This blog post was written by Voices intern Cat Atkinson.
“If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” – Lilla Watson, Indigenous Australian artist, scholar, and activist.
This year marked Virginia’s 3rd Racial Truth & Reconciliation Week (RTRW); a virtual week-long conference hosted by Voices for Virginia’s Children. This year’s RTRW took place August 22-27, 2022. The mission of RTRW is to empower the voices and experiences of marginalized communities in acknowledgment of truth to promote healing, reconciliation, and justice for children and families. This week promotes the reckoning of our past to reconcile our present and future. In this blog post, we’re taking a look back at this year’s themes and workshops.
RTRW seeks to advance policies that dismantle systems that perpetuate racial trauma, oppression, and inequity by educating Virginians, encouraging advocacy and activism, promoting equity, inclusion, and justice, and uplifting the voices, truths, and experiences of communities of color.
As we continue to navigate divisive political landscapes and strive to promote trauma-informed healing, compassion, and justice, we intentionally selected RTRW themes to reflect the intersections of current events, history, culture, time, and policy that we find ourselves in. RTRW 2022 highlighted the themes of “Good Troublemaking: Necessary Trouble to Enact Change”, “Voices of Virginia’s Future: Highlighting Young Advocates”, and “Activists and Organizational Change: Reckoning and Reconciling Our Truth”, centering the voices and stories of youth and community members as the experts on their lived experiences in these topics.
“Our kids were born for this time.” – Ann Zweckbronner, Parenting an Activist
Over the course of the week, we had 19 workshops, 31 presenters, and 586 registrants from 29 states and Canada! RTRW went international! We had attendees from state agencies, non-profit organizations, community-based organizations, students, youth, parents, and more. 95% of those polled were satisfied with the programs and 98% of those polled thought the content was relevant to their work. We have been celebrating the community that RTRW has created by continuing to engage with repeat attendees over the years.
The workshops this year highlighted the importance of community partnership and the collective liberation of the communities we uplift through advocacy. We engaged in conversation about DEIJ (diversity, equity, inclusion and justice) within organizations and communities, we discussed the importance of understanding intersectionality, how to support and encourage social justice advocacy within youth and cause “good trouble” within our social system to bring about radical change. There was collective storytelling, intentional self-reflection, engagement with new lenses of focus, and a buzz of energy from attendees and organizers to take this work back to their own spaces. In one week, we got to see the power of community engagement in mobilization for radical change.
Voices is able to convene events like RTRW that ignite change in pursuit of healing, reconciliation, and justice thanks to your generous contributions. Please consider giving a gift to support the dedicated work of Voices staff in putting together RTRW and other events focused on improving the lives of Virginia’s children.
This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.
For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.
The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people
The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.
Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.
This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.
At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.
For 9-8-8 to be truly transformative, investments are needed now.
While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:
Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.
Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.
This post was written by former Voices intern Abby Aquije.
Between a rigorous academic schedule, part-time job, and extracurriculars, my high-school self often had 12+ hour days. Just thinking about it makes me overwhelmed and exhausted. This, unfortunately, is the norm for young people, especially those that are looking to go to college or who have families they help to support. It is a lot of pressure to put onto young people and having graduated the year before COVID-19 started its impact, I can only imagine how much worse it has gotten.
Current Events and Societal Stressors are Worsening the Impact
With all the uncertainty throughout the first years of the COVID-19 pandemic, motivation was low. I remember in the fall of 2022 I barely got ready for my second year of college. I did not want to fully commit myself to something that could be taken away from me as it was the semester before. Beyond the fear of having to go back into a full lockdown, I also knew the year was not going to be anything like the college experience everyone talks about. Online schooling, frequent testing, and following the ever-changing safety guidelines all contributed to my burnout. Yet, I know I did not have it bad.
Tackling Burnout Can Help Prevent Other Mental Health Crises
Burnout is certainly not at the top of the list for reasons young people struggle with depression or stop pursuing higher education, however, tackling it can help prevent those outcomes. Catching signs of youth burnout early can allow adults to help these individuals engage in routines and other preventative measures. In addition, there are many stressors that adults can work on limiting or managing better. This is especially so for students that have additional hardships and stressors. Students with learning disabilities, students from low-income families, and students of color are all at higher risk for burnout. Policies aimed at alleviating these stressors can tackle symptoms of burnout early on. If burnout is inevitable, it is necessary to integrate peer support and other forms of behavioral health resources to assist youth through the symptoms.
Our youth are facing an unprecedented number of stressors that can explain rising rates of depression and anxiety among children and adolescents. Gen Z youth are experiencing stress from sources ranging from school demands to family issues, and even “eco anxiety.” Though these statistics tell us that most youth are struggling with similar hardships, those that work closest to them assure us that this is not how they see it. Recent conversations with Virginia youth directors have made it clear that a key element in this crisis is that youth are feeling alone and disconnected from those around them.
Most of us have been there, feeling as if we are the only ones stressing about school, social image, or family issues, when in reality the majority of us go through similar issues. As a society, we are becoming more open about mental health issues, yet, there is more to be done. If youth do not feel comfortable talking about their struggles, they will continue to feel alone. Think of a student falling behind in a class. On top of feeling the academic stress, they may also feel shame, which could lead to feelings of isolation and then more serious mental health issues. Even in the Netherlands – whose COVID-19 response included short lockdowns, equitable funding, and high rates of broadband access – student test results revealed a learning loss. How can a student blame themselves for something that is happening globally, even in “best case” scenarios? Why is it that they feel shame rather than solidarity?
The COVID-19 pandemic has worsened the already concerning rates of loneliness
Loneliness is being described as an epidemic, with over 60% of young adults feeling it. They are unable to connect with those around them and have to tackle their challenges alone. This all makes the perfect recipe for deteriorating physical and mental health issues that must be addressed.
High rates of youth loneliness can easily be attributed to the COVID-19 pandemic: the nationwide lockdowns, social distancing, and virtual schooling all caused disconnection. Efforts to boost human connection were admirable, but the damage is done. No amount of virtual connection can make up for the formative middle school years, high school celebrations, and other important in-person experiences youth missed. While it is easy to point fingers at the pandemic, we cannot forget that these rates were rising prior to it. Social media and changing family structures also play a role in limiting the connections youth build with one another.
Program Response: Employ connectedness strategies
As we move forward, we have to be more intentional about forming and maintaining connections. Those that work with youth should prioritize creating spaces for youth to meet and truly connect with one another. Youth thrive when they feel they belong, they need to know that people hear and care about them.
Most parents and caregivers know the importance of forming secure attachment in early childhood and actively work toward developing it. Attachment building paves the way for healthy and independent children, however, as they grow up there is less of an emphasis on developing and maintaining these sorts of connections. It is important for kids to learn independence, but no one can survive on their own, not physically or mentally. It is no surprise that youth connectedness is a protective factor for negative mental health outcomes and that the CDC supports the implementation of connectedness strategies, policies, and activities. As we move forward, we must value building youth connections just as much as we do infant attachment building.
Policymakers should push for Peer Support Services before crises arise
Combating the loneliness epidemic will take time as it requires youth buy-in and societal shifting. Working alongside young people as we continue to research and develop solutions will be essential as we move forward in an effort to improve the overall mental health of our youth.
This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.
**This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.
On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.
Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.
The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.
Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019
Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021
Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021
Barriers to Accessing Mental Health Services
Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.
As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”
LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).
LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.
Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.
These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.
As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.
The momentum was in place for children’s mental health in Virginia. The US Surgeon General and key advocates declared a national emergency to confront a decade-long decline in children’s mental health. Despite widespread concern, Governor Northam’s original budget proposal did not fund new programs in schools for children’s mental health. To meet the moment, a bipartisan group of legislators and advocates from various communities lobbied for investments in psychological services and counseling. Additional resources of $1.4 million per year will expand the Virginia Mental Health Access Program to integrate services in health care settings. Noted below are other new investments integrating mental health in school settings, increasing reimbursement rates, and supporting the workforce.
A First Step for School-Based Mental Health Integration
Over the last three years, the General Assembly has focused on improving school-based mental health by funding specialized student support positions—counselors, social workers, and psychologists. While students have benefited from better relationships with faculty, COVID presented unanticipated disruptions, rapidly increasing needs, and barriers to vital care. School divisions have responded by allocating federal recovery funds into training, coaching, and even bringing community-based mental health professionals into schools.
However, federal support during this emergency is impermanent and mental health threats are ongoing. School divisions need resources to continue to support these efforts. Voices led advocacy for additional state general fund resources supporting school-based mental health in flexible ways to assist school divisions in identifying key partnerships and resources. The General Assembly allocated $2.5 million in FY23 to begin supporting school-based mental health services and included language asking the newly established Behavioral Health Commission to study how schools can better integrate mental health services with sustainable funding streams such as Medicaid.
The General Assembly also approved funding to establish a regional Recovery High School based in Chesterfield where substance abuse recovery is incorporated into the school day. The proposal by Delegate Carrie Coyner was finally approved after the 2020 COVID response cut funding. Other high schools will be able to look toward this model to support health needs in the classroom.
The lynchpin to support the social and emotional well-being of students is having an appropriate workforce. We are excited about two changes that will help address pressing workforce challenges.
The House and Senate approved HB829, proposed by Del. Tony Wilt, that will provide flexibility on a provisional basis for licensed mental health professionals without certification to work in school-settings. This flexibility will ensure that school divisions can hire more mental health staff.
The budget adopted by the General Assembly includes funding for a new initiative to help mental health professionals seeking licensure when they must pay for their supervision time out-of-pocket. The new initiative, Boost200, will provide resources to cover out-of-pocket expenses for licensure and match them with approved supervisors. This initiative is poised to make a significant impact on removing barriers towards licensure and diversifying the mental health field. Learn more about participating to address licensure costs or to work as a supervisor.
Improving Medicaid Reimbursement Rates
The third area that the legislature improved on mental health services was improving Medicaid reimbursement rates for several mental health services. Federal funds from the current “public health emergency” have increased payment rates for community-based services by 12.5%. The General Assembly approved resources to continue financing those services. The General Assembly also improved rates for psychiatric residential treatment facilities. Many facilities served children from other states and lacked placements for children in Virginia, leading to greater instability for the hardest to place children, who are the focus of the Safe and Sound Task Force. The increased rates should help caregivers meet immediate needs, but challenges remain to ensure that children are not placed in inappropriate and lengthy stays in congregate settings. While increasing Medicaid rates is a positive step, adequate reimbursement is essential to looking after the mental health of economically disadvantaged children and vulnerable children in the foster care system.
Advocates, school personnel, mental health clinicians, and families have been saying for years – even before the pandemic – that children’s mental health access is in a state of emergency. Over the summer, we heard from outpatient treatment clinicians who had months-long waiting lists and emergency departments that were filling up with children in mental health crisis without other options. As school returned, more reports of mental health and behavioral disruptions resonated across the Commonwealth. Now, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association are declaring a “National Emergency” in children’s mental health.
Virginia lawmakers are paying attention too. During a discussion about education funding in a Senate Finance Committee meeting, Senator Jennifer McClellan stated, “the kids are not okay.” The compounded effect of the pandemic, racial trauma, and individual traumatic experiences are causing anxiety, depression, and more severe mental health issues in students. It was evident to Senator McClellan as a parent that mental health is causing major distress and barriers to learning.
Young people are ready for policymakers and leaders to address this emergency.
Justice, a young adult in Richmond told us this week, “I believe that if we can put more free mental health services out there for young people to turn to if they don’t have somebody to talk to they won’t just keep things in and one day just explode… It’s okay to not be okay.”
Children’s Mental Health Discussion Paper: October 2021
Children’s mental health needs touch all systems and all aspects of life. To fully address children’s mental health issues, we need an “all-hands-on-deck” approach. There are no easy solutions to address a “state of emergency” but there are many points to begin trying.
Voices has released a discussion paper for lawmakers to tackle children’s mental health issues from the perspective of the child-student and outside any one silo. This paper is relevant for lawmakers serving on the education funding committee, health and human resources funding committees, and the newly formed Behavioral Health Commission. It also creates a framework for the incoming governor to tackle a pressing issue and create some opportunities to continue collaborative efforts such as the Children’s Cabinet.
The most important steps lawmakers must take to address the current emergency include:
Addressing workforce shortages. Children’s clinical workforce shortages existed even before the pandemic, but overall workforce shortages are contributing to even longer waits for care. We need to retain the current workforce, attract a future workforce, and align the current workforce to opportunities for licensure and appropriate reimbursement. We support a proposal in front of the Behavioral Health Committee and consideration for the governor’s budget to assist clinicians in paying for supervision towards licensure to help meet immediate needs. Additionally, retention bonuses proposed for providers in the public mental health system and loan repayment programs are critical. In the longer term, stakeholders and leaders should spend time defining the best fit for certain roles, particularly the roles that can be filled by Qualified Mental Health Professionals (QMHPs) in schools and community settings.
Building out the capacity of health providers to address mental health issues. Continuing efforts to expand the Virginia Mental Health Access Program to reach more health providers, such as emergency department staff, and enhancing awareness of early childhood mental health issues are necessary. Additional recruitment and professional development for the health care workforce to identify and address mental health needs can help children who might not have robust school-based services.
Facilitating connections between schools and community providers. School have gotten very creative at finding ways to meet mental health needs during the pandemic. And thanks to investments from state lawmakers, many have been able to add additional school counselors and specialized support staff. For these new initiatives to meet increased demand and increased severity of need, the schools will need support to implement trauma-informed and multi-tier support from the state Department of Education and from their school divisions.
Additional federal resources and Medicaid reimbursement will be critical to supporting school-initiated services in the long-term. There are several opportunities to create strong support systems for student mental health with American Recovery Act funds, the recalibration of Medicaid-funded mental health services through Project BRAVO and the ability for schools to bill for health and mental health needs outside a students’ IEP through the “free care” rule. Stakeholders, students, providers and schools should come together on some ideal plans and programs to implement at the school and child care level to meet student needs.
It is an unfortunate truth in this country that we must have difficult and scary conversations that follow acts of violence, including school shootings. These events stir up confusion, fear, and unease for ourselves as caregivers or parents who are witnessing our worst nightmare, and also alarm the young people in our lives. It is during these difficult moments that children and youth look to trusted adults to understand how to react, cope and how to trust the world around them again. As you embark on these challenging conversations, consider the guidance below:
Name emotions together. Anxiety. Hypervigilance. Name the things that are coming up and be open about what comes up for you as a parent/caregiver. Sharing like this demonstrates that a) emotions are acceptable and b) gives them an opportunity to model their coping styles after you. Reserve processing more intense emotions with other supportive adults. While it is good to be open about emotions, you do not want children to think they must care for you too, or that they are somehow at fault. Phrases like, “I’m upset about what I saw, it’s not you,” can also help ease heightened and worried young minds.
Consider what is developmentally appropriate. You are the expert in your child. For any child or youth, approaching the conversation with curiosity and playfulness will be most helpful, but there are some things to keep in mind depending on age.
Remember that younger children (up to Elementary School age) tend to think in more linear, concrete terms, so keeping things simple, clear and concise will be important in addressing their anxious behaviors. Accept and hold the full range of their emotions. Phrases like, “A scary thing happened here, and grown-ups are working hard to try to fix it and keep everyone safe.”
Older children (Middle to High school) are keenly aware of when they are being condescended to and already have access to so much information on their own. Begin by being curious about what they already know. Anchor your conversation in facts. Invite a check-in later, if needed. “This scary thing happened and it’s making me think about safety. We can talk whenever you’re ready.”
Reassure safety. School is supposed to be a safe place. Help the young people you are connecting with understand that school is still a safe place to learn and connect with friends and trusted adults. You can approach this practically by helping to identify the things that keep them safe day-to-day, like talking to trusted adults when they are feeling afraid or unsure. Reiterate their safety by reminding them that you are always there for them and that authorities are investigating. “It’s okay to feel scared, but know that your teacher(s) works with me and other helpers to keep you safe.”
Keep the news and any violent or potentially triggering media away. If you as an adult are eager for the information, practice discretion, or try distracting your child to shift their focus. For older youth, filter the news for optimal times of day (avoiding close to bedtime) and/or watch together. Consider youth-centered news resources as well, such as Xzya: News for Kids.
Maintain routines. Keep it as “normal” a day as possible. Regular schedules are reassuring and can reduce anxiety. Ensure plenty of sleep, regular meals, and movement. Encourage academics and extracurriculars, but if your child is overwhelmed, take those cues and suggest a more emotionally accessible activity to do.
Navigating these conversations is not an exact science. You and the child you are supporting may have different needs depending on aspects like age, race and ethnicity, where you live, and the resources available to you for support. Let these talking points and recommendations guide you, but recognize when to ask for help.
We want to raise awareness about the importance of having mental health professionals of color and why children in particular need clinicians who present and reflect their same racial and ethnic experiences. This post focuses on the recruitment of clinicians of color, barriers to recruitment and how you can be an advocate.
Intentional Recruitment of Clinicians of Color
As mentioned in the first part of this series, there is a shortage of Black and Brown mental health providers and those that do exist can be difficult to access, especially depending on where you live. So, in addition to raising awareness about the need for more mental health professionals of color, we have to speak to why there is a shortage. One of the reasons is recruitment and retention. The mental health arena consists of many types of job settings and positions and for a long time, the field has not been intentional about recruiting Black and Brown people. While better efforts have been made with the help of increased conversations about diversity, inclusion and equity, we still have some ways to go to close the gap.
Barriers to Recruiting and Retaining Mental Health Professionals of Color
The Reach of Job Postings
I have benefited from recruitment efforts that involved being personally referred for a job opening by an inside person. This is a common practice in the mental health field especially in the non-profit world. I don’t knock this kind of recruitment effort, however I do have a problem with it being providers’ primary or sole recruitment strategy especially if the organization or agency’s staff is predominately white and have little or no connections to other professionals of color. This will not help reach more clinicians of color. Intentional recruitment of clinicians of color requires diversifying the places/platforms where job opportunities are posted. Posting jobs in places that attract the same pool of applicants every time and then simply concluding that Black and Brown clinicians don’t apply for whatever biased reason is a barrier.
Fair and Equitable Pay
Traditionally, the mental health care field has been known to have low to average paying positions. Though we are beginning to see increases in pay, we still need to consider the equity implications for why White mental health clinicians generally would be more likely to accept a lower paying job than clinician of colors. Funding for Black and Brown mental health providers to start businesses of their own is also a barrier.
We cannot deny that workplace discrimination continues to occur and when it does, the discrimination is mostly based on race and sexual orientation, which is reflected in a 2017 Report from the Behavioral Health Workforce. This report highlights that discrimination against the client population also deters mental health clinicians of color from working with particular employers or is a factor that leads to them leaving their job.
Call to Action
What you can do? Mental health providers of color can connect with/join area chapters of organizations like the National Association of Black Social Workers, National Association of Black Psychologists, and National Association of Black Counselors. Membership benefits can include networking, educational opportunities, mentorship, greater access to job referrals/job postings, and other community resources, just to name a few. These associations often have directories and other resources that can help community members of color find Black and Brown mental health providers in their areas. Additionally, the aforementioned associations oftentimes have student chapters at various colleges and universities that allow students of color to get connected to strong professional networks which helps prepare them for the workforce post-graduation.
We can create pipeline structures for future mental health professionals of color by increasing exposure about employment opportunities in the mental health field to Black and Brown youth as early as possible. Increased positive experiences between Black and Brown clients and mental health providers who reflect their ethnicity and cultural norms can lead to increased interest and desire for people of color to enter the field. White providers working toward intentional recruitment of clinicians of color can reach out to local Historically Black Colleges and Universities and connect with their Department of Field Education and Career Centers to share job/internship opportunities. Go to these places and participate in their job fairs, build relationships with the Schools of Psychology, Social Work, Counseling, etc.
Last, but not least, keep addressing systemic racism and its impacts on Black and Brown people. Invest in more trainings for administrators and employees that address biases, structural racism and other barriers to achieving equity, inclusion and diversity in the workplace. Advocate for more equitable funders/funding sources so Black and Brown mental health providers don’t have to continue struggling to effectively meet the needs of their communities.
This is a guest blog post written by Olivya Wilson, MSW, LCSW, the Parent Engagement Coordinator for Greater Richmond SCAN.This is part one on the impact of having clinicians of color.
We want to raise awareness about the importance of having mental health professionals of color and why children in particular need clinicians who present and reflect their same racial and ethnic experiences.
I want to do this by first introducing you to Tamika. Tamika is a Black/African American mother of four. She has three boys and one girl. Her oldest son was diagnosed with Autism as a child, something she knew nothing about as a new mom several years ago. This diagnosis led her on a winding path of trying to learn all she could about the diagnosis and how to find the right kind of resources and supports for her son. She fought many battles trying to advocate for her son’s needs. He was completely non-verbal at the onset of his diagnosis and struggled with aggressive behaviors, among other challenges. Additionally, he was in a school system with personnel that didn’t know how to appropriately respond to his needs, especially with him being a tall Black adolescent and later, a teenage boy with Autism.
When her son began receiving intensive in-home counseling services, she requested a Black male counselor, but for the first three to four years, her son was assigned mostly White female counselors. He received a Black female counselor once, but shortly after was switched back to a White female counselor. Tamika persisted with this request until her son was finally assigned a Black male counselor, who she said has made all the difference in her son’s progress.
If you asked Tamika, she would tell you that the reason it took so long to get a Black counselor for her son is because there aren’t enough Black mental health providers to meet the ever-growing need and demand. Black male mental health providers are even more scarce. Tamika shared her story with me and continues to share it every opportunity she gets about why it was so important for her to find a Black male counselor for her son. She went to these lengths because she knew it was important for her Black son to be connected with someone who looked like him and who could identify with him and relate to him in a real way. She wanted someone for him who shared similar, or even the same, ethnic and cultural values.
Why Children of Color Need Clinicians of Color
I’m always reminded of Tamika’s story whenever I engage in conversation about the need for more Black and Brown mental health professionals. Her story is just one of many that helps convey why having clinicians of color is so important. When we consider the needs of children of color, we must consider their unique backgrounds and experiences as well. We have to take into account what it means for them to have mental health professionals that represent and reflect their identities, as well as have spaces to share and process their experiences without the added stress of having to explain themselves or feeling fearful of being misunderstood, judged, invalidated, or further marginalized by their therapists.
In season 4 of the award-winning drama series This Is Us, Randall Pearson, played by Sterling K. Brown, finally acquiesces to seeking therapy for his past traumas and history of mental health challenges. He begins working with a White female therapist, who Randall appears to develop a positive rapport with and who seems to help with his first breakthrough. However, with COVID-19, the resurgence of violence against Black people, increased racial and political tensions happening, he comes to realize he needs to find a therapist that could help him show up more authentically in a therapeutic space and he finds that with a Black male therapist.
When I think about the mental health of children of color, I think about how the history of racism and systems of oppression are in many ways connected to their presenting circumstances. Just like we advocate for more representation of Black and Brown people in other professional arenas such as the medical field, politics, mass media and sports that have been dominated and run by White people and white supremacist systems for so long, the advocacy is desperately needed in the mental health field as well.
Raising awareness about the racial-ethnic disparities in the mental health field doesn’t dismiss or deny the ability of some White mental health professionals to work with Black and Brown children and their families. However, it does remind us how neglectful the mental health field has been to Black and Brown individuals and communities. For me, not acknowledging the importance of having and needing more mental health clinicians of color keeps us at risk, whether consciously or unconsciously, of perpetuating the “White Savior” complex.
“From Sachs to Kristof to Invisible Children to TED, the fastest growth industry in the US is the White Savior Industrial Complex. This world exists simply to satisfy the needs—including, importantly, the sentimental needs—of white people…The White Savior Industrial Complex is not about justice. It is about having a big emotional experience that validates privilege,” according to a piece in The Atlantictitled “The White Savior Industrial Complex”. (Source: https://www.theatlantic.com/international/archive/2012/03/the-white-savior-industrial-complex/254843/)
I’ve come to recognize more than ever that Black, Indigenous, Latino and Asian people, especially our children, need to see more people like themselves participating in the healing process. Attending cultural competency or cultural sensitivity trainings are helpful and necessary, but it’s not enough. We must start to recognize how important the lived experiences of Brown and Black mental health professionals are to the practice. In these Trauma Basics or Intro to Trauma Informed Care trainings, we learn that trauma doesn’t discriminate, it has no respect of person, it crosses color lines, class, socioeconomic lines, etc. This is true, trauma can and has impacted all kinds of peoples and communities. I’ve also learned in my Urban Trauma training courses that there is a history of trauma, cultural biases, mistrust, and stigmas that are unique to Black and Brown people that White clinicians will never truly be able to understand, with regards to the importance and relevance of these experiences to their identities.
Egette Indelele is the founder and CEO of Safe Haven Space and a recent graduate of George Mason University. Egette and her family were refugees from Tanzania some years ago. Her experience of being a refugee and realizing the impacts of that experience on her and her family’s mental health, along with understanding the cultural stigmas around mental health led her to founding Safe Haven Space. They offer mental health and well-being programs to refugee and immigrant students and their families, helping them to succeed in American life and culture through programs in schools and community organizations. This delivery of services most likely wouldn’t have the same impact if someone without the experiences of being a refugee or immigrant was leading this work.
These are just a few examples and reasons of why we encourage more Black and Brown providers to work in mental health and why children in particular need clinicians who represent and reflect that same racial and ethnic or cultural experiences.
In part two of Olivya’s guest blog post, she’ll be discussing the recruitment of clinicians of color, including barriers, retainment, and how you can help.