increase in drug overdose deaths in 2019. These provisional data showed an estimated 71,999 Americans died from overdoses last year, a nearly five percent increase in numbers of deaths as compared to 2018 and a reversal of the prior year’s small decrease in such deaths.

The 2019 increase was largely driven by a rise in deaths from synthetic opioids, like fentanyl, as well as methamphetamine, and cocaine.

“These new data are a stark reminder that we must fight the dual public health threats of COVID-19 and substance misuse at the same time,” said John Auerbach, President and CEO of Trust for America’s Health. “While understandably focusing attention on the pandemic response, we can’t neglect the devastation caused by substance misuse and overdoses.”

An area of concern is that the COVID-19 pandemic could contribute to more substance misuse and overdose deaths. Preliminary data from the Office of National Drug Control Policy has found a substantial increase in suspected overdoses since the start of stay-at-home orders on March 19th, 2020.  And a new study, out this week by RTI International, found that alcohol sales have surged nationally during the pandemic.

In response to the pandemic, policymakers have eased certain regulations on the delivery of mental health and substance use services.  Telehealth requirements have been altered to allow for increased access through audio-only services and federal authorities have allowed for prescribing of buprenorphine and methadone, drugs t treat opioid use disorder, without an initial in-person examination.

Despite these changes, challenges remain.  COVID-19 has made access to substance misuse treatment more difficult for many.  Millions have lost or will soon lose health insurance coverage as unemployment rises.   Some are fearful of seeking care because of the threat of infection.  And relatively little is being done to address the upstream factors that elevate the risk of substance misuse, such as lack of educational and economic opportunities and racial injustice.

“How many more lives must we lose before we take seriously the need for a comprehensive call to action? We are going in the wrong direction and need to prioritize this larger epidemic within the COVID-19 pandemic,” says Benjamin F. Miller, Chief Strategy Officer for Well Being Trust. “We must begin by investing in solutions that work – those solutions that more seamlessly integrate mental health and substance use disorder treatment into all the places people show up for help.”

Trust for America’s Health and Well Being Trust co-produce the Pain in the Nation series which has tracked alcohol, drug, and suicide deaths nationally since 2017.  For more information visit: http://www.pitn.org/

 

 

COVID-19 School Closures Put 30 Million Children at Risk of Hunger

Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates

(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.

In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students.  For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.

Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.

A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.

“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government,  should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.

Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.

Many of the states hardest hit by COVID also have highest school meal programs participation rates

States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.

States in which more than half of students are enrolled in school-meals programs are:

Percentage of students enrolled in school meal programs

D.C.                                        76.4%

Mississippi                           75.0%

New Mexico                         71.4%

South Carolina                    67.0%

Arkansas                              63.6%

Louisiana                             63.0%

Oklahoma                            62.5%

Georgia                                62.0%

Nevada                                60.8%

Kentucky                             58.7%

California                            58.1%

Florida                                 58.1%

Arizona                                57.0%

Missouri                              52.7%

New York                            52.6%

Illinois                                 50.2%

Alabama                              51.6%

Oregon                                 50.5%

Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.

“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.

# # #

 Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter:@HealthyAmerica1

Addressing the Crisis of Black Youth Suicide: Interview with Dr. Michael A. Lindsey

Dr. Lindsey is the executive director of the McSilver Institute for Poverty Policy and Research at New York University. He also leads the working group of experts supporting the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. The Task Force report, Ring the Alarm: The Crisis of Black Youth Suicide, released in December 2019, is a comprehensive examination of the alarming rise in suicide rates for Black youth over the past generation; a survey of available data and evidence; and a call for policymakers and communities to take action to better understand and to reverse this emergent trend.[1]

 

TFAH: Please describe your work at the McSilver Institute.

Dr. Lindsey: We focus on the social determinants of mental health, as well as trauma and treatment disparities, all of which intersect with intergenerational poverty. If you are experiencing inequality related to, for example, food insecurity or underemployment, that has a psychological impact. We are looking for ways to break that cycle. We are committed to studying intergenerational poverty, not only to understand its consequences, but to also do something about it.


TFAH: Where does your passion for your work come from?

Dr. Lindsey: I’ve always been interested in mental health treatment disparities, particularly the lack of treatment access for serious mental health issues among Black people. I know the consequences of lack of mental health treatment. My passion derives from growing up in the Southeast section of Washington, D.C., where I saw the effects of drug use and undiagnosed, untreated addiction and mental health issues. I want to bridge that gap to make sure kids and families are connected to treatment in meaningful ways.


TFAH: If you could recommend to policymakers one or two actions that would make a real difference on the social determinants of mental health, what would they be?

Dr. Lindsey: Let’s focus that a bit. And that’s a key point. Whatever we design as an intervention has to speak to the unique issues that are experienced by a specific group. For example, looking at the rising rates of suicide among Black youth. We need to have mental health professionals in schools, proportionate to the number of kids in that school. We can’t have one provider trying to serve 500 kids or even 100 kids; that’s too many. We also need to see more federal research dollars, specifically, for studying the increasing rate of Black youth suicide. The data are clearly telling us that Black youth are at high risk.


TFAH: Does the research you are calling for need to be population-focused?

Dr. Lindsey: No question, it does. The research also needs to be gender-sensitive and culturally appropriate. We need to understand how families of color, in this case, Black families, resolve mental health challenges. For example, do we need to involve clergy in the intervention programs? Do we need services in non-traditional settings? Do we need to provide services in places other than those that the community believes are where “crazy people” go? Setting up services from the consumer perspective will help us establish services that are going to be meaningful.

TFAH: What’s the impact of the school environment on the lives of Black children? Are you concerned about school disciplinary policies that have unintended consequences for students who end up in trouble with the juvenile justice system?

Dr. Lindsey: This is something I’m particularly concerned about. For students of color, there’s implicit bias in how their behaviors are interpreted. If you have a White kid and a Black kid and a Latino kid—if the Black or Latino kid aggresses toward someone, the reaction is that kid is a bad kid, one who should be removed from school. But if a White kid acts up, he is perceived as having emotional challenges. The White kid is not suspended, he’s offered mental health services. It happens a lot.

When Black kids are suspended from school, they can be wayward in the community, they’re not engaged, their behavior comes to the attention of law enforcement—it’s a vicious cycle. It’s also tough for those same kids who are suspended from school to return to school because those school communities often don’t want them back. The largest number of students who have this lack of school engagement tend to be Black and Brown.

If we had intervened on those behaviors early on and gotten those kids to mental health treatment and associated services, we could have averted that later suspension from school. It’s a matter of how we interpret the behavioral presentations of kids. It happens to be that Black and Brown students are the ones who are not getting the requisite services surrounding their mental health.


TFAH: What has been the impact of zero-tolerance policies in schools on students of color?

Dr. Lindsey: Zero-tolerance has had a big impact on what I would call school persistence and staying connected to school among Black and Brown kids. Zero-tolerance policies do not work, and they disadvantage low-income kids and kids of color.


TFAH: McSilver’s Step Up program is established in two New York City high schools. Can you tell us more about it?

Dr. Lindsey: Step Up is focused on positive youth development. What we do is take students who are at risk for truancy or school dropout, and we wrap-around services to support them. It includes peer support—so a lot of peer-based mentoring—as well as professionally led activities to help kids stay on a positive course. The program has an 85 percent graduation rate; that’s about 10 percent higher than the general graduation rate in New York City. Programs like Step Up or school mental health services that can be offered to kids who are struggling can be very important to ensure that these kids stay connected.

TFAH: You led the expert working group that helped inform the work of the Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. What did the task force find and what did it recommend?

Dr. Lindsey: Black youth suicide and suicidal behaviors are rising. Black boys (ages 5 to 12 years old) are twice as likely to die by suicide as compared with their White peers. We led a study at the McSilver Institute that found that the self-reported suicide attempt rate for Black youth increased by 73 percent between 1991 and 2017; meanwhile, self-reported suicide attempt rates fell for White and Latino kids and for Asian and American Indian/Alaska Native kids during the same period.

What needs to be done is many of things we’ve talked about. We’re calling for mental health professionals in every school and for more National Institutes of Health funding. We’re calling for Mental Health First Aid to be widely implemented in schools. All the professionals in schools should be well-versed in the presentation of mental health issues, the signs that a student may be having trouble and how to get that student connected to supportive treatment.

We are also calling for more demonstration projects, programs that would implement evidence-based and best practices for clinicians and teachers and anyone who interacts with Black youth. We are calling for investment in demonstration projects to identify exemplars and then implement those programs at scale.


TFAH: What is required to scale up promising programs?

Dr. Lindsey: We have a program called Making Connections. In this program, we are targeting kids who have depression. The program works to reduce stigma. It is designed to help families understand what mental health treatment is all about and to address any concerns they might have about it. It’s a promising program I’d like to see delivered at scale. In order to do that, we are going to have to invest dollars in understanding how this program works. We are currently funded by NIMH [National Institute of Mental Health], but we are going to need increased funding to be able to do this in other places. If we are going to deliver these programs at scale, we are going to have to engage in the research to take them to scale. That means establishing the efficacy of programs like Making Connections, but also determining how best to implement programs like it at scale.


TFAH: Anything else you want to share?

Dr. Lindsey: I’m reminded of the power of storytelling. We need to demonstrate how implicit bias is impacting Black and Brown kids, bias that is potentially an underlying feature of why we are seeing the rising suicide trends. We need to tell the story of implicit bias in compelling ways. I believe that will challenge folks to action. It’s also important to recognize the role that stigma and mistrust play in the disconnection from services. They play a huge role in terms of the disconnection from mental health treatment. We need to work on bridging those gaps between need and use of treatment.

[1] Watson Coleman B. Ring the Alarm: The Crisis of Black Youth Suicide in America. Washington, D.C.: Congressional Black Caucus Emergency TaskForce on Black Youth Suicide and Mental Health, December 2019. https://watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf (accessed April 30, 2020).

 

TFAH’s Statement on Racism and Health and Well Being in America

Trust for America’s Health (TFAH) stands in solidarity with those opposing racism and seeking racial justice. The recent horrific deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery further expose the persistence of racism and racial violence in American society. We must remember the lives of so many Black people taken by such violence. We keep the families in our minds and hearts.

Systemic racism undermines equity and opportunity and is far-reaching – in health, education, economic opportunity, employment, housing, transportation, and criminal justice, only to name a few examples. The toll from racism on the lives and health of Black people and other people of color is vast.  It is seen in the impact of the disinvestment in and marginalization of communities of color, the unhealthy social, economic, and environmental conditions, and the lack of opportunities within community, work and school settings, which result in deaths at earlier ages and high rates of chronic and infectious diseases.  It is seen in the impact of racial violence as well as daily instances of prejudice and racial discrimination that result in adverse mental and physical health effects such as stress, trauma, and elevated blood pressure.  The recent cases of violence against Black people and the disproportionate impact of the COVID-19 pandemic on people of color have highlighted once again the importance of combating racism as a public health imperative.

At Trust for America’s Health, we envision a nation that values the health and well-being of all, where equity is foundational to policymaking at all levels of society.  Together with all justice-seeking people in America, we remain steadfast in advocating for policy solutions to achieve equity so that everyone has a fair and just opportunity for optimal health.