May is Mental Health Awareness Month – BIPOC and LGBTQ Youth Mental Health in King County

By: Isis Garcia, Graduate Student Intern

Youth Mental Health Challenges are on the Rise in King County

In March 2021, Governor Jay Inslee proclaimed a Children and Youth Mental Health Crisis for Washington state. Mental health challenges for youth have been on the rise, but COVID-19 has further exacerbated the existing issues. In King County, over a third (36.4%) of 8th, 10th, and 12th grade students experienced symptoms of depression in 2021. Figure 1 shows that depressive feelings among youth have been increasing in King County since 2008. Yet BIPOC and LGBTQ youth are experiencing disproportionate impacts of the ongoing youth mental health crisis.

*Figure 1: Depression Prevalence among 8th, 10th and 12th graders in King County (2021)*

Imei Hsu, a Public Health – Seattle and King County Reserve Corps Volunteer and mental health therapist observed firsthand the increased need for services among BIPOC individuals at the start of the pandemic (Inside the pandemic: Two mental health workers and community volunteers discuss how cultural experiences and racial trauma affect mental health in BIPOC communities – PUBLIC HEALTH INSIDER). :

“But these populations were being hit very, very hard, and they didn’t always feel safe and willing to just accept the next available therapist. They wanted someone who understood their lived experience, someone who knew about intergenerational racial trauma and fragmented immigration stories. ”

— Imei Hsu

Disparities In Youth Mental Health

There are a variety of reasons for the increase in mental health challenges among youth such as the growing use of social media, increasing academic pressure, engaging in risky behaviors, limited access to mental health care, and broader stressors such as the COVID-19 pandemic, income inequality, systemic racism, gun violence and climate change. Yet, disparities experienced by BIPOC and LGBTQ youth are due to the impacts of systemic racism and oppression. Historical and ongoing experiences with discrimination, involuntary treatment, and language and cultural barriers in mental health services and care continue to impact diverse youths’ access to services.

The 2021 Healthy Youth Survey, which provides information for Washington State youth on mental health, substance use, safety and violence, and related risk and protective factors, found that LGB+ youth were almost twice as likely to report depressive symptoms compared to the county average in 2018 and 2021 combined. In addition, LGBTQ+ youth also experience higher rates of suicidality: 18.9% of LGB+ youth reported a suicide attempt in the past year, compared to 7.8% of youth overall. When asked to reflect on access and experiences with healthcare, LGBTQ youth identified complex systemic and interpersonal barriers and oppressions that contribute to inequities. Family, friends, and community support are known to contribute to mental health and self-esteem. However, LGB youth (63.9%) were less likely to report that there were adults who they could talk to, compared to heterosexual students (70.7%).

“They [adults] could be nicer, and ask for my pronouns, and ask how our parents will react. They should stand up for us when other students disrespect our identity. ”

— Gender diverse 6th grader

Students of color, including Hispanic/Latinx (41.0%) and multiple race (40.9%) students, were also more likely to experience symptoms of depression compared to the King County average (34.6%). Asian students (30.6%) were less likely than the King County average to report symptoms of depression, but when broken down by ethnicity, students identifying as Filipino (42.2%) had higher rates than the King County average. In King County, American Indian and Alaska Native youth had the highest rate of emergency department visits involving suicidal ideation, at 805.4 per 10,000 ED visits in 2020 (see Figure 2).

*Figure 2: Rate of emergency department visits involving suicidal ideation among King County residents age 10-24. July-September 2019, 2020, and 2021*

Feelings of safety at home or school can have an impact on youth mental health. The Healthy Youth Survey found that 83.5% of King County students reported that they feel safe at school. However, data shows that BIPOC and LGB+ students are less likely to feel safe at school.

Listening sessions with middle school youth revealed that Native Hawaiian and Pacific Islander students felt that social media and gossiping made their schools feel unsafe and that adults were not aware of the problem. Additionally, the lack of diversity among staff can worsen the situations:

“Our school environment here can be toxic, and adults do not see it. But because I have connections with students in each grade, I do not think I receive the same toxicity that others do. So much ‘tea’ goes around, aka information about students, and there are even social media problems that make people feel uncomfortable. ”

— Native Hawaiian/Pacific Islander 8th grader

Lack of A Diverse Behavioral Health Workforce

Mental health outcomes are affected by a broad range of factors. However, the lack of access to culturally competent care plays a role in youth mental health outcomes. Increasing diversity among the workforce, can increase access to diverse providers that may have shared experiences, ergo leading to a sense of understanding and connection between the patient and provider. However, the behavioral health workforce is far from diverse, which according to the US Bureau of Labor Statistics, in 2022 82.4% of mental health counselors were white. Though ethnic matching (pairing a client with a therapist based on race/ethnicity alone) can be effective in some instances, it is not the end all be all solution. Mental health stigma, credibility, and trust of conventional mental health treatments impact whether and how people of color seek mental health services. Diversifying the workforce to be more representative of BIPOC and LGBTQ+ youth is a first step to improving mental health outcomes among these populations.

Reducing Disparities in Youth Mental Health

In order to reduce disparities experienced by BIPOC and LGBTQ+ youth, we need to move towards a culturally competent, community based, and trauma informed mental health care system. Alternative mental health approaches such as healing practices and restorative justice programs provide BIPOC youth with the tools needed to thrive, all the while dismantling systems of racism and oppression that continue to be upheld in conventional mental health systems. Lastly, understanding a community's strengths and implementing strength-based interventions among communities could lead to improved mental health outcomes for youth.