This story contains discussion of suicide. If you or someone you know is struggling with suicidal thoughts, call the 988 Suicide and Crisis Lifeline.

Black children and adolescents have the highest rate of mental health-related emergency department visits, according to a report by the Centers for Disease Control and Prevention released this week. 

It’s an indication that experts’ long brewing concern around the state of mental health is bleeding into a crisis. From 1991 to 2019, Black adolescents experienced the largest jump among any racial or ethnic group in the rate of suicide attempts. It rose nearly 80%. Many more experience symptoms of depression and are exposed to discrimination and racial trauma. 

“It’s a public health crisis,” said Dr. Ashley Maxie-Moreman, a clinical psychologist at Children’s National Hospital in Washington, D.C. She studies how exposure to racism, particularly online, affects Black children. For her, the CDC data was not surprising.  

According to that data, from 2018 to 2021, more than a million visits were made by children and adolescents to emergency rooms across the country that involved a diagnosis of a mental health disorder. Rates were higher among those ages 12 to 17 compared to younger kids. Diagnosis of mood disorders, anxiety disorders, and behavioral and emotional disorders were most frequent, and suicide attempts were among the reasons kids visited. Often, hospitals are the first point of contact for those with mental health concerns because of the accessibility of quality services before an emergency, especially for Black children. 

The rate for Black youths visiting emergency rooms for mental health treatment per 1,000 kids was nearly 21, compared to 13.2 for Hispanic children and 14.4 for white kids. The racial disparities in mental health-related emergency room visits are similar to those of overall visit rates. Black children are overrepresented in both. 

Read more: The Racism Black Kids Endure Is Spiraling Into a Health Crisis

Black kids are less likely to access and remain in therapy, said Dr. Amanda Calhoun, an adult and child psychiatry resident at Yale University. She often sees children in crisis who, when asked if they’ve ever been to therapy, say “yes” but explain that they didn’t stay because they felt dismissed, misunderstood, or discriminated against by the clinician. As a Black woman, Calhoun makes up less than 2% of psychiatrists. 

Ideally, she said, you’d reach these kids before it’s a crisis, but the realities of finding a therapist that accepts your insurance, has availability and understands what it means to be Black in America adds barriers. 

Another reason is that their symptoms are also often misdiagnosed because they might show up differently than clinicians are trained to spot them. For example, Black girls may report physical symptoms like fatigue and insomnia when they experience depression, more than stereotypical symptoms like feeling sad. Similar trends are true for Black boys when they’re diagnosed with disruptive mood disorders when they’re actually dealing with attention-deficit/hyperactivity disorder, or ADHD. That spirals into overrepresentation in special education and disciplinary programs. 

What this means, experts say, is that Black kids are falling out of care early, and often only getting the treatment they need in an emergency. 

In an increasingly digital era, how children and teens navigate the internet greatly influences their mental health, Maxie-Moreman said. “Our youth are constantly online. They’re constantly consuming videos on YouTube, on Instagram, on Snapchat,” she said. Moreover, the racism and discrimination that these kids face out in the world is also permeating digital spaces, she said. In turn, it can have a negative impact on their mental health. 

Her research shows that online exposure to racial discrimination and traumatic events can lead to increases in symptoms of trauma, and thoughts of suicide. 

“Racial discrimination is really harmful for our kiddos,” Maxie-Moreman said.

Margo Snipe is a health reporter at Capital B. Twitter @margoasnipe