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Delta Kappan
Bridge over troubled waters: Meeting the mental health needs of black students
Kevin Cokley, Brettjet Cody, Leann Smith, Samuel Beasley, I.S. Keino Miller, Ashley Hurst, Olufunke Awosogba, Steven
Stone and Stacey Jackson
Phi Delta Kappan 2014 96: 40
DOI: 10.1177/0031721714561445
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http://pdk.sagepub.com/content/96/4/40
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Learning and mental health
Bridge over troubled waters
Meetingthementalhealthneedsofblackstudents
Black children are overidentified for behavior issues at schools and
underidentified for mental health concerns.
By Kevin Cokley, Brettjet Cody, Leann Smith, Samuel Beasley, I.S. Keino
Miller, Ashley Hurst, Olufunke Awosogba, Steven Stone, and Stacey Jackson
On April 8, 2014, Karyn Washington, creator of the For
Brown Girls web site, committed suicide. Just 22 years old,
Washington reportedly had dealt with depression and mental
illness for much of her life and had created For Brown Girls
to promote self-love for black girls who struggle to embrace
their dark features.
What access to mental health services did Washington have
as a student? What cultural considerations would mental health
professionals in school settings have given to her
and other black girls who contend with
the same self-esteem and body image
issues that all girls confront as well
as the racialized and culturespecific issues related to skin
color, hair, and white standards of beauty?
Now think of the archetype of the black male
student who is labeled emotionally/behaviorally disturbed because he is perceived to be impulsive, aggressive because he
acts out and gets in fights, and exhibiting learning difficulties because he performs below grade level. According to the
U.S. Department of Education, black children are almost
three times more likely than white children to be labeled
as having a mental disorder and almost twice as likely to be
labeled as having an emotional/behavioral disorder (Losen
& Orfield, 2002).
Are black boys really disproportionately emotionally
and behaviorally disturbed compared to other students? Or are they reacting to the biases and the cultural incompetence of teachers and mental health
professionals who often harbor negative stereotypes about them?
Now consider the highly publicized incidences of violence against black teenagers.
Fifteen-year-old Hadiya Pendleton was
shot and killed on Chicago’s South Side,
one week after performing with her high
KEVIN COKLEY(kcokley@austin.utexas.edu)isa
professor of counseling psychology and African and African Diaspora Studies in the Department of Educational
Psychology in the College of Education at the University
of Texas at Austin, and editor-in-chief of Journal of Black
Psychology. BRETTJET CODY is a postdoctoral fellow with
Fort Worth Independent School District. LEANN SMITH
is a school psychology doctoral student at the University
of Texas at Austin. SAMUEL BEASLEY and OLUFUNKE
AWOSOGBA are counseling psychology doctoral candidates at the University of Texas at Austin. I.S. KEINO
MILLER is a counseling psychology doctoral student
at Indiana University, Bloomington, Ind. ASHLEY
HURST, STEVEN STONE, and STACEY JACKSON
are counseling psychology doctoral students at the
University of Texas at Austin.
40 Kappan
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school band at President Obama’s 2013 inauguration.
Unarmed 17-year-old Trayvon Martin was killed in
Sanford, Fla., by volunteer security guard George
Zimmerman, who perceived him to be a threat. In
Ferguson, Mo., a white police officer killed unarmed
18-year-old Michael Brown in broad daylight.
The psychological effects of violence are longlasting. Rates of post-traumatic stress disorder are
undoubtedly high among black youth who are frequently exposed to random and senseless acts of violence, either by other black youth or by police. How
prepared are school mental health professionals to
deal with the psychological and emotional aftermath
of black students struggling with the seemingly low
value placed on black life?
These are examples of mental health challenges
that we believe uniquely affect black students. However, far too little attention and research has examined the specific mental health needs of black students. And urban areas offer less mental health care
to African-American and Latino students than their
white peers (Howell & McFeeters, 2008).
According to the Children’s Defense Fund, black
and other racial/ethnic minority children have many
unmet mental health needs (Children’s Defense
Fund, 2010). Complicating matters is the interaction of low socioeconomic status with mental health
functioning. Because a disproportionate number of
black and racial/ethnic minority children are from
low-income families, their mental health needs can
be overlooked or misinterpreted as other problems.
Socioeconomic status and race
A critical component in understanding mental
health issues in black communities is recognizing
the connection between mental health and socioeconomic status. Individuals living in poverty are more
likely to experience psychological distress because
of insufficient familial, social, and psychological resources (Wickrama & Vazsonyi, 2011). According to
the 2011 American Community Survey (U.S. Census Bureau, n.d.), 39% of children younger than 18
living in poverty are black. Thus, about 4.3 million
black youth are confronted with race and povertyrelated stressors.
Experiences common to low-SES populations
include single-parent households, overcrowded
homes, multigenerational experiences of financial
stress, exposure to neighborhood violence, and substance abuse. All of these bring their own share of
challenges and can be overwhelming to cope with for
low-income black adolescents already dealing with
common development stressors related to puberty,
peer-related stress, academic motivation, and identity formation. The interaction of race, low socioeconomic status, and culture interact in ways that
make the detection of mental health issues among
black students more challenging.
Racial disparities
Exploring how teachers perceive and respond to
black students’ behavior affects mental health outcomes. Educators are gatekeepers for the interventions students can receive when problems are identified. If educators fail to critically interrogate their
responses to diverse students, they risk criminalizing
what are essentially symptoms of psychological distress. Furthermore, the pervasive negative stereotyping of blacks can bias teachers toward addressing externalizing symptoms (e.g., delinquent and
aggressive behavior) rather than being sensitive to
their underlying internalizing causes (e.g., depression and anxiety). This limited focus on underlying
mental health concerns can, in turn, lead to punitive
responses from educators.
Individuals living in poverty are more
likely to experience psychological
distress because of insufficient familial,
social, and psychological resources, and
39% of children younger than 18 living
in poverty are black.
For more than three decades, black students have
been disproportionately affected by exclusionary
discipline practices, such as special education placements, suspensions, alternative learning center
placement, and expulsions. These practices are often
based on interpreting culture and behavior within a
universal perspective rather than seeking to understand culture and behavior within a black context.
Exclusionary discipline practices start early. For
example, black preschoolers are three to five times
more likely to be expelled from school than their
Asian-American, Latino, and white peers. Nationally, black males are 2.9 times more likely to be identified as mentally challenged as their white peers
(Moore, Henfield, & Owens, 2008). More disturbing, one study found that black students were more
harshly penalized than their white peers for similar
behavioral infractions (Skiba, Michael, Nardo, & Peterson, 2002). This study also found that black students were disproportionately sanctioned for more
subjective forms of misbehavior, such as “disrespect,
excessive noise, threat, and loitering” (p. 332). These
findings suggest that teachers’ perceptions and their
subsequent reactions to students’ misdeeds may be
moderated by students’ race. These differential acV96 N4
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tions contribute directly to the school-to-prison
pipeline for black youth (Alexander, 2010) and ultimately negatively affects their mental health.
Often, black children who are sanctioned at school
are less likely to have their misbehavior attributed
to internal sources, such as depression or anxiety.
Identifying potential psychological causes not only
would reduce the criminalization of behavior that
is better explained by underlying mental health
concerns but also would encourage educators to
use different interventions. There is evidence that
when black students present with the same internalizing symptoms (e.g., depression, anxiety) as white
students, they are viewed more extremely. A recent
study that compared depression-related symptoms
for black and white adolescents found no differences in symptom severity when adolescents rated
themselves (Stein et al., 2010). However, when
rated by nonblack observers (one Latina and one
white), black youth were rated as demonstrating
more severe symptoms when compared to white
youth. Different perceptions of the same behavior
can lead to racial disparities in exclusionary discipline. Misbehaving white students may be labeled
as having “made a mistake and got caught,” whereas
black students may be classified as “oppositional
and noncompliant.” These different explanations
inevitably lead to disparate responses from teachers. The recommendation for a white student likely
would incorporate mental health counseling, while
a black student would more than likely be subject to
exclusionary discipline. Therefore, teachers should
work to understand what underlies the student’s
behavior rather than using their misconduct to
harshly judge students and set them on a trajectory with differential treatment and expectations.
School discipline toll on black pupils
Students receiving suspensions and expulsions, by race and ethnicity
Black/
African-American
White
Asian
24%
16%
51%
5%
Out-of-school
suspension
(multiple)
22%
In school
suspension
(single)
23%
Expulsion
Enrollment
Hispanic/Latino
22%
32%
42%
34%
1%
40%
31%
36%
1%
1%
Note: Individuals from two or more races and American Indian/Alaska Native categories were not included because of
percentageslessthan3%.
Source: U.S. Department of Education Office for Civil Rights. (2012). Civil rights data collection. Washington DC: Author.
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Exacerbating teachers’ differential responses is
the reality that many schools have limited mental
health service providers. This means the responsibility for identifying mental health concerns often falls
on teachers because of their close interactions with
Black children who are sanctioned
at school are less likely to have their
misbehavior attributed to internal
sources, such as depression or anxiety.
students. However, most teachers are not trained to
identify mental health concerns. Mental health service providers are important because they can help
students work on controlling and expressing their
emotions in healthy and more socially acceptable
ways. Collaborations between mental health service
providers and educators could help teachers learn
to differentiate between behavioral problems and
mental health ones.
Cultural considerations & depression
One of the most important mental health issues to
understand relative to black students is depression.
Depression is one of the most prevalent and debilitating mental illnesses in the United States. Depression should not be mistaken for the typical bouts of
sadness and/or irritability that subside within a few
hours to a few days. In addition to sadness/irritability, common symptoms of depression include loss of
interest in pleasurable activities, changes in appetite
and sleep, decreased energy, difficulty concentrating,
and feelings of guilt, worthlessness, and/or helplessness. However, understanding depressive symptoms
is culturally oriented around white Americans. Black
adolescents are often diagnosed with schizophrenia
more than the more accurate diagnosis of a depressive disorder, in part due to differential symptoms
and clinician bias. Instead of the standard feelings
of sadness and hopelessness, black adolescents often
exhibit increased irritability, anger, and aggression
(Choi, Meininger, & Roberts, 2006). In addition,
although not included in the criteria for depressive
disorders, somatic symptoms — headaches, stomachaches, back pain, and limb pain — are among
the prominent signs of depression among racial and
ethnic minority adolescents (Choi & Gi Park, 2006).
One of the authors witnessed firsthand the failure
to recognize depression among black students. She
worked as a clinician in a community mental health
center in the Dallas (Texas) Independent School District. She indicated that the major mental health issue
she saw was depression. She also noted that depression presented differently among black students and
manifested in “behavioral concerns.” Black students
were referred to her because of aggressive outbursts
or “anger issues.” Once she started talking to them,
she saw many more layers begin to unfold. She deduced that many students had not learned how to
express their emotions in a healthy way. Instead,
they held them in until someone pushed them over
their limit, and they exploded. Teachers were often
“wrapped up” in testing and academics so much that
they missed students’ psychological or mental health
issues or simply reduced them to behavioral concerns.
Recommendations
While black students face stressors common to
all adolescents, they also disproportionately face
chronic exposure to race-related stressors that adversely affect their well-being and mental health.
Helping these students deal with the various concerns present during their development will require increased access to mental health services and
a multisystem, culturally relevant, strengths-based
approach to treatment.
Consistent with under-representation in primary
care use, access to mental health services for black
children is among the lowest of all ethnic groups
(Holm-Hansen, 2006). Primary care physicians often identify black mental health needs but refer patients to other facilities for treatment. Since these
facilities are often unfamiliar, students and their
families are likely not going to follow through on
referrals very often.
Communities can remove some of these common
barriers to mental health service delivery by working with school districts to offer school-based mental health clinics. These clinics can include mental
health professionals, typically psychologists and psychiatrists, who receive referrals from the school staff
and serve students during the school day.
Research on school-based clinics has found that
they not only increase students’ mental health service
use but also improve their mental health outcomes,
school attendance, and grades (Ballard, Sander, &
Klimes-Dougan, 2014; Rofey, Nabors, & Parkins,
2008). Although the mental health professionals in
the clinic often are not school employees, being in
the school expands the opportunities for consultation and advocacy. School-based clinics not only
improve student outcomes, but they may have a
positive effect on school outcomes as well. Mental
health professionals in the clinic may offer psychoeducational workshops for teachers and staff that can
help increase mental health awareness and culturally sensitive identification of potential mental health
treatment needs. This is important because teacher
identification and referral concerns of black students
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kappanmagazine.org 43
are often misinterpreted due to teacher bias and lack
of knowledge of mental illness. Some of these clinics
also have regular psychiatrists staffed to prescribe
medicine and refer out for more intensive treatment
if necessary.
Early prevention and identification programs specific to black youth are vital. The outlook of student outcomes and symptom reduction gets worse
as the child gets older. To this end, it is important
that school staff and teachers, especially in elementary school, implement schoolwide, evidence-based
prevention and Response-to-Intervention programs
to identify at-risk students early. In addition, routine
pediatrician visits in the black community should be
encouraged as most black adults seek help from their
physician rather than a mental health professional
when a psychological difficulty is present (Snowden
& Pingitore, 2002). This is especially helpful given
that well-child checkups now include important
mental health markers (Talen, Stephens, Marik, &
Buchholz, 2007).
Teacher identification and referral
concerns of black students are often
misinterpreted due to teacher bias and
lack of knowledge of mental illness.
Of course, not every school has access to community mental health clinics and mental health professionals such as psychologists and psychiatrists.
Another approach to addressing mental health concerns among black students is to incorporate mental health education in the classroom. Students can
learn how to respond when other students exhibit
signs and symptoms of mental health challenges
such as depression, anger, or anxiety. California has
had success creating school-based wellness centers.
In California, the Riverside Unified School District
implemented several school-based wellness centers
as part of a Safe Schools/Healthy Students Initiative.
Qualitative data from students suggested that wellness centers positively contributed to student mental
health (Guerra & Williams, 2003). However, schoolbased wellness centers are generally expensive. Ideally school-based wellness centers would have a first
year of start-up funding followed by four or five years
of implementation funding (Guerra & Williams,
2003). Several California schools have found that
using students as first responders is an effective and
inexpensive way of getting help for students who
are more comfortable going to peers for help. This
supports the utility of including topics on depression
and other mental health and health issues in the cur44 Kappan
riculum to help raise overall awareness of health and
wellness issues.
Lastly, ameliorating the mental health of black
students will take more than just increasing access
to mental health services and early identification.
It also requires a critical evaluation of the practices
and models being used to diagnose and treat mental
health concerns. Frameworks have been established
that use a positive, strengths-based, culturally appropriate approach in working with black children
and adolescents. These models recognize that while
black youth go through the same developmental processes as nonblack youth (e.g., puberty, identity, and
maturation), culture and context play a unique role
in their lives.
Strengths-based models can be used with other
existing models that have consistently been found
to work such as cognitive-behavioral therapy, wraparound services, and family systems (e.g., Padesky &
Mooney, 2012). These models move us away from
traditional conceptualizations and treatment methods that are often deficit-based (i.e., focusing only
on the risks that the student brings: low SES and
test scores) and challenge practitioners to consider
a child’s unique strengths, including those of resilience, family strengths, and cultural values (e.g.,
interdependence, spirituality, peer relationships),
and build on those strengths. To this end, practitioners should consider adapting evidence-based
programs to be culturally relevant to the child, as
culturally adaptive mental health interventions have
been found to be effective (Griner & Smith, 2006).
Examples of culturally appropriate, strength-based
frameworks that may be helpful in the conceptualization and treatment of black students include
Phenomenological Variant of Ecological Systems
Theory (PVEST), Positive Youth Development
(PYD), and Celebrating the Strengths of AfricanAmerican Youth. Culturally adapted versions of evidence-based treatments and assessment scales are
still developing and can be found with relative ease
(Breland-Noble, 2012).
Conclusion
Meeting the mental health needs of black students
(and all racially and ethnically diverse students) is
imperative as schools are becoming more diverse.
Cultural competence is a buzzword that is frequently
used in mental health training to emphasize the importance of awareness, knowledge, and skills as the
foundation for adequately serving diverse populations. Certainly the issues that we briefly addressed
are important to understand if real progress is going
to be made in serving black students. Another important and rather pragmatic step to address the mental health needs of black students is increasing the
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number of black mental health professionals. As psychologists and psychologists-in-training, we are well
aware of the fact that blacks are under-represented
in psychology (APA Center for Workforce Statistics,
2010) and likely other mental health specialties too.
Black students may be hesitant to seek counseling or
therapy with a white counselor or therapist because
of cultural mistrust (Whaley, 2001). One of the authors observed that there was a lack of same race
therapists and mental health providers for black students in her school district. Black students and their
families were always shocked when they met her for
the first time because she was a black therapist. She
said these students and their families often said they
expected to be judged by white therapists, with the
implication being they felt more comfortable and at
ease with her.
Black students have many mental health needs that
go unaddressed. Raising awareness of issues related
to race, culture, and bias is an important component
of addressing black mental health. School-based
mental health clinics, wellness centers, and using
peers as first responders are all proven solutions to
help improve the mental health of not only black
students but all students.
K
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