Barriers and Stigma: Mental Health Challenges among Minority & LGBTQ+ Children
In the fourth story of Cook Children's Joy Campaign, we're examining the unique mental health challenges faced by minorities
Four in a series.
When it comes to mental health and suicide, minority children face unique and underreported challenges. From access to care to stigma, there are several barriers minorities face. On top of that, LGBTQ+ children and teens account for one of the largest percentages of admissions for suicide at Cook Children’s Medical Center of any minority group.
Continuing the written series of the Joy Campaign, aiming to prevent suicide, we are examining the distinct issues that affect minority children and families.
Stigma and Education
According to Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, there are several barriers minorities face when they require mental health services.
“The first and biggest issue I see is the stigma around mental health in our minority communities,” Dr. Carter said. “Mental health is not something widely talked about or discussed in Black and Hispanic communities.”
Dr. Carter said she and her team at Cook Children’s Medical Center spend considerable time with minority patients and families, educating them about what mental health encompasses and what children may be facing.
“Minority children have usually been struggling for a while and are often too uncomfortable to tell their parents or their school counselor,” Dr. Carter said. “Oftentimes they’re taught, ‘What goes on inside of our home, stays in our home.’”
Another angle that affects minorities is the fear of being judged or not taken seriously by professionals.
“Minority parents are fearful of being judged that their child has a mental illness, or being judged that they’re not taking care of their children or not raising them well,” Dr. Carter explained.
In a 2018 study released by the US National Library of Medicine National Institutes of Health, the fear of being judged was a widely recognized issue for low income minority youth, along with confidentiality and embarrassment. Participants in the research said they often feel that keeping feelings inside is a better option, and that they fear bothering others or seeming less ‘tough.’
Dr. Carter said education is necessary. Parents must understand there is no need to be embarrassed, and their children deserve the same help as any other child with a mental illness.
“I think most minority parents feel their children need to get better and stronger. This puts pressure on parents, as opposed to understanding their child is suffering from a mental illness the parent can’t fix on their own,” Dr. Carter said.
Access and Barriers
“When we examine our population of children on Medicaid and our highest risk zip codes, minorities are the highest percentage,” Dr. Carter said.
She further explained that minorities are often unable to get the care they need because most psychiatrists and therapists don’t take Medicaid. One way Cook Children’s is combating this issue is by performing mental health assessments in its Neighborhood Clinics since that’s where many high-risk families receive care.
In December 2020, Cook Children’s Neighborhood Clinics added additional licensed masters-level mental health professionals such as clinicians and therapists to the department. The professionals travel to all seven neighborhood clinics so children 12 and older can receive a depression check during every wellness screening. The Neigborhood Clinics also offer post-partum screenings for new mothers and can refer them to resources if they are in need.
Vida Amin, M.D., medical advisor of Neighborhood Clinics and Population Health at Cook Children’s says the additional staff has been fundamental to the neighborhood clinics.
“Our families now have someone who is going to ensure they have the resources and services that they need and we can now help more families across multiple facilities,” Dr. Amin expressed. “There is an element of trust having these mental health professionals on staff that ensure our families are comfortable with the help they’re receiving.”
Another obstacle Dr. Carter sees in her practice is the cultural barriers that minority families face.
“African American and Hispanic cultures often believe their children are fighting things such a psychosis and seeing ghosts and spirits,” Dr. Carter said. “Mental health professionals must seek to understand those cultural beliefs and where they come from.”
Dr. Carter also works with her colleagues and legislators to push for better care for minorities within underserved neighborhoods.
“When parents don’t have commercial insurance, they don’t have the access to the care they deserve,” Dr. Carter explained. “It is important that we figure out the big picture and provide minority families with what they need before their children are in dire situations.”
Not only do minority families and children lack resources in the community for various reasons, but Dr. Carter also says a lack of resources exists in the schools minority children attend. “Some minorities live in areas that don’t have enough providers to access them,” Dr. Carter said.
Dr. Carter explains school districts are working to bring more social workers to campuses. But the challenge to meet the need is great.
“Fort Worth ISD is one of the largest districts, and they educate a large number of minorities,” Dr. Carter explained. “It’s a big challenge to provide enough psyco-social support, school counselors, and social workers to meet the growing needs in their schools.”
When we think of minorities, we often think of race and ethnicity. However, Cook Children’s psychiatry team reports 30% of admissions for children who attempt suicide fall within the LGBTQ+ community.
Kim Cox, a clinical therapist at Cook Children’s, sees patients at the medical center. She says she is seeing more LGBTQ+ patients now than before the pandemic.
“Our LGBTQ+ patients have all the stressors any patient would have. Family stressors, school, their peers, etc.,” Cox explained. “I think they have the added stressor of what they internally are trying to come to terms with. Who they are and what that means for them. Also, how to tell people and fear of what their reactions are going to be.”
As a clinical therapist interacting with children, it is important to understand that every individual is unique and dealing with their issues, and meeting them where they are is the first step to understanding how you can help them.
Dawn Hood-Patterson, Ph.D., program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health, led by Cook Children’s, says the number of LGBTQ+ patient admissions is alarming.
“Being able to go out in public without harassment is a big issue,” she said. “Furthermore, so many of our children are closeted and have a fear of living in their true identity.”
U.S. News reports “nearly two-thirds of transgender teens say they avoid using the bathroom at school whenever possible, but when they have to, they use a restroom that doesn’t match their identity.” Furthermore, youth report that their anxiety and depression remain at high levels, despite growing support for LGBTQ+ rights.
Dr. Hood-Patterson is a former chaplain at Cook Children’s and has worked with patients from all walks of life. As an ally for the LGBTQ+ community and someone who has done research in this area, she says feeling excluded can be a driving factor in suicide attempts.
“Any group who faces marginalization, or experiences oppression, is often treated differently than their peers,” Dr. Hood-Patterson explained. “Pre-teens and adolescents tend to be the ones that are more apt to have suicidal ideation, suicidal completion, and suicidal attempts. Within that social group, age-wise, there is a longing to fit in and feel safe and comfortable.”
Societal norms also tend to play a considerable role in LGBTQ+ youth feeling lost and out of place. Dr. Hood-Patterson believes society has made it hard for those in the LGBTQ+ community to feel like they have a place of belonging.
“If society didn’t make it wrong or make it bad, it could be accepted,” she said.
Dr. Hood-Patterson said it is vital that youth who identify as LGBTQ+ understand that their identity isn’t an issue and they are just as important as the person next to them.
"The problem is the social norms, religious norms, familial norms, and school norms,” she said. “To be who you are is never the issue.”
Coping skills are essential as LGBTQ+ youth learn to navigate within a world where there is a stigma because of how they identify. Dr. Hood-Patterson recommends starting with these suggestions:
- Learn that your worth is more than any cruel thing someone can say about you. Find people who will remind you of that.
- Remember that you are perfect just the way you are; no changes are needed.
- If you are feeling particularly down, sad, or low, reach out for help. Connect with the Trevor Project or call their helpline at 1-866-488-7386.
- Remember that it gets better. Find that reminder at www.itgetsbetter.org
It is vital for children who identify as LGBTQ+ to have support. Support, starting at home, can help LGBTQ+ youth navigate the pressure they feel within the community. How can parents help? Dr. Hood-Patterson gives the following suggestions:
- Be their strongest advocate, cheerleader, and ally.
- Never deny your child’s full humanity. What this means: since a person’s sexuality is an interregnal, beautiful part of who they are if we deny that aspect of a child, we deny their full humanity and full belonging.
- Know that they will face marginalization and fight with them! Help them navigate the pain of oppression. Celebrate the triumph of liberation.
- Learn what it means to be an ally for your child. Meaning, you may have to let your child teach you some things.
- If you say something wrong, ask for their forgiveness and commit to continue learning.
Lastly, there is something everybody can do to support LGBTQ+ youth—become an ally. Dr. Hood-Patterson gives these suggestions:
- Know what it means to be an ally. Fundamentally, it means that you take direction and leadership from the LGBTQ+ community. Heterosexual allies are not in charge of policy platforms. Make sure you have the backs of those you champion. At times, having someone’s back means taking a back seat.
- Do your homework! Take some time for self-examination and reflection. Try to understand social bias and how these impact your own life, decisions, attitudes, and values. Understanding an issue, understanding the oppressive factors, and the proper language is the ally’s responsibility. Although allies have a lot to learn from the LGBTQ+ community, we cannot expect the LGBTQ+ population to be our teacher, tutor, and homework monitor. Allies have to put in the work. Own the mistakes you will make along the way—don’t use your ignorance as “cover” for the mistakes you will (inevitably) make.
- Recognize that change away from oppression is in the institution’s best interest and your own best interest. Be committed to that end.
- An ally is committed to an issue, not just a person. The commitment is to work toward justice for all LGBTQ+ people, not just my personal friend or coworker.
- Be willing to take risks but don’t put those who are already experiencing marginalization at greater risk. Trust an LGBTQ+ person’s sense of safety. Don’t ask them to do something that jeopardizes their sense of safety and security in the world. Meaning never “out” someone or encourage them to “come out” if they are not ready. You may not know what safety factors they are weighing. Support each person where they are.
- Make it known that you are a safe person with whom to speak. You can also make sure to ask people what pronouns they prefer. Include your preferred pronouns to your Zoom name and email signature. Speak freely about your position as an ally.
There are many unique challenges that minorities face as it relates to their mental health and wellness and the prevention of suicide. Regardless of how a child identifies, parents must have the resources needed to protect their child from attempting or death by suicide.
Signs Your Child May Need Help & What to Do
- If you see your child is more withdrawn than usual, ask questions to gauge how they’re feeling.
- Don’t judge how your child feels. If your child tells you they’re depressed or anxious, dig deeper with open-ended questions.
- Look for shifts in your child’s mood. If you realize your child isn’t as active as usual or seems more reserved than normal, ask questions and see if they’ll talk about what’s bothering them.
- Take note of lack of motivation. If your child isn’t completing schoolwork, wanting to sleep more than usual, or not coming out of their room, it may be worth a conversation to see what is happening within your child.
- If you believe your child may have a mental illness, talk to your doctor. Don’t wait until your child is suicidal to ask for help.
Dr. Carter says being open and available to your child is the first and most significant thing you can do to help when your child struggles with mental illness. “Ask questions, check their social media, ask about how school is going,” Dr. Carter said. “Open dialogue goes further than most people understand.”
Another essential tool is to ensure your child doesn’t feel like a burden when they express their feelings. “Oftentimes children feel more like a burden to their parents, especially when a single mom is working multiple jobs and not getting home until late,” Dr. Carter said. “Children see their parent struggling and don’t want to feel like a burden so they hold their feelings inside.”
Dr. Carter says she wants all parents to know that suicide is a preventable cause of death. “If we intervene early, we can prevent more kids from attempting suicide or from dying by suicide,” Dr. Carter explained. “If we focus on prevention and early intervention, we can all do a better job of saving our youth.”
About the Joy Campaign
Cook Children's Joy Campaign is a communication initiative that aims to encourage hope and resilience among children and teens.
Joy stands for: Just breathe. Open up. You matter.
The number of children and teens suffering from anxiety, stress and depression is skyrocketing. Sadly, Cook Children's has seen a record number of patients attempting suicide in the past year. The Joy Campaign is a suicide prevention communication initiative led by Cook Children's to bring hope and needed resources to children and families facing struggles and dark times in their lives.
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