2021 Youth Mental Health Disparities Conference: Identifying Opportunities and Priorities in Youth Mental Health Disparities Research - Summary
In the United States, mental illnesses impact approximately 50% of adolescents in their lifetimes. Even before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people. In 2016, about half of the 7.7 million children with a treatable mental illness did not receive adequate treatment . In the United States, adolescents from minoritized racial and ethnic groups are more vulnerable to mental health problems than White adolescents. They are also less likely to use mental health services. In addition to racial and ethnic minoritized groups, other youths facing mental health disparities include those from lower socioeconomic households, those exposed to significant trauma, LGBTQ+ youth, and youth involved in the child welfare or juvenile justice systems.
This virtual conference was developed to probe the state of the science in these areas, focusing on youth from racial and ethnic minoritized populations and the intersection of race and ethnicity with other drivers of mental health disparities. Below are brief summaries of each panel presentation and an overall summary of prominent themes.
Panel 1: Disparities in Mental Health Risk and Etiology
Topics in this panel included: the impact of adversity on brain development and functioning; racism as a stressor; the need for new research methods; and approaches to understand risk and etiology.
It has been established that neighborhood adversity and poverty in childhood affect brain development, structure, and function. These factors often contribute to poor mental health and other cognitive challenges that can persist into adulthood. A better understanding of the mechanisms and pathways by which these factors lead to poorer outcomes could inform the development of systems- and policy-level interventions with the potential for broad impact.
In addition, coping with racism is an acknowledged mental health stressor that is under-explored in terms of its contribution to risk and etiology for mental and emotional disorders in racial and ethnic minoritized youth. More broadly, studies that establish what factors mediate or moderate significant differences in outcomes for groups or subgroups can inform the development of novel interventions and may also shed light on factors contributing to resilience. New research methods and greater engagement of the community as research partners may also lead to innovation and progress in disparities reduction.
Panel 2: Disparities in Detection, Identification, and Screening
Topics in this panel included: addressing bias in research approaches; the importance of examining systemic contributors and community perspectives in detection and identification; and detection challenges for youth experiencing multiple risk factors or being served in child welfare or juvenile justice settings.
In research on detection and screening, biases in measures, constructs, and sampling can be significant limitations to achieving informative results. The importance of including community perspectives and context related to salient variables was highlighted. In community settings, systemic contributors to inequity are created when the detection of mental health needs is inadequate, non-systematic, inconsistent, or occurs without a strong connection to intervention settings that provide quality care and family engagement. Populations for whom detection and screening are particularly challenging include Crossover Youth (i.e., victims of abuse who also engage in delinquent behavior) and Dual System Youth (i.e., involved in both child welfare and juvenile justice settings). Collaboration among investigators, families, and clinicians is critical to designing better screening tools (especially for younger children) and clinical implementation tools. There continues to be an urgent need for better screening and detection of suicide risk in minoritized youth.
Panel 3: Disparities in Mental Health Interventions and Treatment Services
Topics in this panel included: the multi-level benefits of community engagement in intervention and services research; the challenges of merging data across service settings; and the logistical barriers in service delivery in low-resource settings.
Mental health disparities researchers have moved toward study approaches that involve youth as co-researchers. This partnership often: (1) fosters engagement and retention in research participation; (2) reduces stigma that can be involved in understanding community, family, or individual issues; (3) educates and empowers youth to understand and address their own needs and the larger issues faced by families and communities in access to and quality of care; and (4) increases the potential for innovation in ideas and approaches. Researchers have faced challenges in merging data across child-serving settings, including health and mental healthcare settings, schools, child welfare systems, and juvenile justice systems. Logistical barriers in service delivery remain a significant problem in many low-resource communities. In suicide prevention, warning signs seen as “common” may not be present across all racial/ethnic groups, and this is relevant to both detection and intervention.
Panel 4: Disparities in Mental Health Follow-up Care
Topics in this panel included: service capacity; complex family service needs; and multi-tiered intervention approaches.
Service capacity for children remains limited and a broader range of service options is needed to meet the needs and preferences of diverse groups and families. Distal factors that may not appear directly relevant to mental health (e.g., social determinants such as housing instability, food insecurity, etc.) and their associated services can be critical to bolstering mental health outcomes and reducing disparities in outcomes. For families facing multiple challenges, multi-tiered interventions that address family complexity and competing demands may be most effective. Innovative new approaches must also enable providers to balance the tension between uniform delivery of an intervention versus personalization for family factors.
Summary of Prominent Themes: Engaging community members in research was broadly viewed as an approach that can facilitate mutual understanding between academic researchers, research entities, and the communities which they aim to serve and better targeting of interventions.
The involvement of community members as co-researchers is intended to both improve researchers’ understanding of the community (their norms, values, functioning, customs, needs, approaches, etc.) and to involve the community in the research enterprise as thought leaders and content experts while enhancing the community’s research capacity. Such partnership offers the potential for promoting: (1) identification of research questions from a new perspective; (2) innovation and development of new research approaches; and (3) accurate and ethical interpretation of research results.
Direct and careful understanding of and attention to contextual factors and social drivers of disparate outcomes may elucidate root causes—particularly those that occur at a systemic level—and may offer an important new avenue for intervention. Deepening research partnerships with youth-serving systems such as schools, healthcare settings, child welfare systems, juvenile justice systems, and state and local policymakers can enhance the eventual implementation of strategies that prove effective.