The U.S. mental health system requires significant improvement.
The system leaves many people and families facing challenges accessing resources and
receiving treatment.
Meanwhile, the weight of mental health disorder and suicide has significantly increased among
Black and African-American communities, leading to significant racial disparities for Black
families across the country.
In this episode of Badly Governed, our guest speaker, Cole Voyard, discussed with us the
occurrence of suicide among Black youths and what needs to be done.
Cole Voyard is a veteran psychiatric master prepared nurse.
He has been working in mostly all capacities for over 30 years to ensure that patient-centered
care remains at the forefront of all nursing thinking.
Working process while meeting, planning, and caring for all our vulnerable population
struggling with mental illness.
Welcome to the podcast.
Thank you.
Thank you, Andrew.
Well, thank you.
Just in February 2023, the CDC reports a disturbing trend among Black children between the ages
of 10 and 24 years.
The data shows that from 2018 to 2021, the rate of suicide among Black children increased
by 37%.
The same data shows a decrease among White children in the same age group.
However, it is not understood why this phenomenon is occurring to this specific population.
In your opinion, why do you think Black youths are dying at an alarming rate through suicide?
I would say loneliness, hopelessness, lack of support, shame, ignorance, adverse childhood
experiences, racial discrimination, PTSD from the death of Trayvon Martin, Michael Brown,
and other young Black individuals, and the psychological barriers, the stigma related
to mental health treatment.
Right.
So, go ahead, please.
I think with all of that, it's been extremely, in addition to COVID and all this, on top
of that, I think COVID didn't help the situation because the isolation on top of it makes things
a little bit more difficult.
Do you think perhaps during the pandemic, the fact that a lot of Black youths experienced
loss, a sense of loss, not just the isolation, but a lot of them, their parents were actually
front desk workers or taxi drivers or Uber drivers, service delivery type work that they
were doing, and therefore, they sort of had to go out even in the middle of the pandemic
while it was at its highest, and a lot of them sort of endured loss in their family,
whether it was a parent or a grandparent or a brother or a sister.
Do you think this sort of all kind of added to some of the pre-existing conditions that
were causing Black people stress, Black kids stress already?
Like I said, it's been so complex that it's hard to really pinpoint out exactly what happened,
and you also have the phenomenon where a lot of people had those parents always at work
doing a lot of things, so now the parents had to stay home, and they're like, okay,
who are you?
They both had to truly trying to understand each other or learning each other and learning
to know who my son or who my daughter was truly.
That person who had been living in that house for so long with certain identification that
perhaps they never know, certain personality, certain social anxiety, certain behavior,
none of that or all of that had to be exposed because of the COVID situation as the parents
had to stay home, most of them, during the pandemic.
That's a good point.
So what do you think within the same vein, the world, that technology sort of had to
play during the pandemic where children went from a classroom setting and now they're being
taught through this device or technology at home, and the parents sort of had to have
some sort of more involvement, I should really say they've always had involvement in their
school schooling, their kids' schooling, but there's more involvement to set up this
technology and help it being available to help assist them with this technology.
Now do you think having to add that technology to these kids, even though a lot of them are
very savvy, technology savvy, but do you think that added to the level of stress that, for
instance, they were already experiencing with school?
Certainly, yes, because at least they don't have school provide mentor or tutor so much
support that most of even the immigrant parents, the folks who don't have that, a lot of black
kids don't have that, those type of parents with the knowledge, the education that could
help them, I think that create, I'm sure that create a lot of stress and added stresses
to their time during the pandemic.
I think the pandemic overall was never a joy for anyone and of course could contribute
to added stresses and anxieties to most of these children.
That's a very good point.
Also the Lancet published an article last year, last August actually, and they're hinted
that a few clues to us, and they said that the reason for such an increase in suicide
actually were multifactorial, including mental health issues and disruption to the social
relationships that the kids used to have.
The CDC data actually shows a decrease in the white populations in that same age group.
They went through the same experience with COVID.
Can you help explain that?
What would you think attributed to such a discrepancy between two different races in
the same age group?
I would say kudos to the white community.
I think as you can see with the social media, a lot of good things have happened lately
where many shows have exposed the mental health and really present the mental health as something
that normal, something that most of folks with in the white community or people with
some what we would call money would use as something relaxing, as something helpful,
as something productive.
So I think that helps the media in all of that to help the folks in the white community
to accept mental health as something positive.
So we hope that we could at least that would start becoming a trend in the other culture
where we could see it as something positive.
We could use it as something positive because it is something helpful that people need to
use instead of seeing it as something negative as the stigma presented it.
So you think the attitude and the beliefs of white people can help in that sense?
Definitely.
Okay.
So how do you think we as public health advocates can sort of help narrow that gap and improve
the attitude and some of the beliefs that the black community has as it relates to mental
health?
I think first of all we have to look at the stigma behind it.
The stigma can include the reluctance to seek help in our treatment, the lack of understanding
by family, friends and co-workers and others, the fewer opportunities for work, school or
social activities or trouble finding housing, the bullying in the school, physical violence
or harassment, health insurance that doesn't adequately cover your mental health treatment
that needs to really improve greatly, the belief that you'll never succeed at certain
challenges or that you can improve your situation once you have mental health, those got to
go.
So I think to help we really need to take steps to cope with those stigma which is get
treatment, don't let the stigma create the self-doubt and shame that it brought to most
of us, don't isolate yourself, those are the signs and symptoms that family, friends, people
need to start looking at when you have kids at home, don't equate yourself with that illness,
illness like any illness, mental health or diabetes or anything, it's an illness, you'll
treat it as an illness but you cannot say I am, you cannot equate yourself to it because
at the end of the day you will take care of that illness and you will move on so you should
not really equate yourself to the illness, then I would always say to join yourself and
your family, to join support groups so that you can understand better how to treat yourself
and treat the illness and then get help at school, there's always support around but
be vocal, let them understand what you're going through so they can be more supportive
to you, speak out against the stigma, that's the only way you can really be above it versus
suffer from it.
I think that's a very good point but I also think that there needs to be some significant
social changes that occurs at various levels, not just the individual but also community
and system level in order for stigma to stop being addressed and start to disappear.
So just prior to Governor Baker leaving office, he did pass a mental health law which requires
that just like a physical exam, annually every single individual as part of the standard
of care gets a mental health exam, I think that's going to actually start addressing
the stigma issue that you bring up but do you think this law, and it's okay if you
don't have an opinion about it, but do you think this law sort of went far enough in
terms of a way of addressing this mental health issue, especially when it comes to youth mental
health who feel isolated, alone, a lot of them are suffering from PTSD and depression.
So do you think just a screening is enough or are there other components that this law
could have incorporated in it in order to provide youth more support?
No, I don't believe this is enough.
Why I'm saying that is because if you do have a law but you don't have the infrastructure
with the law, it really doesn't help.
And I'm going to explain why.
You have the law but you have the myself here in the Commonwealth that pays less than all
the private entity.
How that helps folks like the black community who really, most of their parents, they don't
have enough income so of course they're going to have to have myself.
Then myself doesn't pay the provider equally as Blue Cross, Blue Shell, equally as Harvard
Pilgrim.
So no provider wants to deal with myself, therefore you can have all type of problem.
You can want any type of mental health screening but you won't get it because you don't have
any provider in your system who wants to deal with your mental health issues.
Do you see what I'm saying?
Yeah, I totally see it.
But are providers actually accepting mass health at all?
Most of the providers don't and that's the crisis that we have.
We have a lot of providers who refuse to deal with myself because myself is not paying well.
So I think the issue has to be equally dealt with the fact that if you have a law, you
have also to get the insurance, the public insurance to pay equally like the private
insurance so people can get the treatment they need anytime they want it and anywhere
they want it.
Yeah, so Dr. Christine Crawford actually does share the same sentiment as you do.
She thinks that stigma plays a big role in it and also the lack of providers and access
to care whereby it's sort of impeding families from getting diagnosed and even receiving
adequate care.
Of course.
But it's compounded by even provider biases.
So she basically was talking to a reporter at ABC News and she brought another point
to the conversation is why the general public doesn't seem to be aware of this gross inequity
in the black community.
So the question that I have is why do you think it has taken so long for this issue
to surface?
It only surfaced just this year by the CDC in February of this year.
Yes, there's been a lot of evidence in the literature of other research work that signaled
this.
But why do you think that it's only taken this year for the CDC to really take a position
on this and alert the general public that this is a real issue that's going to be very
complex and that's going to take a lot of resources and a long time to fix?
And why has it been so slow for people actually to see the urgency of it?
Can you speak to that?
It's sad, to me it's like a crisis that brings death that should be much more an alert to
family because we should not be looking at death and not paying attention to it.
It's really sad.
We are so behind as being the number one nation and this is unfortunate and it doesn't make
sense to me.
It remains a fact that our society is fighting with themselves, struggling to acknowledge
and accept the color as a factor, especially in 2023.
They are making decisions and policies that are not favorable to the black community,
which is completely to me absurd.
But like the doctor is pointing at, even on a general practice, I do work sometimes in
the emergency room, you see many, many people come in on a regular basis, come in with suicidal
thoughts because they've been waiting for six months for a mental health appointment.
What is that?
We're not living in a rural area here.
This is Massachusetts.
This is what?
One of the richest states in the United States and we have people waiting for six months,
nine months, a year to get a mental health appointment.
This is ridiculous.
You're not going to mention some of the best hospitals in the country.
I'm telling you, this is absolutely absurd to me and really this needs to be looked at
and this needs to change.
What do you think now needs to occur, especially with the urgency of the black youths killing
themselves?
What could we do now, whether it is individual or a community leader or a religious leader,
what can we do?
What is our capacity in terms of addressing this issue while we wait for more permanent
solutions from policymakers and the scientific community, et cetera?
Definitely this is the work of everyone.
We all need to be aware of this crisis.
We all need to put our hands in this game to try to bring a solution to it, whether
or not you're part of a church.
You need to be in your full alertness to make sure that the kids that's next to you, around
you, that you pay attention to how they behave and how they're doing and their affect, how
they look and how they talk to you and how they're presenting on a regular basis.
You can question when you don't see them, when they stay at home and they're not coming
to church and say, what's going on with them?
When you're at home, you have your kids and they refuse to get out of bed.
You want to know why is that happening?
Is that, are they sick or what is the problem?
As a police officer, you need to spend time with your community, learn to know your community
because that's supposed to be the job of most police officers.
Everyone needs to go to the basis, knowing to learn, learning what your position as a
nurse, when I'm on duty, I'm smiling, I'm friendly, I'm trying to, and as I'm friendly
going around, I'm assessing and monitoring everyone and I'm watching everyone and I'm
paying attention to everyone that comes to me and I'm welcoming everyone and I'm making
those as a clinical assessment on every second by second.
So everyone needs to do their part of this game.
When you're a teacher, you're a professor, learn to know your student and if the student
has a problem, go on the side, find out what the problem is, how you could be helpful to
them because sometimes you'll be surprised, the student in the school may be troubling
by bullying, troubling by issues at home that you could be of a support but if you don't
do your job, unfortunately you won't be able to be helpful if you close yourself and not
opening yourself to be the person that can be helpful to that person, that person won't
tell you anything and you will miss out on things.
So we need as a society to wake up from that busybody thing and be open to be willing to
bring support and help to each other and be helpful to each other and stop, I don't know,
being so negative and trying to value the moment that you spend with each other and
be supportive and helpful as much as you can to each other.
Right, thank you.
So I want to talk a little bit more about provider bias which is a big problem currently
within the context of black youths because they don't receive the same quality of care
as everybody else.
I myself, I can admit to having experienced this in the healthcare system where I was
not receiving the best care as a diabetic patient to the point that I needed to speak
for myself and have it addressed.
Now children don't have that kind of power, right?
So how do they get allyship or support from hospital leadership when they feel that the
actual provider is making them feel uncomfortable or not really providing them the best care?
How would they even recognize if they are being given the best care?
It's really tough to say.
I often look at sometimes when you work around as a black person, you go on to start your
work and you look at it around and you see yourself as the only black person.
In 2023 you wonder why is that but it's hard to tell.
I don't know.
I don't know how this is possible and I don't know how this is allowed.
I would strongly encourage the industry to understand that the diversity is a reality.
It's happening.
When you go to your emergency room waiting list you don't see just white people.
When you look at all your data you don't have just white people coming to your hospital.
So at the end of the day you need to know because you're serving diverse clientele
you've got to have a diverse also worker.
They've got to have somewhat cultural humility.
That's right.
And increase that.
So I think that's one of the things.
Unfortunately I think I remember one of the examples.
When the people are reading patients coming to the hospital and they see African American
with a history of whatever and then everybody's hair is pumping up and everybody's ready to
put soldiers, soldiers and security all over the place because a black man is coming unfortunately.
But at the end of the day the person that they think that's going to come as a terror
can be a teddy bear.
The person may be the most gentle person.
But why do people think that way?
I don't know.
I think the people are so far behind in their thinking and judging people so radical, so
weird like this.
It's just so, it's impossible for me to get it and I'm not sure why they can't get it.
Especially after you had a black president, after so many changes have been made in this
country we are in 2023 you would think.
People would be more accepting to dealing with so many different cultures including
the black community.
But to me it's just really a lot of questions in my mind when I see those things happening.
But they are happening and we do our best.
I do my best even as a director in a psychiatric hospital.
Sometimes I go to the floor and welcome my African American patient and make them feel
comfortable because I feel that it's okay to do that and that makes them feel welcome
as well but I'm not sure why other people don't do it.
Do you think there should be some sort of a toolkit like a social determinant toolkit?
Well, which would incorporate some sort of a checklist for example that youths could
have especially when they are seeking for help or undergoing mental health treatment.
Like a checklist that they could check after each visit and sort of keep a record of what
happened at that visit.
How did things go?
How did they feel?
So that there's some sort of data at least at the individual level parents can collect
and sort of help them identify whether or not there is a systemic problem with the treatment
that their child is receiving.
I kind of feel like as a child who is receiving mental health treatment I'm not exactly sure
if they would even have the know-how on how to understand when they are being treated
differently.
Of course that depends on their age, right?
Let me tell you something, the problem is not even, I don't know if the problem is the
system versus the problem being the individual caring for those kids.
And I'm going to give you an example.
Over the past weekend I've worked with an individual person.
He does have mental health with also some developmental issues but no one read the developmental
issue, right?
The developmental issue that he had made him had a lot of staring at you, a lot of, how
do you call that?
It's almost like a child because that's what developmental issues are, they regress, right?
So he wants to be your friend, he wants to talk to you and he wants to have a conversation
with you 24-7.
However because no one pay attention to that they felt scared about him, that's number
one.
And when I saw him as threatening they gave him every single adjective in the book and
that was a Latino kid, dark skinned Latino kid.
So I kept reminding folks, hello, this kid had some developmental issue.
So each time I said that, oh my God, and then by day three everybody was loved, everybody
was like in love with him, working with him, the kid was very happy, life was good.
But from the first two days I had to truly educate everyone one by one, one by one, one
by one until they got to understand this kid is not a monster, this kid wasn't staring
at them because he was a pervert.
This kid wasn't trying to scare them or to get them scared or anything like that, he
just wanted, because he's delayed, he just wanted their attention and wanted to be their
friends and wanted to talk to them and nothing bad about it.
And they all got the message by me educating them and then by the time day three was we
all were friendly with this kid.
So to me it's like, it really takes one person in that team to educate all of them should
they really all look at the patient chart and then read the same thing that I read and
then provide the same service that I was providing to the patient?
Yes.
Every individual working in healthcare should be going with that open heart, open heart
and willing to care first before you have all these insane thoughts, you understand?
However, at the end of the day to me it's like at least they were receptive to listen
to what I was providing, what I was telling them.
And that's why to me I always say to other folks that even though you come to a place
where you feel there are negativity, there are bad, I don't know, ways of things, the
way things are doing, just be the one that if you could be the one who could open the
light, turn on the light and bring that education and get people to change and be good to those
patients I think that's all I want from our colleagues to do.
Do you understand?
I totally understand.
That's a good point actually.
Yeah, there's definitely a need for additional training with mental health practitioners
especially around the space of cultural equity and cultural humility.
So that was a good example of how this kid was judged and as a result of that he didn't
receive the best care because all you did was look at his chart.
You saw him as a person, not just as this dark skinned kid who's staring at me looking
crazy.
And ready to hurt me.
Yeah, so that was a really good example.
Thank you for sharing it with us.
So community health centers have the potential to advocate for policy and structures that
promote health equity rather than perpetuate inequities in the system as you just demonstrated.
So what actions can community health centers take to influence social change and address
this issue at the systems level?
First I think they need to do something better in the hiring process.
Like I said earlier, they need to show some diversity among themselves.
So you're talking about they need to have a more diverse staff?
Correct.
They need that would help greatly.
Now that COVID is also over, they need to start going out and start back some community
outreach.
Be present in the community.
Target this concern at heart.
Be part of the community.
Reach out of these families.
Provide those education directly to the folks in the community, these black communities,
and offer service that would help them understand what's going on and let them know that they
are also as a support to them in case they have questions and so forth.
And lastly I would say the community, those community services sometimes they offer very
early in the evening, they should at least offer their lobbies in the evening as a place
where people could congregate and even do their support group there.
Because most people know those community health services in the community.
So having a support group going on right there would probably, would be like an open eye
for everyone and would allow people to just come in and not feeling pressured in any way
to come and join and do many support groups, diverse ones, different evening and allow
the community to join there and participate in those things.
I think that would be very helpful.
Do you think that those community health centers should also think about social impact investment,
whether it is through their funds or whether it is there was grants or funds to sort of
create community based programs to help support families more holistically or even advocate
at the state level for certain communities that are experiencing these disparities in
the health care system?
Of course and some of them are so well connected.
Some of them are so powerful in terms of the amount of patient they have, the amount of
money they have.
So they should probably do more investment in the community as they should because that's
the goal of the community health centers to begin with.
Well that's really great.
Are there any last minute thoughts that you want to, anything else you want to say?
I don't know, I think I would, it is as you look at the data, as you look at the information,
it is, it took me by surprise to realize that we were so far behind.
I thought we were a step ahead when I realized, when I read all this information.
It was truly surprising to me to see how far behind we are.
And I hope that a year from now we'll be so much more ahead.
It hurts to see that our community, our people are still suffering and are still going through
this pain after you have so many great philosopher, great people like Maya, like Oprah, so many
people have spoken so widely and so much about mental health and to see people are still
suffering and still going through those pain and not getting the help that they deserve.
I think this is really uncalled for and whatever that we need to do as a community, whatever
that needs to be done, myself I'm trying to work hard with my team right now to put together
some clinics around to help the community.
I'm hoping that Knock on the Woods that we are able to put that together so we can help
those myself folks and help whatever that comes through the door and help our black
folks to have black providers to help them so they don't have any issues on that.
But we cannot lose any more lives.
I think it's not right.
It's in whatever we can do.
I'm working with my institution right now to work with the leaders in the community
to train them, to educate them about mental health so they can then in turn go back to
the community and be able to assess and detect and prevent crisis from happening.
So we are doing a lot of work to prevent and to be at least on the forefront of the crisis
and prevent those from happening so we don't lose any more lives.
But it's really hurtful at this point to see that we are still losing lives because of
lack of knowledge and lack of support in this community and that's a shame.
Hopefully we have all the support that we can.
We have folks behind us to help us really help this community because enough is enough.
We need to get the help that we need for our community.
That's great.
Well, yeah, it definitely is going to take a more collaborative effort to address this
issue.
It's going to be a long journey though.
But I'm pretty sure that with people like you who are so dedicated to this cause and
who are willing to come here and talk to us as well as training other people who might
not be as well versed in this topic, in this area, urging them to see the importance of
this issue and why it needs to be addressed, I appreciate that.
I thank you for that.
I would love to actually have you back to the podcast.
I'll be more than happy and I will do my best to do that.
Thank you.
This is a very broad topic and there's so many aspects of it that needs to be covered
which we can do in just one episode.
So I'd love to have you back for future episodes about other parts of this issue.
Thank you for joining us today.
Thank you.
Thanks.