Behavioral Health
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Racism as a Public Health Crisis: Mental Health Pipeline

Eboney Thornton
Assistant Director, Communications
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April 25, 2022
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A temper tantrum over a pair of sunglasses led to the arrest of a six-year-old. That six-year-old child with known medical issues was arrested by the school’s resource officer, placed in zip ties by another officer, put in the back of a police car, taken to a juvenile center for processing fingerprinted, had their mug shot taken, and received a date and time for a court hearing before being released to their guardian. Later that day, another six-year-old at the same school would be arrested by the same resource officer.[1]  

These aren’t isolated incidents.

Policing our children

Between 2000 and 2019, of the 5- to 9-year-olds arrested, Black children comprised 41 percent, even though they make up only 15 percent of kids that age, according to data analyzed by USA Today. While some of these arrests may have stemmed from safety issues—a weapon brought to school, a fight that results in significant injuries—some are the product of inadequate support for children dealing with the inability to handle behavioral issues that could be attributed to possible mental health diagnoses, like autism, or physical conditions, like sleep apnea.  

But it doesn’t start with the police. Previously, my colleague Kate Warren highlighted the racial disparities in the juvenile justice system, particularly in Cuyahoga County’s Cleveland Metropolitan School District, where Black students were almost twice as likely to be suspended as white students. Since 2004, 12 children in Cuyahoga County have been arrested in school. The youngest was a six-year-old Black boy.  

Source: Warren, Kate (2019) Solutions that chip away at racial disparities in criminal justice. The Center for Community Solutions[/caption]  

Another study by the National Center for Youth Law, also found that Black students in elementary school were more than twice as likely to receive at least one disciplinary referral compared with students of other races, a number that nearly doubled in middle school, according to the same study.[2] Implicit biases play a significant role in some of the disparities in school disciplinary actions. The report highlighted how teachers are more likely to hand out harsher punishments to non-white students.

 Black students in elementary school were more than twice as likely to receive at least one disciplinary referral compared with students of other races.

This is the case for many Black and Hispanic youth. Pre-existing bias regarding the appearance and demeanor of people of color (Black, Hispanic, Indigenous), can lead school administrators to levy harsher punishments for these minor infractions when compared to white or Asian students.[3]  Examples might include Black boys being seen as threatening or the over policing of Black girls, Latina girls and Latino boys’ appearances. These minor infractions, once accumulated, could eventually lead to harsher punishments (suspensions and expulsions), impacting the mental and social well-being of the student and their family and introducing students into the multi-system youth pipeline.

Racial bias and system silos have created a multi-system youth pipeline

Serving children with diagnosed and undiagnosed mental, emotional or social disabilities can strain an educational system that is already underfunded and overworked. When you add in racial biases or prejudices, you create a situation that fails the school, community, families, and most importantly, the youth.  

Additionally, the same National Center for Youth Law report also found that racial bias within the mental health system results in inadequate treatment for youth of color by either “1) leaving symptoms undiagnosed and untreated, which increases the likeliness that the child will end up in the juvenile justice system; or, 2) creating a ‘revolving door’ phenomenon where children who are diagnosed receive more and more restrictive placements, eventually often including incarceration.”[4]  

Youth who receive services from one or more systems, such as the child protective services, mental health and addiction services, developmental disabilities services, and juvenile court, are considered multi-system youth.[5] Ideally, once a child, young person or their families begin to interact with the multiple systems, services would be coordinated across the systems being engaged. For instance, mental health and addiction systems would monitor and inform the treatment plan for youth involved in the juvenile justice system, or youth in child protective services would be connected with the developmental disability system, and both systems would be able to implement a care plan.

OhioRISE is designed to help children and families with complex needs

But while the current system is trying to accomplish this, it isn’t doing it well, and more children and their families are losing out. This is the primary purpose that OhioRISE (Resilience through Integrated Systems and Excellence) would serve. OhioRISE is a new managed-care approach[6] that will focus on a population of children and youth with serious behavioral health needs, who are often involved in multiple public youth-serving systems and their families. While OhioRISE tries to address the issues that multi-system youth and their families encounter, acknowledging and implementing policies that address racial and system disparities should be a key component in ensuring that the system adequately serves everyone.  

Governor DeWine, in his 2022 State of the State address, highlighted the shortcomings of the current system and the unrealized promise of OhioRISE and related initiatives:

 …We have started the reform of Medicaid out of our shared-commitment to multisystem kids, through a program we call OhioRISE. Under OhioRise, children who have multiple medical and behavioral health challenges will now get the help they need—in their own communities. Parents will no longer be forced to give up custody in order to get their children the help they need—and families will stay together.    

We have also worked to create a landmark program to address the mental and physical health needs of children right in their own school buildings!  

 

We’ve specifically focused dollars for schools across Ohio to provide for on-site medical clinics; additional counselors and mental health services; prevention and after-school care; family supports, such as English classes and access to healthcare; as well as new training and programming around childhood trauma and mental health for our most vulnerable kids.  

 

We are helping struggling families get better access to addiction and mental health treatment so that their children don’t end up in foster care. And, we have more than doubled medication-assisted drug treatment capacity across Ohio, and have dramatically increased crisis stabilization services.  

 

But—despite our best efforts so far, it still is not enough.

Our children shouldn't endure inadequate services because of policies built on systemic racism, implicit biases, and the criminalization of those with mental and behavioral illnesses. Addressing these issues NOW will give them a chance for the future they deserve.  

[1] ‘She looks like a baby’: Why do kids as young as 5 or 6 still get arrested at schools? https://www.usatoday.com/in-depth/news/investigations/2022/02/10/school-arrests-include-kids-young-5-why-does-still-happen/8419814002/, retrieved 04/15/2022  

[2] Lee, Jina, Bell, Zenobia and Ackerman-Brimberg, Mae (2015) Implicit Bias in the Child Welfare, Education and Mental Health Systems. National Center for Youth Law  

[3] Lee, Jina, Bell, Zenobia and Ackerman-Brimberg, Mae (2015) Implicit Bias in the Child Welfare, Education and Mental Health Systems. National Center for Youth Law  

[4] Lee, Jina, Bell, Zenobia and Ackerman-Brimberg, Mae (2015) Implicit Bias in the Child Welfare, Education and Mental Health Systems. National Center for Youth Law  

[5] Addressing the Needs of Ohio’s Multi-System Youth (2016), https://www.pcsao.org/pdf/advocacy/MultiSystemYouthBriefPCSAO.pdf  

[6] Kanary, Patrick (2021) Why OhioRISE? The Center for Community Solutions

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