Children of color face an invisible threat. Here's how we can support them.

As the mother of a high school student, I can’t think of any scenario more terrifying than knowing my child was in danger, with no one to call for help. Any caring person recognizes the need to protect children against threats to physical health. Unfortunately, Americans aren’t as attentive to children’s mental health needs.

Every year, millions of children and teenagers in the United States find themselves stuck in vulnerable situations because they have no support through a mental health issue. Facing anxiety, depression and other challenges alone is scary and potentially life-threatening. In North Carolina, 51.9% of youth who experience a major depressive episode don’t receive treatment that could help.

Of course, the situation in North Carolina is far from unique. In December 2021, Surgeon General Vivek Murthy issued an urgent advisory on youth mental health, identifying the widening gap between need and treatment capacity as a crisis. This situation impacts young people and their families from all walks of life. But it’s important to recognize how communities of color experience this crisis in particularly profound ways.

As the advisory points out, young people were already experiencing significant behavioral health challenges even before the pandemic disrupted our lives on so many levels.

• Before the pandemic, as many as 1 in 5 children ages 3 to 17 in the U.S. had a mental, emotional, developmental, or behavioral disorder.
• From 2009 to 2019, more than 1 in 3 high school students reported lingering feelings of sadness or hopelessness.
• In the decade leading up to the pandemic, nearly 19% of high school students seriously considered attempting suicide.
• Between 2007 and 2018, suicide rates in the U.S. among people ages 10 to 24 increased by 57%. Early estimates indicate that more than 6,600 in this same age group died by suicide (PDF) in 2020.

And then the trauma of COVID-19 emerged. The pandemic disrupted the school and social routines that provide stability for many kids. It has introduced employment and financial uncertainty in many households, which can increase the risk that a child will face abuse, neglect or other adverse childhood experiences (ACEs). Nationally, COVID-19 has driven sharp increases in substance use, and in North Carolina, that has contributed to record levels of need in our foster care system. All of this takes a toll on the well-being of children and young adults.

On top of these universal challenges, young people of color also contend with unique pressures, including bias and discrimination; elevated rates of unemployment, leading to financial and food insecurity; and limited access to care.

The accumulation of these challenges is having a significant impact. Historically, people of color have experienced relatively low rates of suicide. But in recent years, that’s begun to change, especially for Black youth. According to the National Institute of Mental Health, “as of 2018, suicide became the second leading cause of death in Black children aged 10 to 14, and the third leading cause of death in Black adolescents aged 15 to 19.”

Tragically, our nation lacks the capacity to meet this growing need for evidence-based mental-health support. Here in North Carolina, 69 of our 100 counties have no child psychiatrists; 27 have no psychiatrist at all.

Failure to address this challenge will have long-term consequences. If they're left untreated, mental health issues increase the odds that a young person will have difficulty making a successful transition to adulthood. Children and youth with even a mild behavioral health challenge are six times more likely to experience health, legal, financial and social problems as adults, which is likely to impact the health and well-being of their own children.

The Surgeon General’s advisory reflects the growing awareness that solving our children’s mental health problems will strengthen families and communities for generations to come.

Dr. Murthy’s voice is not alone. Last fall, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association issued a joint statement declaring a national state of emergency in children’s mental health. In his March State of the Union Address, President Biden identified mental health as a national priority. In North Carolina, the North Carolina Healthcare Association called the crisis “a second pandemic,” and Governor Roy Cooper acknowledged that the issue will “worsen as we witness the pandemic’s full impact.”

More recently, the North Carolina Department of Health and Human Resources (NCDHHS) published a comprehensive report on “Transforming Child Welfare and Family Well-Being Together: A Coordinated Action Plan for Better Outcomes (PDF).” Included among its recommendations for creating a more coordinated approach to helping children and families in crisis, the report outlines the need for enhanced behavioral health supports.

This groundswell of attention won’t solve the crisis without sustained effort, but it’s an important step in the right direction – one that gives me hope.

Rising to the challenge, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has announced our commitment of $1 million to support community-based initiatives  that improve access to high-quality, evidence-based behavioral health treatment for adults and children in rural and underserved communities. This effort reflects Blue Cross NC’s ongoing commitment to improving the health and well-being of all North Carolinians. We recognize that eliminating health disparities can’t be accomplished without prioritizing a whole-person approach to care, which addresses both physical and behavioral health.

Everyone understands that a child stranded on the side of a remote road should have someone to call for a rescue. Dealing with a behavioral health need is no different. When individuals confront a mental health crisis, they might not be physically lost, but that doesn’t make their need any less urgent.

In year three of an ongoing pandemic, an era of social media pressures and an intense period of escalating global tensions, our children are calling for help. Caregivers, leaders in health care and community changemakers alike should all work together to answer.