https://nonprofitquarterly.org/how-can-we-support-youth-mental-health/?mc_cid=bae20bf5bd&mc_eid=a235032a0d Nineequa Blanding November 8, 2022 In Michigan, a 15-year-old girl was sentenced to juvenile detention for violating her probation because she did not complete her online homework during the pandemic. This young person required special education services while coping with ADHD and—like many young people when schools abruptly closed—struggled with the transition to online learning. Despite these factors, a judge deemed her a “threat to community” and stripped her of the foundational support she received from her school and community. In Brooklyn, an 18-year-old trauma victim was rushed by her family to a local emergency room one evening after they learned she survived multiple rapes that day. Although she was diagnosed with a severe intellectual disability at the age of four and was incapable of giving consent, the attending ER physician deemed otherwise by refusing to provide a rape kit, and responding police officers repeatedly asked the young woman whether she had invited the assaults. That same night, while in distress, she—along with her family—traveled several miles to another local ER that responded with the proper course of treatment, including a forensic exam. In Rochester, a nine-year-old girl suffering from a mental health crisis who verbalized suicidal thoughts was pepper sprayed by the police officers that responded to her family’s call to 911 for support. At the scene, as the young girl cried out to her father for help, she was told “you’re acting like a child” by officers, who then placed her in handcuffs, exacerbating her trauma rather than de-escalating it. “This isn’t how the police should treat anyone, let alone a nine-year-old girl,” was the response of Governor Cuomo, and many others, after body camera footage of the Rochester incident was released. Yet, these stories represent the unfortunate reality of the ongoing mistreatment and criminalization of young people experiencing mental health challenges—not just in New York and Michigan—but across the nation.
Youth Incarceration and the Criminalization of Mental Illness People coping with a mental illness are “three times more likely than the general population to interact with police and more likely to be arrested.” According to the National Alliance on Mental Illness (NAMI), the criminal legal system in the US incarcerates people with serious mental illness about 2 million times each year. Youth in the juvenile system have a high prevalence of mental disorders and severe psychosocial stressors. In fact, nearly 75 percent of youth arrested each year have experienced traumatic victimization either before the arrest or while in juvenile detention. Further, approximately 50 percent of youth involved in the juvenile legal system develop posttraumatic stress disorder (PTSD). Structural racism and patriarchal misogyny leave youth of color, particularly Black girls, disproportionately impacted. Last year, the Annie E. Casey Foundation conducted a survey of juvenile legal systems across the country. Its analysis captured “trends from 144 jurisdictions in 33 states, representing more than 30% of the nation’s youth population (ages 10–17).” The survey findings revealed that the population of Black youth in juvenile detention has steadily increased and, during the pandemic, reached the highest level it has ever been, while the population of detained white youth declined. Indeed, from May 2020 to February 2021, the overall percentage of youth sentenced to detention rose by more than six percent, an increase largely driven by incarceration rates of Black and Latinx youth. Although the population of white, non-Latinx youth fell by six percent, the population of Black and Latinx youth grew 14 and two percent, respectively.
Meanwhile, girls under the age of 18 are the fastest growing population in the juvenile legal system. Four out of five girls in juvenile detention suffer from a mental health disorder. Black girls are disproportionately represented within this system; more than 40 percent of girls in youth detention are Black. The stories shared in the opening of this article are that of young Black women and girls. Other studies show an overrepresentation of LGBTQ+ youth in the juvenile legal system. A 2015 report on gender injustice—entitled Gender Injustice: Systems-level Juvenile Justice Reforms for Girls and produced in partnership with the National Women’s Law Center—notes that 40 percent of girls in juvenile detentions across the country identify as lesbian, bisexual, gender non-conforming, or transgender. Overall, researchers estimate that 20 percent of youth in the juvenile justice system are lesbian, gay, bisexual, gender nonconforming or transgender, although they make up less than 10 percent of the nation’s population. The juvenile legal system is ill-equipped to accommodate LGBTQ+ detainees, leading to threats and trauma. The report recounts a 2014 case involving the Connecticut Department of Children and Families (DCF) and a 16-year-old transgender girl of color, named “Jane Doe” to protect her identity. DCF petitioned the court to place Jane in Connecticut’s adult women’s prison as the state does not have a separate facility for girls under the age of 18. Jane, who had been abused and sexually trafficked, was charged with delinquency. Though this is a minor charge, under DCF’s direction, she was placed in a maximum-security facility that houses women convicted of serious crimes. While detained, she was further “isolated in order to comply with federal laws mandating the separation of youth and adults.” In response to “a months-long public outcry, Jane was moved to a treatment facility in a neighboring state and then to isolation in a secure facility for boys, in denial of her gender expression as a girl.” While detained, Jane experienced further trauma—abuse, she says, by DCF employees. Jane’s story is unfortunately far from unique. As the Gender Injustice report notes, over the course of an 18-month period in Connecticut alone, “nearly 250 girls were placed in this [maximum security] adult women’s prison, many of them—like Jane—for violations of probation, running away, or fighting.” A National Emergency Amid these systemic challenges, we are seeing unprecedented—and increasing—rates of mental disorders among young people in the US. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association released a joint statement declaring a national child and adolescent mental health emergency. They note, “worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19, and the ongoing struggle for racial justice represents an acceleration of trends observed prior to 2020.” Young people in the US are experiencing increasing exposure to trauma, whose effects are exacerbated by the COVID-19 pandemic. School closures and online instruction, social isolation, and the death of loved ones have compounded the complex challenges facing young people today. Such stress and trauma exposure are driving high rates of mental illness, with ADHD, anxiety, behavioral challenges, and depression being some of the most common diagnoses among youth. According to a data analysis led by the Centers for Disease Control and Prevention (CDC), approximately six million young people aged three to 17 years old were diagnosed with ADHD and anxiety in 2019. Within this same age group, nearly three million young people were diagnosed with depression—one of the leading causes of disability among adolescents and a major contributor to the overall global burden of disease. Moreover, since 2006, suicide rates have more than doubled among young people ages 10-14. To date, suicide is the second leading cause of death of people in this age group. Despite these staggering rates, only one in two youth with a mental health disorder receives treatment. This data does not account for undiagnosed cases. The World Health Organization (WHO) notes that half of all mental health disorders start by the age of 14 years, yet most cases go undetected and untreated. According to the University of Michigan’s Health Lab, as many as one in seven young people currently suffers from an undiagnosed mental health disorder. Criminalization of mental health disorders only widens the mental healthcare gap for young people. We can seize this moment by deepening our understanding of the forces driving the staggering rates of incarceration among youth with mental illness, listening to the young people most impacted by it, supporting their leadership, and letting their voices shape policy and systems change.
According to the Office of Juvenile Justice and Delinquency Prevention, approximately 424,300 youth were arrested in 2020. A significant number of these arrests were driven by mental illness and our society’s responses to it: a congressional study concluded that every day, approximately 2,000 youth are incarcerated because community mental health services are unavailable. Yet, juvenile detention and correctional facilities exacerbate mental health challenges due to overcrowding, lack of available mental health treatment and services, solitary confinement, and separation from support systems such as family and friends. A Path Forward In a 2022 report, Surgeon General Dr. Vivek Murthy notes, “if we seize this moment, step up for our [young people] and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.” We can seize this moment by deepening our understanding of the forces driving the staggering rates of incarceration among youth with mental illness, listening to the young people most impacted by it, supporting their leadership, and letting their voices shape policy and systems change. The National Black Women’s Justice Institute (NBWJI) has done just this. NBWJI Executive Director Dr. Sydney McKinney notes, The link between unmet mental health needs and Black girls’ involvement in the juvenile legal system is undeniable. Therefore, dismantling pathways to confinement for Black girls requires a commitment to building and expanding the landscape of gender-responsive and culturally-affirming mental health services for Black girls and gender-expansive youth. Too often we look to adults for the answers when we should be asking [young people, particularly] Black girls what will best support their mental health and wellness. Given increasing rates of youth mental health disorders, the systemic criminalization of mental illness, and the disproportionate burden shouldered by young people of color, particularly Black girls, NBWJI joined forces with the Children’s Partnership to form a youth-led policy council, the Hope, Healing, and Health Collective (H3 Collective). Dr. McKinney recounts, “We created a space and opportunity for Black girls and other youth of color to be the experts we know they are.” NBWJI reports that 15 youth leaders and grassroots organizations with expertise in “community-based, trauma-informed care; healing-centered community engagement; and youth organizing” convened to develop policy recommendations for meaningfully addressing youth mental health challenges and the systemic barriers to accessing “culturally-responsive and gender-affirming treatment.” According to NBWJI, “our work intentionally centers the experiences of Black and Latina girls, Indigenous youth and LGBTQ+ youth of color, who data show are disproportionately at risk for depression, anxiety, suicidal ideation and self-harming behaviors.” As such, the H3 collective conducted six listening sessions with youth from across the US to explore four key questions:
Where were BIPOC youth seeking mental, emotional, and/or social support before the pandemic?
How did the COVID-19 pandemic affect how BIPOC youth addressed their mental health and wellness?
What barriers impacted BIPOC youth’s access to mental, emotional, and/ or social supports before and during the pandemic?
What can clinical mental health services learn from community-based strategies to improve the quality and effectiveness of services they offer BIPOC youth?
The findings from these listening sessions and subsequent policy recommendations are detailed in a recent publication entitled Youth-Centered Strategies for Hope, Healing, and Health. The report calls for an expansion of access to quality, affordable mental health care and the creation of policies that ensure that, instead of surveilling and disciplining BIPOC youth coping with mental illness and their often distressed families, the state offers such youth treatment. Dr. McKinney states: US prisons and jails are filled with people who are trauma survivors, particularly Black women and girls. And those experiences paved the paths that led to their criminalization and confinement. [Those impacted] need opportunities and support with healing from the harm they have endured, not the punishment and violence the criminal legal system subjects them to. As such, the H3 collective outlines several policy recommendations to reduce systemic harm and support young people in their healing as they cope with mental illness. The report calls for an expansion of treatment from professionals in the field—in schools and communities—that reflect the race, cultural, and community experiences of youth. Their recommendations include an increase in the number of therapists of color providing care and the creation of supportive “safe spaces” for all youth, particularly girls, transgender youth, and youth with immigration status concerns. Further, the collective demands an expansion of the scope of mental health services, investment in the capacity of youth leaders to provide peer support, and prioritization of the civic engagement of youth from historically marginalized communities. Ultimately, In considering what serves young people well, it is imperative that we address these systemic barriers and develop innovative strategies, leaving space for healing outside of and in tandem with the traditional mental health system. We must be expansive in our thinking about what supports and strengthens youth mental health—inclusive of community-based strategies that mobilize, organize and build power among marginalized youth—if our youth are to thrive. How do we stop the criminalization of mental illness and create systems that enable all youth to thrive? Mental health is a human right, and our youth should be supported instead of criminalized as they experience mental health challenges. The WHO defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.” In other words, mental health is not the mere absence of disease; “it is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.” We must create conditions conducive to mental health and reform our responses to mental illness because—as the WHO states—mental health is “crucial to [our society’s] personal, community and socio-economic development.” Now that youth mental health has been declared a national emergency, how might we galvanize efforts that center youth’s voices—including those of girls, youth of color, and LGBTQ+ youth—to develop practical solutions for meaningful change? How do we stop the criminalization of mental illness and create systems that enable all youth to thrive? Mental health is a human right, and our youth should be supported instead of criminalized as they experience mental health challenges. As demonstrated by NBWJI, a critical step forward is listening to young people and letting their voices serve as guideposts in the development and implementation of policies and programs that support young people’s mental health and well-being. Our future depends on it. Notes
Susan Seligson, “ER Care for Sexual Assault Victims,” BU Today (27 September 2011), https://www.bu.edu/articles/2011/er-care-for-sexual-assault-victims/.
Francine Sherman and Annie & Black, Gender Injustice: System-Level Juvenile Justice Reforms for Girls (Portland, OR: The National Crittenton Foundation, 2015).
ABOUT THE AUTHOR Nineequa BlandingNineequa Blanding is the Health Justice Senior Editor at Nonprofit Quarterly. With over 15 years professional experience, she has dedicated the entirety of her career towards working at the intersection of health and social justice. Prior to joining NPQ, Nineequa was Vice President at Health Resources in Action where she led the direction and growth of the organization’s grantmaking services, comprising a portfolio of over $50M towards community health and biomedical research. Nineequa was the former Director of Health and Wellness at the Boston Foundation (tBF), where she applied her vision, leadership and racial equity lens to develop, implement, and evaluate the Foundation’s strategic priority to improve population health. Prior to her work at tBF, she held senior leadership positions at the Boston Public Health Commission where she led local and statewide strategies to advance health equity. She also held former roles with Mount Sinai School of Medicine, and the New York City Department of Health and Mental Hygiene. Nineequa currently co-chairs the Harvard T.H. Chan School of Public Health Prevention Research Center (PRC) Community Advisory Board. She received her bachelor’s degree in psychology from Spelman College, a master’s degree with honors in public health from Long Island University in—her hometown—Brooklyn, NY. Nineequa was previously funded by the National Institutes of Health to conduct post-baccalaureate research in trauma-related risk factors for post-traumatic stress disorder at Emory University and the Center for Cognitive Neuroscience at Duke University.