Black kids face racism before they even start school. It's driving a major mental health crisis.

But at predominantly Black schools like the one in Columbus, Ohio, where Strother works, students’ mental health is further tested by pressures and discrimination they endure because they are Black, as well as poverty and violence in some communities that have faced years of disinvestment.

“Anytime you deal with African American mental health, you’re not dealing with one thing,” Strother said. “It is several things. It is trauma that has not been addressed.”

The drivers of the mental health crisis for Black children begin early and persist through a lifetime. Black children’s first encounters with racism can start before they are even in school, and Black teenagers report experiencing an average of five instances of racial discrimination per day. Young Black students are often perceived as less innocent and older than their age, leading to disproportionately harsher discipline in schools.

Black adolescents are far less likely than their white peers to seek and find mental health care. In part, that’s because Black families often distrust the medical system after generations of mistreatment — from lack of access to care to being subjected to racist practices and experimentation like the Tuskegee Study. The country also has a shortage of providers who understand the roles that racial identity and racism play in shaping young Black people’s mental health.

Research and health surveillance data point to a growing mental health crisis among Black youth over decades. Between 1991 and 2019, Black adolescents had the highest increase among any racial or ethnic group in prevalence of suicide attempts — a rise of nearly 80%.

About 53% of Black youth experience moderate to severe symptoms of depression, and about 20% said they were exposed to racial trauma often or very often in their life.

These disparities and lived experiences have systemic roots, including discrimination in housing, education and health care, and they have led to Black people experiencing higher rates of poverty and being underinsured. But financial stability does not shelter Black youth from the toll of racism on their mental health, said Dr. Alfiee Breland-Noble, a psychologist and founder of the AAKOMA Project, a mental health nonprofit focused on youth of color.

“Socioeconomic status adds another layer to it, but that’s not the thing that’s driving a lot of the behaviors that our young people are experiencing,” she said. “It’s the fact that people make assumptions about Black kids, based purely on their stereotypes.”

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EDITOR’S NOTE: This story is part of an AP series examining the health disparities experienced by Black Americans across a lifetime.

For 17-year-old Lillian, navigating a predominantly white school as a high-achieving Black girl wore heavily on her mental health. The AP is only publishing her first name to protect her privacy in discussing sensitive topics.

At its worst, anxiety isolated Lillian from her close-knit family. She sometimes went days without sleeping, kept awake by her schoolwork and the pressure she put on herself to excel.

All the insensitive comments and racial microaggressions felt relentless, and often came just as she was starting to become closer friends with someone. This school year alone, at least four people have tried without warning to touch her hair, which she loves wearing in puffs, braids and other natural styles.

Others told her she didn’t seem like what they expected, leaving her wondering what exactly they expected of Black girls like her. With few teachers who were people of color at her school, she often felt like she had to work harder to prove herself capable and deserving of the same opportunities and recognition that white students easily received. But in advocating for herself, she worried about coming across as too aggressive.

“I think in predominantly white spaces, we naturally code switch. We’re softer,” Lillian said. “I had to have this large patience for things that I wouldn’t normally have. Because it was my school, it’s like if I’m so aggressive, and it becomes known that I’m the aggressive Black girl, it’s gonna be terrible, and it’s gonna follow me.”

Although many of Lillian’s family members supported her in seeking more intense support for her anxiety — she was ultimately diagnosed with two anxiety disorders — others were less receptive, dismissing her mental health as a need to focus more on her faith.

Outside of school, Lillian volunteers with suicide prevention and mental health workshops. Another Black girl once told Lillian about a white therapist making a dismissive comment about Black families during a session.

“If you’re going into it with a stigmatized belief about how Black people see mental health, then of course no one is going to want to open up to you,” Lillian said.

As young as 4 to 6 years old, children of color begin to experience race-based traumatic stress, said Dr. Steven Kniffley, a licensed psychologist and senior associate dean for diversity, equity and inclusion at the University of Cincinnati College of Medicine.

Racism affects mental health on multiple levels. Besides direct hostility and microaggressions, experts said seeing people of color subjected to racist violence also takes a toll. Called vicarious racism, research has found it can result in greater symptoms of depression and anxiety.

“When we think about our young folks specifically, because of the strong influence of social media on their lived experience, they’re constantly inundated and really overexposed to all the bad things that are going on in our society,” Kniffley said. “You see a police shooting, and they’re retraumatized over and over again.”

In the Columbus area, where Lillian goes to school, the killing of 16-year-old Ma’Khia Bryant brought the feeling close to home for Black girls in the city. Bryant was holding a knife during a confrontation with a woman at her foster home when police shot the teen. But Bryant’s family later revealed it was Bryant who had called for police to come to the scene, saying she was being attacked and needed help.

The shooting made Fran Frazier, founder of the Columbus-based Black Girl Rising, want to do something for Black girls in the city, who she said felt denied of their girlhood and “adultified” — viewed as older and less innocent. She bought time on a radio station and asked Black women in the area to read love letters to Black girls on the air.

“Our girls have the assumption that, ‘If we don’t look like you think we’re supposed to look, then you can address us as adults,’” Frazier said. “‘You’re not thinking about us as actual girls.’”

Frazier led a 2011 study into the lives of Black girls in Ohio that forms the basis of her work now with young Black women around mental health, leadership and resilience.

Through the Black Girl Think Tank, Frazier said participants identified six key areas affecting Black girls’ mental health: colorism, bullying, body shaming, lack of conflict resolution skills, depression and LGBTQ+ issues.

While nearly all the girls who responded said they liked being Black, and liked being a girl, they felt they had been treated unfairly for being both.

“When you are walking around every day, being reminded that you are a female, that you are a female of color, and nobody in the world actually likes you, that helps you see what the future could be like,” Frazier said. “Our girls have a lot of hope, but not necessarily what they need to get there.”

Suicides for all Black youth between the ages of 5 and 17 climbed between 2003 and 2017 — but the increase was sharpest for girls and 15- to 17-year-olds. A Centers for Disease Control and Prevention survey found that 22% of Black youth had considered suicide in the past year. For Black youth who are also LGBTQ+, that number was 44%, according to the Trevor Project, a suicide prevention and crisis intervention organization.

Individually and systemically, barriers to accessing mental health care disproportionately deter Black teens from getting the support they need.

The cost of care — sometimes hundreds of dollars for a single therapy session if providers don’t take insurance, and many do not — can make services inaccessible, but poverty and insurance rates do not fully explain the disparate outcomes.

The fear of being misunderstood or even mistreated by the medical establishment is not without foundation. Most mental health care providers are white — only 4% of psychologists are Black, according to the American Psychological Association. And 80% of mental health providers are not trained in treating race-based trauma, said Kniffley, the psychologist.

Racist treatment of Black people in medical care dates to slavery, and psychiatry and psychology are not exceptions. In 1851, physician Samuel Cartwright hypothesized that mental illness was what drove enslaved Black Americans to escape to freedom. Termed “drapetomania,” the belief was rooted in the idea that slavery was such an improvement to Black peoples’ lives that only those who were mentally ill would wish to escape.

And in 1968, psychologists Walter Bromberg and Franck Simon developed the theory of “ protest psychosis,” the idea that Black male participation in the Civil Rights Movement caused violent, schizophrenic symptoms.

“That legacy has contributed to a mistrust that Black and brown folks have where their experience has been pathologized,” Kniffley said. “They’ve been overlabeled with behavioral challenges and learning challenges that have very real-world consequences in terms of what type of schooling you get, what type of jobs are accessible to you, how people treat you.”

Psychologists have taken steps to acknowledge their profession’s history. In 2021, the American Psychological Association issued a public apology and resolution noting psychology’s roots in eugenicist and racist ideas and the negative impact that the field has had on communities of color. The resolution called for prioritizing training and policies meant to address these inequities.

Though Black parents, activists, clinicians and teens said in interviews that while they feel the stigma of mental health has lightened overall, individual experiences are still shaped by pressure to keep personal struggles private.

A distrust of formal systems still lingers among Black Americans in response to decades of medical mistreatment, said Dr. Michael Lindsey, professor of social work at New York University. In response, families may seek support through informal systems in their communities such as churches, Lindsey said, rather than speaking of their personal affairs to people outside the family.

Society still treats those struggling with mental health differently, Lindsey said. And for people of color who are already marginalized because of their identity, admitting they are struggling with their mental health adds a “double consequence,” he said.

Counselors and therapists must overcome those hesitations with young people before they open up about their needs. But in schools — often the only places where many teens can access mental health support — social workers, psychologists and counselors are frequently overwhelmed by the number of students in their caseloads.

In Columbus, there are an average of 465 students for each school counselor, which is not uncommon in U.S. schools, even though the recommended ratio is one counselor per 250 students.

One time, Strother, the counselor, recalled looking up from her desk and seeing 10 students in her office, hoping to talk to her about something on their minds.

“You have that happening with 100 students, 200 students, who always want to hang in your office because you’re their safe space in the school,” she said.

The school partners with community providers for additional counseling, but even if students say they’re ready for more intensive mental health support, staff still may face resistance and distrust from parents.

One girl told Strother that she thought fighting with her mother at home might be the root of her anger issues and that therapy might help. Strother told the girl she was brave to advocate for herself, and the girl’s face lit up.

But when Strother said she needed her mom’s permission, the girl’s face dropped. The girl had asked her mother about counseling before, but was told no. Strother called the mother but got no answer. And when she eventually returned Strother’s call, it was to say her daughter was just being dramatic and didn’t need counseling.

“And at that point, what do you do?” Strother said. “You can’t harass a parent to make them give their child counseling.”

Outside the school hallways, the high concentration of poverty in the surrounding neighborhood, as well as food insecurity and gun violence, seeps into the lives of her students, she said.

“This is a difficult place. But I’m gonna tell you: You walk in there, you meet some of those kids and there are days where you wouldn’t want to be anywhere else,” Strother said. “They are the most loving children who just need someone to love them.”

Through hip-hop, Archie Green hopes to create a safe space for young Black men to unpack their lives.

In 2021, he started a program called Cope Dealer for young boys in Kent, Ohio, offering them a space to discuss how gender, race and mental health intersect for Black boys and men and ways to cope with daily stressors.

“For Black men, it’s so hard for us to open up, to be vulnerable to know it’s OK to cry,” Green said. “It’s OK to feel.”

Schools should be that safe space for kids. But symptoms of depression, anxiety and traumatic stress in Black students are often viewed by adults as disobedience, anger or insubordination.

Those perceptions lead to Black students being policed or disciplined rather than protected in schools, said Tai Collins, associate professor of school psychology at the University of Cincinnati.

“Oftentimes in schools, students have these racialized experiences,” Collins said. “And they don’t experience a safe space where they can be supported.”

On the first day of the Cope Dealer program, officers entered a room where participants gathered and arrested a boy, who was between homes, for having an unloaded pellet gun that he used for protection. And on the last day, the group was accused of stealing a wallet that had gone missing at the school.

“Of course, they’re gonna knock on the door where all these Black boys are meeting, to profile us as if we’re automatically the suspects,” Green said.

Program participants have grown in their mental health and their ability to speak up for themselves, he said.

“They were very vocal with the principal and the police officer, saying: ‘We don’t feel served or protected’,” Green recalled of the wallet accusation. “And they were very diplomatic in their approach. And when our facilitator asked them again, ‘All right guys, how are you feeling?’ One of them said, ‘I think we handled that better than last time.’”

Over 10 weeks, group members who call themselves Cope Kingz analyze hip-hop songs and talk about grief, identity and coping.

They also put their experiences to music, producing a mixtape with five songs.

“Struggled inside my nature, that’s how I define oppressed,” one young man raps on the opening track, titled “A Different View.” “Wonder if the things I’m going through are just inside my head.”

Annie Ma, based in Washington, is a member of AP’s Race and Ethnicity team. Follow her on Twitter: https://www.twitter.com/anniema15.