This series, created by Amanda Calhoun of the Yale Child Study Center, aims to share and analyze stories related to a variety of mental health issues among Black youth.
james steel
Contributing reporter
Provided by Amanda Calhoun
Content warning: This article contains references to suicide.
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On Tuesday, more than 300 clinicians, psychiatrists, health care providers, social workers, and students gathered in person and via Zoom to participate in the first conference of the inaugural Black Youth Mental Health Clinical Case Conference Series.
This clinical case conference series was organized by Amanda Calhoun, a child psychiatry fellow and chief resident at the Yale Child Research Center. Following her introduction to the history and current state of black youth mental health, Ms. Calhoun presented a narrative account of a clinical case, which was discussed and analyzed by a panel of experts.
“In October 2021, experts declared child and youth mental health a national emergency,” Calhoun said in his opening remarks. “But black youth have been at risk for more than 20 years, and there are no signs of improvement.”
Calhoun explained that suicide rates among black youth are rising faster than any other race or ethnicity. While suicide rates for other races and ethnicities remained the same or decreased during the pandemic, Black suicide rates increased for only three other groups.
Calhoun explained how the mental health field is ill-equipped to care for Black children. Calhoun said suicide prediction algorithms are less effective at predicting suicide among black populations. Similarly, psychotherapy is less effective for Black youth in areas where anti-Black sentiment is strong. Additionally, she argued that when medical researchers study Black youth, they often study people living in poverty, excluding Black youth above the poverty line.
For Calhoun, all of these factors highlight systemic problems with the medical health system's ability to treat Black youth with mental illness.
“Clinical cases, clinical case reports, and clinical case conferences that focus on inappropriate behavior by medical teams are very rare, if ever,” Calhoun said.
By curating the six cases for both health care providers and the general public, Calhoun hopes to foster discussion about the health care system and Black youth. Traditionally, clinical case studies presented to medical professionals focus solely on the patient's problem and include only clinical, impersonal expressions. They also rarely emphasize mistakes by medical staff.
According to Calhoun, the Black Youth Mental Health Clinical Case Conference Series contradicts all of these rules. At each meeting, presenters will call attention to mistakes and racist behavior by medical staff.
Calhoun also chose to make the case conference series open to everyone. Instead of using clinical language, each presentation is delivered in a narrative format.
“We're going to start with this, and this is going to be the same structure for every clinical case conference. We're going to start with a story,” Calhoun said.
Ms. Calhoun told the story of Christina, a 13-year-old black girl. White nurses made racist comments about Christina before she arrived at the hospital. Additionally, some doctors speculated that she had anger management issues, although they did not make the same assumption for white boys her age.
Gradually, Christina became more responsive to the black doctor and eventually submitted the case to a clinical case conference.
“Christina [was initially diagnosed] “She is a 13-year-old girl who has previously received psychiatric diagnoses of oppositional defiant disorder and disruptive mood dysregulation disorder,” Calhoun said.
For Calhoun, Christina's initial diagnosis was a particularly bad sign for treatment. Black youth are disproportionately diagnosed with ODD and DMDD, Calhoun said. These diagnoses often carry unfavorable stigma within and outside the medical community.
Additionally, it is difficult to treat with effective drugs. In many cases, the comprehensive antipsychotic medications given for these diagnoses do not address the underlying problem. Calhoun said she does not diagnose her patients with ODD.
“First of all, I think one of the most important things for us is that our society learned hundreds of years ago to treat black people and even black children differently.” said Carolyn Roberts, assistant professor of history and African American studies. “Hundreds of years ago, that was the norm from the beginning of our encounter.”
Roberts pointed out that the transatlantic slave trade existed hundreds of years before the founding of the United States. Doctors dehumanized black people during the transatlantic slave trade, Roberts said. Black people were labeled as savages, and their skin was labeled as a form of leprosy that inhibited their nervous senses.
With this history in mind, Roberts insisted that Christina's treatment was nothing new. Black people and children have been mislabeled and dehumanized for centuries.
“I think the other impact this has had on psychiatrists is this,” says Terrell Holloway, a principal investigator in the Clinical Neuroscience Research Unit at the Connecticut Mental Health Center. “Some psychiatrists within this group are attempting to develop relationships with patients as a means of treatment, but are also encountering resistance from the treatment team.”
Calhoun said she hopes to use the series to present case studies that highlight how to provide a high level of care to Black youth. She says clinical cases of Black youth are often all categorized into her one category, failing to capture the diversity of Black culture. She said she aims to use each incident to highlight Black diversity.
You can sign up to attend the next conference here.
