Black adolescents in Canada face barriers to mental health care access

Black adolescents with mental distress are less likely to use mental health services than their White peers, and Black girls are the least likely to access care, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241733.

“Adolescence is a crucial developmental stage and a critical period for onset of mental health problems,” writes Mercedes Sobers, a PhD candidate in epidemiology at the Dalla Lana School of Public Health, University of Toronto and research coordinator at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, with coauthors. “In Canada, Black adolescents disproportionately access services through crisis situations, such as justice system interactions or when intensive care is required, suggesting they are less likely to access mental health care until intense intervention is needed.“

There is a lack of data on mental health services usage in Canada for Black youth and other racialized populations.

The study, which included data on 12 368 middle- and high-school students (grades 7–12) who identified as Black or White from the 2015, 2017, and 2019 Ontario Student Drug Use and Health Survey, encompassed schools from as many as 52 school boards in Ontario. It included students from English and French schools in both the public and Catholic systems from the Greater Toronto Region, Northern, Western and Eastern Ontario.

The researchers found distinct trends for Black males and females. Black females consistently used mental health services less than their White peers, with the gap widening as their distress increased. Although Black males with low distress were more likely to use services than their White counterparts, once their distress increased to moderate levels, their odds of service use dropped significantly. In general, Black youth (both male and female) who were more distressed were less likely to report using services than their White peers.

“Black adolescent mental health must be discussed with consideration of the interaction between being Black, sex, and mental distress,” write the authors.

Many barriers may reduce access to care, such as a lack of culturally competent care, inaccessible services, racism, and cultural stigma that can contribute to misunderstandings, misdiagnoses, and misconceptions that foster mistrust in the system. The shortage of mental health professionals who understand the unique perspectives and challenges of Black adolescents can hinder diagnosis and treatment.

“Black boys are more likely to be perceived as older, less innocent, and more threatening than White peers. When Black males exhibit signs of psychological distress, they are more likely to be met with disciplinary or punitive responses, sometimes with fatal consequences, rather than mental health support. This may also explain why, once they overcome access barriers, their care frequency matches that of White peers,” write the authors.

They call for specific policy and practice changes to help equalize mental health service use.

“Intersectional strategies that tackle racism and the specific mental health challenges faced by Black students are needed. Enhancing mental health service utilization for Black adolescents demands culturally responsive and sex-specific adaptations to care.”