HEALTHCARE
A Mother’s Story and the Urgent Fight to End the Black Maternal Health Crisis Congresswoman Robin Kelly A newborn baby should be a joyous occasion for a family. For Black women, though, pregnancy and labor is far too often filled with pain, trauma, and, in the most tragic cases, death. My constituent, Mercedes Wells, was traveling with her husband, Leon, back home from Michigan when she started to feel labor pains. She was pregnant with her fourth child and was no stranger to labor; she knew what was coming. She and her husband found the closest hospital in Crown Point, Indiana, right over the border from Illinois. What happened next went viral on social media and made headlines as many Americans watched with horror. Mercedes was wheeled out of the hospital, screaming and crying in pain. Without ever seeing a doctor, a nurse discharged her while she was in active labor. It was mid-November in the Midwest, but the nurse did not even wait for Leon to warm up the truck. Eight minutes later on the way to the nearest hospital, Mercedes gave birth to her daughter in the truck on the side of the road with only Leon to help. He didn’t have any medical experience, and the truck was not sanitized. By the grace of God, Mercedes and her baby are now healthy and happy—but I could not help but think how easily this story could have ended differently. It should not take luck or divine intervention for a Black woman to safely deliver a baby in the richest country in the history of the world. Mercedes’s story reminded me of too many other Black women’s birthing experiences.
Shortly after I was elected to Congress, a constituent called me and said, “You have to hear this story.” She told me about her friend’s daughter-in-law, who gave birth to a beautiful baby—but she did not survive to raise her newborn. She was a healthy and well-educated Black woman, but she died on the operation table during a routine C-section. After we talked, I did my research. At that time, I had no idea that Black women are three times more likely to die than white women due to pregnancy-related causes. I held a listening session about maternal mortality, and the room was crowded with women who had similar experiences or knew someone who did. It was clear that our country had—and continues to have—a maternal mortality crisis, so I got to work. As Chair of the Congressional Black Caucus Health Braintrust, I leveraged my legislative work to center Black women in public health discussions and legislation. I amplified Black women’s voices in Congress and urged all healthcare professionals to elevate their standard of care for every patient. Eventually, I passed Medicaid postpartum coverage for a full year, extending it from just 60 days. Anyone who’s given birth knows that it takes longer than 60 days to recover. Many mothers don’t die in childbirth, but rather in postpartum due to depression, hemorrhaging, or infection. By extending healthcare coverage to a full year, mothers can focus on their own health, and we know that when mothers thrive, the whole family thrives. I know that more work needs to be done. Mercedes’ story proves that. When I met with her and her husband, she told me she wanted to be a vessel for change. Her bravery to share her story and her compassion to ensure no other mother experiences the same trauma moved me. I will never forget Mercedes’ courage, and I made sure our public health system won’t forget either.
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I introduced the WELLS Act in honor of Mercedes to urge hospitals and birthing centers to implement safe labor discharge plans. The plan outlines every element missing from Mercedes’ experience including clinical justification for discharge, patient understanding, and identification of the nearest hospital. The other half of the bill includes racial bias training for healthcare professionals. Mercedes told me that there was not a single staff of color on the hospital floor as they all watched two nurses wheel her outside. The nurse didn’t even hand the discharge papers to her; she just plopped them on her legs. The lack of respect and dignity should outrage anyone and point to the clear racism in our healthcare system. Racial bias training cannot be a simple checkmark for hospitals, but a priority, until it’s well integrated into the care received by every patient. I will make sure our healthcare systems change for Mercedes, her newborn daughter, and every Black woman and girl. Congresswoman Robin Kelly has dedicated her career to public service as an advocate for Illinois families. Since being elected to serve the 2nd Congressional District in 2013, she has worked to expand economic opportunity, community wellness, and public safety across the state, championing numerous initiatives to generate job growth, reduce health disparities, and end gun violence. Congresswoman Kelly is a member of the House Energy and Commerce Committee and serves on the Health, Communications and Technology, and Commerce, Manufacturing, and Trade subcommittees. Her Energy and Commerce work is focused on expanding access to healthcare, consumer protection for American families, and economic development.
It should not take luck or divine intervention for a Black woman to safely deliver a baby in the richest country in the history of the world.
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Health, Justice, and the Work Ahead Dr. Marjorie Innocent I arrived at the Congressional Black Caucus Foundation in late 2006 as I was a newly minted PhD with more than a decade of work experience and an appreciation for the complexities of what drives health. My concentration had been in health and social policy, and I understood that people need good education, good-paying jobs with benefits, quality housing, safe environments, clean air and water, and affordable, healthful foods along with good medical care to live their best lives. During my time at the Foundation, theory met reality in the most profound ways. Led by an ingenious, dedicated, and tenacious group of professionals, CBCF educated communities nationwide about obesity and chronic disease; but we also heard about neighborhoods without grocery stores, jobs that didn’t pay enough for fresh produce, and stress from violence and economic insecurity that no amount of nutrition education could solve. Our financial literacy and homeownership programs connected the dots between stable housing, financial planning, and stable health. Our research on education policy and economic security revealed how childhood experiences and family income created health trajectories long before anyone stepped into a doctor’s office, and we translated landmark policies into user-friendly language for the general population. Our internship and fellowship programs brought young Black people to Washington who never imagined they could work in the nation’s capital and today are leading policy work across myriad sectors, while our scholarship programs helped thousands achieve their academic pursuits. As a legislative body, the Congressional Black Caucus understood the premise behind the social determinants of health long before it became fashionable. For decades, while mainstream health policy focused on individual behavior change, CBC members in partnership with several other caucuses were legislating toward comprehensive policy solutions to advance lives in the Black community and beyond.
The Affordable Care Act was a policy win that exemplified this approach. Yes, it expanded insurance coverage, but it also invested in community health centers, addressed workforce diversity, and expanded Medicaid to reach millions locked out of care. More recently, we’ve also seen rising investments in community health workers and early childhood education, as well as growing state and local efforts to increase minimum wages. Courtesy of the COVID-19 pandemic, our nation has greater insight that such policies are part of a holistic set of solutions to address the root causes of our persistent health disparities. Yet today, much of that hard-won progress is being steadily dismantled. Policies that took decades to build are being undone rapidly. But this moment also reveals something important: You don’t fight this hard to undo policies that don’t work. Efforts to return to the days of old underscore the power of comprehensive approaches to creating health and opportunity. Which is why we cannot quit now. Moving forward will require truth-telling. We cannot build an equitable future on a foundation of lies about the past. We must name the exclusionary systems—racism, sexism, classism, and others—that created health inequities in the first place. Not as accusation or an exercise in labeling, but as diagnosis. You cannot treat what you refuse to name. Our country is a work in progress, but progress demands acknowledging where we’ve been and how we got here. My vision for the future rests on three commitments. First, inclusive voice. Policies must be shaped with communities, not for them nor laden with assumptions about them. Black, brown, and all people must be architects of solutions, not just recipients. Second, a focus on community capacity building. We need sustained investment in local infrastructure, local education, local leadership, and local wisdom. Communities have real ideas about what they need, and
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resources and strategies must incorporate that knowledge. Third, proactive policies. We must put down our superhero capes, stop waiting for crisis to intervene, and focus intently on building systems that engender health and treat illness. This work requires all of us—not just policy professionals and elected officials, but also business leaders, religious groups, educators, and neighbors. Within and across communities, within and across racial, ethnic, and geographic lines, we must be engaged in shaping our collective future. We know what good health and wellness look like when people have what they need to thrive. We’ve seen glimpses through past policy wins. Now we need political will and sustained commitment to make those glimpses the norm. As a nation, we must believe we can learn from the past, be honest about where we are today, build a blueprint that includes all of us, and advance smartly, effectively, and steadfastly together. On many levels, my years at CBCF taught me that comprehensive change is possible when people are committed and policies are bold. The future is still ours to shape. This is not optimism for its own sake: It’s a commitment rooted in decades of witnessing what is possible when together, we refuse to accept that health is a privilege and opportunity is for the few, and when we’re willing to do the hard work of building systems that reflect all of us. At the cusp of our country’s semiquincentennial, I say let’s go. Dr. Marjorie Innocent, is a health policy expert who integrates research, advocacy, capacity building, and engagement to advance just policies and optimal health. For nearly a decade at the Congressional Black Caucus Foundation, she led the development of policy-centered leadership programs, community engagement initiatives, and research projects focused on health equity, economic security, and education. She later served as senior director of health and director of learning and impact at the NAACP. Dr. Innocent is an adjunct associate professor at Meharry School of Global Health and serves on the board of Generation Citizen. She is a lover of God, fairness, music, and culture.
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The Silent Burden We Carry: A Journey Toward Fibroid Equity Sateria Venable As I approached my third, of what would ultimately be four fibroid surgeries, I wondered why it was so difficult to find a fibroid specialist to treat me. When I learned that over seventy percent of all women develop fibroids, the seed was planted to begin my advocacy journey. Until then I didn’t know that my experience was far from unique. I was part of a sisterhood—millions of women strong, disproportionately Black women—who had been told to endure, to accept, to simply live with a condition that was stealing our quality of life, our fertility dreams, causing us to suffer through work and endure challenges in relationships. According to biased medical literature, women’s pain was ‘normal’, and the heavy bleeding requiring us to change products every hour was “just how it is.” The historical silence around uterine fibroids is not accidental. For generations, women’s reproductive health has existed in the shadows, deemed too intimate, too uncomfortable for public conversation. But this silence has been particularly deafening for Black women, who develop fibroids earlier in life, experience more severe symptoms, and face higher rates of hysterectomy than any other group. When I founded The Fibroid Foundation, I understood that we weren’t just fighting a medical condition—we were confronting centuries of medical racism, gender bias, and the systematic devaluation of Black women’s pain. There have been many pivotal moments that have defined our advocacy efforts. Women began sharing their stories—not in whispers, but loudly, unapologetically. We talked about missed work days, cancelled vacations, relationships strained by chronic pain and heavy bleeding. We spoke about the trauma of being dismissed by healthcare providers, of being told our symptoms were exaggerated or psychosomatic. These conversations created a groundswell that couldn’t be ignored.
One of the most significant moments in our movement was the increased research attention to racial disparities in fibroid occurrence and treatment. Scientists began including patient input in clinical trial design, execution, and publication. This shift acknowledged what we had known in our bodies all along—that our experience was distinct and shaped by genetics, environmental factors, and systemic inequities in healthcare access and quality. Policy has slowly begun to recognize our advocacy. We’ve seen increased federal funding for fibroid research, though nowhere near what conditions affecting men receive, and nowhere near the level that a diagnosis impacting twenty-six million U.S. women should receive. We’ve witnessed the development of less invasive treatment options, giving women alternatives to hysterectomy. But perhaps most importantly, we’ve seen the medical community begin to take women’s pain seriously, recognizing that “just fibroids” can profoundly impact every aspect of a woman’s life, and that a woman’s uterus is not disposable. Today, I see promising sparks of innovation. Medical researchers are exploring targeted therapies that could shrink fibroids without surgery. Technology is creating platforms where women can track symptoms, share experiences, and find specialists who truly understand fibroid disease. Community health workers are bringing fibroid education to schools, churches, and community centers—meeting women where we are. I’m particularly encouraged by the young physicians and researchers, especially women of color, who are entering the field determined to change the narrative. They’re not satisfied with telling patients to “just deal with it.” They’re asking better questions, listening more deeply, and recognizing that culturally competent care isn’t optional—it’s essential.
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I envision research funding that reflects the prevalence and impact of fibroids, particularly in Black communities. My vision for a more equitable future is clear and uncompromising. I imagine a world where no young girl experiences her first fibroid symptoms and suffers in silence because she doesn’t have the language or permission to speak about her body. I envision healthcare providers who believe women the first time they describe their pain, who offer comprehensive treatment options, who understand that our bodies deserve more than one-size-fits-all solutions. I envision research funding that reflects the prevalence and impact of fibroids, particularly in Black communities. Further, I strive to quantify the impact of fibroids across all ethnicities, since it should not be labeled as a ‘Black woman’s disease’. I see medical schools teaching future doctors about implicit bias and how it literally kills women of color. I imagine workplaces with policies that acknowledge reproductive health conditions as legitimate reasons for sick leave and accommodation.
Support organizations doing this work, whether through donations, volunteering, or amplifying our message. Contact your legislators about funding for women’s health research. If you’re a healthcare provider, commit to ongoing education about fibroid disease and its disproportionate impact on communities of color. Most importantly, recognize that fibroid advocacy is reproductive justice work. It’s about bodily autonomy, health equity, and the radical notion that all women deserve to live without preventable suffering. When we fight for fibroid awareness and better treatment, we’re fighting for the fundamental right to be seen, heard, and valued in our entirety. Together, we’re transforming what was once a silent burden into a clarion call for change. And we won’t stop until every woman with fibroids knows she doesn’t have to “just deal with it”—she deserves so much more. Sateria Venable is Founder of The Fibroid Foundation and a nationally recognized patient advocate and researcher focused on uterine fibroids and heavy menstrual bleeding. Diagnosed with fibroids at age 26 after years of debilitating symptoms that affected her health and professional life, Venable transformed her personal experience into a national movement to elevate patient voices and drive systemic change. Under her leadership, the Fibroid Foundation now reaches communities in more than 180 countries, providing education, support, and stigma-breaking advocacy. A graduate of Carnegie Mellon University, she has co-authored peer-reviewed research in leading medical journals and is a sought-after speaker on women’s health issues.
But this future won’t materialize without action from all of us. Individuals can shape this future by first breaking the silence. Talk about fibroids with your daughters, sisters, and friends. Share your story, even when it feels vulnerable. Demand better from your healthcare providers—you deserve to be heard, believed, and offered options.
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Amplifying Black Perspectives: Spotlight on Healthcare Which of the following best describes the current state of healthcare access for Black Americans? About two-thirds of respondents reported that only some or few Black Americans are consistently able to access quality healthcare. Little to no Black Americans are consistently able to access quality healthcare
16%
Nearly Black Americans are consistently able to access quality healthcare
3%
Nearly Black Americans are consistently able to access quality healthcare Most Black Americans are consistently able to access quality healthcare Some or few Black Americans are consistently able to access quality healthcare Little to no Black Americans are consistently able to access quality healthcare
Some or few Black Americans are consistently able to access quality healthcare
Unsure
68%
Most Black Americans are consistently able to access quality healthcare
10%
DATA SOURCE: THE CENTER FOR POLICY ANALYSIS AND RESEARCH AMPLIFYING BLACK PERSPECTIVES DATA PROJECT. RESULTS ARE BASED ON ANALYSIS OF AN ONLINE SURVEY OF 187 BLACK-IDENTIFYING INDIVIDUALS CONDUCTED BETWEEN JANUARY 14 – 30, 2026.
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Healthcare Policy Landscape Black Americans have historically faced systemic exclusion from quality healthcare. During slavery, white slaveholders deprived enslaved Africans of bodily autonomy and access to medical care, often subjecting them to unethical medical experimentation without consent. These practices established enduring racial inequities in medicine that persist today. Throughout the 20th century, federal involvement in healthcare expanded, yet access for Black communities remained unfair. The Civil Rights Act of 1964, signed by President Lyndon B. Johnson, was a landmark achievement that prohibited discrimination in federally funded health programs and mandated hospital desegregation. This progress was further reinforced by the establishment of Medicare and Medicaid in 1965, which expanded access to healthcare for elderly and low-income populations, including many Black Americans. Nearly fifty years later, the passage of the Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, marked a significant shift in federal healthcare policy. The law expanded insurance coverage, prohibited discrimination based on preexisting conditions, and invested in preventive services, leading to substantial reductions in uninsured rates among Black Americans, especially in states that adopted Medicaid expansion. The ACA demonstrated the federal government’s capacity to narrow racial health disparities through intentional policy design and enforcement. Despite this progress, healthcare access for Black communities remains vulnerable to political shifts. Although recent federal actions under the Biden administration have expanded affordability — such as pandemic-era measures that enhanced ACA subsidies and later reforms that lowered prescription drug costs for Medicare beneficiaries -- these improvements remain fragile. Continuous efforts to undermine the ACA, limit Medicaid enrollment, and reduce federal oversight of civil rights protections threaten gains in coverage and affordability. More recently, the One Big Beautiful Bill Act, signed into law in 2025 by President Donald Trump, has introduced policy
Despite this progress, healthcare access for Black communities remains vulnerable to political shifts. changes — including significant cuts to Medicaid and an estimated additional 10 million people losing health insurance -- raising concerns about its potential to weaken access, increase costs, and stall progress toward health equity for Black communities and other historically underserved groups. Today, Black Americans continue to experience disproportionately high rates of chronic disease, maternal mortality, and reduced life expectancy. These outcomes reflect the cumulative impact of policy decisions rather than individual choices. Current rollbacks of programs and initiatives, particularly those designed to enhance healthcare access and equity, exacerbate these challenges. Policymakers must play a critical role in strengthening the healthcare system by protecting access to coverage, preserving equity-focused initiatives, and ensuring that Black communities are not left behind as federal health policy evolves.
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Timeline November 18, 1895 The National Medical Association was founded to address the exclusion of Black physicians from the American Medical Association and improve healthcare access for Black communities.
August 13, 1946 President Harry S. Truman signed the Hospital Survey and Construction Act into law, providing federal funding for hospital construction while permitting racial segregation and unequal access to care.
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July 2, 1964 President Lyndon B. Johnson signed the Civil Rights Act of 1964 into law, prohibiting discrimination in hospitals and health programs that receive federal funds.
April 7, 1986 President Ronald Reagan signed the Emergency Medical Treatment and Labor Act into law, requiring hospitals to provide emergency care regardless of a patient’s ability to pay.
July 30, 1965 President Lyndon B. Johnson signed Medicare and Medicaid into law, expanding healthcare coverage for seniors and low-income individuals and forcing the desegregation of hospitals nationwide.
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August 16, 2022 President Joe Biden signed the Inflation Reduction Act into law, allowing Medicare to negotiate prescription drug prices and capping insulin costs for seniors. March 23, 2010 President Barack Obama signed the Affordable Care Act (ACA) into law, expanding insurance coverage, prohibiting discrimination based on preexisting conditions, and reducing uninsured rates among Black Americans.
July 4, 2025 President Donald Trump signed the One Big Beautiful Bill Act into law, introducing healthcare policy changes that have raised concerns about potential impacts on coverage, affordability, and equity, particularly for Black communities and other historically underserved populations.
March 11, 2021 President Joe Biden signed the American Rescue Plan Act into law, strengthening ACA subsidies and expanding access to affordable healthcare during the COVID-19 pandemic.
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Black Youth Mental Health at a Crossroads: Trends, Structural Risks, and Policy Pathways for Sustained Equity Dr. Ashley Stewart For more than a decade, researchers and policymakers have raised alarms about youth mental health in the United States. Between 2007 and 2021, suicide rates among youth ages 10–24 increased by 62 percent, according to the Centers for Disease Control and Prevention,1 with especially concerning trends for Black youth. While recent national data show modest declines in distress and suicidal ideation following the peak of the COVID-19 pandemic, these improvements are uneven and fragile. They also risk being reversed by federal disinvestment in mental health infrastructure. Black youth face distinct mental health risks shaped by structural exposure to violence, racism, under-resourced schools, and limited access to culturally responsive care. Federal mental health and substance use programs, particularly those administered through the Substance Abuse and Mental Health Services Administration (SAMHSA), have been central to maintaining access to critical services. The recent proposal to cut nearly $2 billion from these programs,2 though quickly reversed, highlights how vulnerable mental health infrastructure remains at a pivotal moment. When youth mental health data are reported without sufficient racial, gender, and contextual disaggregation, the realities of Black youth are often flattened or rendered statistically invisible. Modest improvements in national averages can mask persistent exposure to violence, racism, and under-resourced systems of care that continue to drive adverse mental health outcomes for Black youth. As a result, policy responses grounded solely in aggregate trends risk misdiagnosing both the nature of the problem and the populations most in need of targeted intervention. At the same time, the capacity
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to conduct rigorous, equity-centered research on Black youth mental health is itself under threat. Ongoing rollbacks of diversity, equity, and inclusion (DEI) initiatives across federal agencies and research institutions, including universities, 3 have begun to constrain funding, language, and methodological approaches explicitly focused on race. These shifts not only limit the scope of inquiry but also signal a broader retreat from acknowledging racism as a determinant of mental health. Compounding these challenges are growing disruptions to public health data access and transparency. Changes in data availability, delays in reporting, and restrictions on how race-related data can be managed or disseminated 4 undermine the evidence base needed to inform responsive policy. For Black youth in particular, whose mental health risks are often undercounted or misclassified, limitations in data access further entrench invisibility at the policy level. Black youth mental health sits at the intersection of public health, education, and civil rights, shaped by structural conditions that distribute risk unevenly and by policy decisions that determine access to supportive school environments and care. At a moment when political and institutional forces threaten the tools used to document inequity, centering Black youth mental health is a policy imperative. Without intentional investment in equity-centered research and targeted intervention, early signs of improvement in youth mental health will fail to translate into meaningful gains for Black youth. This brief first examines national youth mental health trends and demonstrates how aggregate data obscure the distinct and persistent risks facing Black youth. Second, it situates Black youth mental health within its structural context, highlighting the roles of violence
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exposure, racism in school environments, and gaps in access to culturally responsive care. Third, it assesses emerging interventions, including digital mental health tools and community-based models, while identifying new risks and regulatory gaps. It considers the policy implications of recent federal disinvestment and threats to equitycentered research and public health data access. Finally, the brief offers a set of actionable policy recommendations to strengthen mental health infrastructure, ensure data transparency, and advance solutions for Black youth. What the Data Show: Trends and Disparities for Black Youth Across national surveys and mortality data, adolescent mental health indicators have shown concerning levels of distress over the past decade, with some signs of stabilization in recent years. However, for Black youth in particular, structural disparities and intersectional risk factors continue to shape higher-burden outcomes. National Youth Mental Health Trends Recent nationally representative data from the CDC’s Youth Risk Behavior Survey (YRBS) indicate that a large proportion of students in grades 9-12 continue to experience emotional distress.5 It is important to note that YRBS data capture students in school and thus excludes youth who are out of school, who may face even higher risk. In 2023, approximately 40% of students reported persistent feelings of sadness or hopelessness, and about 20% seriously considered attempting suicide in the past year. These figures represent slight declines from 2021 levels, where about 42% reported persistent sadness and higher proportions reported suicidal thoughts, suggesting emerging signs of stabilization following peak pandemic-related distress. At the same time, declines since 2021 have not returned adolescent mental health indicators to pre-pandemic baselines. Compared with a decade ago, when lower proportions of students reported sadness and suicidal thoughts, current rates remain elevated. For example, feelings of sadness/ hopelessness increased by about 10 percentage points from 2013 to 2023,6 even accounting for recent small decreases. Contributing to these nuanced trends are broader efforts in research, policy, and funding. Amid heightened national concern during the
COVID-19 recovery period, underscored by the 2021 Protecting Youth Mental Health report issued by the Surgeon General, the years 2021 through 2023 marked an unprecedented surge in federal, state, and philanthropic investment in youth mental health, including the rollout of 988 crisis services, expansion of school-based mental health grants, and new research initiatives aimed at strengthening early detection and community-based supports. These are factors that could contribute to real-world improvements in some subgroups or settings. These efforts, while not fully reversing decade-long trends, are an important context for interpreting modest positive shifts. For youth suicide deaths, provisional national mortality data show that overall suicide rates have leveled off after nearly returning to their highest point in recent decades. National age-adjusted suicide rates held steady between 2022 and 2023 at high levels (approximately 14 per 100,000),7 a pattern some experts see as cautiously hopeful compared with prior increases. However, rates remain historically elevated, and suicide continues to be a leading cause of death among adolescents. Importantly, these overall patterns mask differential experiences across demographic groups. A broad stabilization should not be equated with equitable improvement, especially for racially/ethnically minoritized and/or LGBTQ+ youth, and those living in poverty. Black Youth Mental Health in National Data Black adolescents exhibit distinct patterns of mental health risk that reflect both universal adolescent distress and unique structural exposures. CDC YRBS data illustrate that emotional distress among Black students parallels national trends but with important differences in how behaviors manifest. Analyses of 2013–2023 survey data show that large proportions of Black high school students report persistent sadness or hopelessness, with overall youth levels of emotional distress increasing over the decade. While detailed racial stratification for every indicator is not always published in public summaries, recent CDC trend reports note that measures of poor mental health and suicidal behaviors have worsened overall from 2013 to 2023 across groups, including Black students. According to CDC trend summaries, the percentage of Black students who attempted suicide decreased from about 14% in 2021 to about
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10% in 2023, and the proportion who were injured in a suicide attempt dropped from about 4% to about 2 % over that same period. These declines track with broader national patterns but still reflect a meaningful burden. Separately, mortality data indicate that ageadjusted suicide rates among non-Hispanic Black youth increased significantly over the 2018–2023 period, even as rates among White youth declined slightly.8 This highlights a complex picture in which attempts and ideation may be showing some moderation, while death rates have increased for Black youth overall in recent years. These indicators capture different populations and points along the risk continuum. The divergence suggests that while self-reported attempts among in-school youth may be decreasing, fatal outcomes, potentially shaped by access to lethal means and inequitable crisis response, remain a serious and growing concern. Importantly, this mortality data accounts for structural risk differentials and underscores ongoing disparities. National YRBS analyses also link structural exposures such as violence with mental health risk. 9 Black students who report experiences of racism at school, including discriminatory treatment, biased discipline, or unsafe environments, show a higher prevalence of multiple behavioral health risks across categories such as sadness, suicidal thoughts, and substance use. Black adolescents also disproportionately experience community violence and school safety concerns, including being threatened or injured with a weapon, bullied, or missing school due to safety fears, all of which correlate with poor psychological outcomes. YRBS data from 2021 to 2023 documented increases in these safety concerns among students overall, patterns that research associates with emotional distress and trauma pathway. Intersectional Risk An intersectional lens reveals compounded vulnerabilities for subsets of Black youth. Female adolescents of all races report higher levels of emotional distress and suicidal behaviors than their male peers. This pattern holds for Black girls, who additionally face gendered racism and higher exposure to sexual violence, factors that research links with adverse mental health outcomes.10 National trend data consistently show that girls’ rates of sadness and suicidal ideation
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exceed boys’, a pattern that intersects with race in complex ways. Additionally, data consistently indicate that LGBTQ+ youth, including Black LGBTQ+ adolescents, experience far higher rates of emotional distress and suicide risk than their heterosexual and cisgender peers. National YRBS analyses show elevated sadness, hopelessness, and suicidal behaviors among LGBTQ+ students; although race and sexuality intersection data are less frequently reported in public summaries, the compounded stress of racism and sexual minority stressors is well documented in research and reflects deep structural drivers. Taken together, national data suggests a mixed but instructive picture. While recent years show modest improvements in some indicators of adolescent mental health, Black youth continue to experience elevated exposure to structural stressors that shape mental health risk across the life course. Declines in reported distress or suiciderelated behaviors should be understood alongside, not in place of, persistent inequities in safety, school climate, and access to culturally responsive supports. At the same time, emerging stabilization may reflect the early impact of increased public attention, funding, and research investments in youth and Black mental health during the 2021–2023 period. Promising Models and Emerging Interventions Recent investments in youth mental health have generated a range of promising models that aim to expand access, reduce stigma, and address workforce shortages. While many initiatives are still in early stages of implementation, emerging evidence and practice-based learning point to approaches particularly relevant for improving mental health outcomes among Black youth. Youth Mental Health Corps and Peer Models One of the most visible recent innovations is the expansion of Youth Mental Health Corps initiatives,11 which place trained young adults in schools, community organizations, and health settings to provide peer support, mental health navigation, and early intervention. These programs are designed to complement licensed clinicians, helping to bridge gaps in access while reducing pressure on overburdened systems. Maryland’s participation in national Youth Mental Health
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Corps efforts reflects this approach, pairing service opportunities with training pathways in behavioral health and human services.12 Programs like these offer a dual benefit: increasing youth access to mental health supports while simultaneously strengthening the behavioral health workforce pipeline. This workforce-development component is particularly important for Black communities, which continue to face shortages of culturally representative providers. Peer-based models are especially promising for adolescents, who often prefer informal, relationship-based support and may be reluctant to engage with traditional clinical services. While these models can be powerful complements to traditional services, their effectiveness depends on clear supervision structures, standardized training, and strong ethical guardrails to ensure that peer roles are offering meaningful support without substituting for licensed clinical care when higher-level intervention is needed. For Black youth, peer models can reduce stigma and increase trust by offering culturally resonant points of entry into care. Community-Embedded Supports Community-embedded mental health supports delivered through schools, faith institutions, community-based organizations, and youth-serving nonprofits play a critical role in engaging Black youth. These models rely on trusted messengers, such as community health workers, peer mentors, coaches, or faith leaders, who are already embedded in young people’s social ecosystems. Research consistently shows that culturally grounded interventions improve engagement, retention, and perceived relevance of mental health supports for youth of color.13 Community-based programs are often better positioned to address the broader social conditions that shape mental health, including exposure to violence, economic stress, and discrimination, while offering flexible, non-clinical support options. For Black youth in particular, these models can counteract distrust of formal systems rooted in historical and contemporary experiences of bias and exclusion. Across these emerging approaches, several lessons are clear. First, meeting youth where they are, geographically, culturally, and developmentally, is essential for meaningful engagement. Second, interventions are most effective when they address both individual
mental health needs and the structural conditions that shape distress. Finally, programs that integrate access with opportunity are more likely to produce sustained benefits for youth and communities alike. Taken together, Youth Mental Health Corps initiatives and community-embedded supports offer a blueprint for scaling youth mental health interventions that are accessible, culturally responsive, and equity-oriented. While continued evaluation is needed, these models demonstrate how systems can move beyond crisis response toward durable, community-centered solutions. Policy Implications The evidence is clear that improving mental health outcomes for Black youth requires intentional, targeted policy responses rather than race-neutral approaches that overlook structural inequities. National trends show modest stabilization in some indicators, but persistent disparities underscore the need for policies that address the specific conditions shaping Black youths’ mental health risks and access to care. Race-neutral mental health policies often assume equal exposure to risk and equal access to resources. For Black youth, this assumption does not hold. Disproportionate exposure to racism, violence, economic instability, and school-based discrimination shapes mental health risk in ways that universal approaches fail to address. Policies that do not explicitly consider race risk reinforcing existing inequities by allocating resources based on population averages rather than on need. Targeted investments are essential to ensuring that mental health initiatives reach Black youth most affected by structural stressors. Additionally, mental health policy must move beyond a narrow clinical lens. Exposure to community violence, unsafe school environments, and discriminatory disciplinary practices are not ancillary concerns. They are core drivers of mental health outcomes. Evidence consistently links school safety, connectedness, and climate with adolescents’ emotional well-being, suicidality, and help-seeking behavior. As such, investments in violence prevention, restorative justice, traumainformed education, and anti-racist school climate reforms should be treated as mental health interventions. Cross-sector coordination between education, public safety, and health agencies is critical for addressing the upstream conditions that shape youth distress.
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Digital mental health tools, including apps, platforms, and online support services, are increasingly positioned as scalable solutions to youth mental health needs. However, without appropriate regulation, these tools risk reproducing inequities, including algorithmic bias or exposing youth to harm. Black youth are highly engaged online and may be more likely to encounter unregulated mental health content, misinformation, or data practices that compromise privacy and safety. Policymakers should establish standards for transparency, efficacy, data protection, and age-appropriate design in digital mental health products. Equity considerations must guide regulation to ensure that digital tools supplement, rather than replace, accessible, highquality, in-person supports. Finally, sustainable progress depends on strengthening the youth mental health workforce. Shortages of licensed providers, particularly providers of color, limit access to culturally responsive care. Policies that support workforce pipelines, including peer support roles, paraprofessional pathways, paid service programs, and loan repayment or scholarship initiatives, can expand capacity while creating economic opportunity. Youth-focused workforce strategies that integrate training, supervision, and career advancement are especially important for ensuring long-term system sustainability. Together, these policy implications highlight the need for a structural, equity-centered approach to Black youth mental health. This approach must recognize mental health as inseparable from safety, education, technology, and opportunity. While the implications outlined above describe the conditions that shape mental health outcomes, the following section presents specific, actionable policy recommendations. These recommendations are designed to operationalize equity, strengthen accountability, and move toward sustained, structural change for Black youth. Policy Recommendations Translating evidence into impact requires policy action that is both targeted and coordinated across levels of governance. The following recommendations outline concrete steps federal, state, local, and cross-sector actors can take to address Black youth mental health in ways that are equitable, sustainable, and responsive to structural conditions.
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Federal Policy Actions At the federal level, investments should prioritize scale, equity, and accountability. • Expand funding for school-based mental health professionals in high-need districts. • Federal grants and formula funding should prioritize districts serving large proportions of Black youth and communities with documented shortages of mental health providers. Funding should support not only clinicians, but also counselors, social workers, and prevention-oriented staff embedded in schools. • Invest in Youth Mental Health Corps initiatives with explicit equity benchmarks. Federal support for peer and paraprofessional workforce models should include requirements related to recruitment, training, and placement in underserved communities, as well as pathways into long-term behavioral health careers. • Establish federal safety standards and regulations for AI and digital mental health tools used by minors. • Policymakers should require evidence of efficacy, age-appropriate design, data privacy protections, and safeguards against algorithmic bias before digital mental health tools are widely deployed for youth. State and Local Policy Actions State and local governments play a critical role in implementation and enforcement. • Mandate culturally responsive, trauma-informed school mental health services. • States should set standards requiring school-based mental health services to address racism, trauma, and community violence as part of care delivery, with professional development and accountability mechanisms to support implementation. • Invest in violence prevention as a mental health strategy. • Funding for community-based violence interruption, restorative justice, and school safety initiatives should be recognized as core mental health investments, not peripheral public safety measures. • Improve racial and intersectional data disaggregation. • States and districts should require consistent reporting of mental health indicators by race, gender, and sexual identity to better identify disparities and target resources.
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Conclusion Policymakers are at an inflection point where early gains can either be reinforced or allowed to stall. Modest improvements in select youth mental health indicators may suggest stabilization, but they do not resolve the structural conditions that continue to shape inequitable outcomes for Black youth. Without sustained attention, early gains risk plateauing or reversing, particularly in communities facing chronic exposure to violence, under-resourced schools, and limited access to culturally responsive care. Importantly, urgency does not require crisis framing. The evidence points to an opportunity to act with intention. Investments made between 2021 and 2023 demonstrated that youth mental health can be prioritized at scale, mobilizing resources across education, public health, and community systems. What remains uncertain is whether those investments will be deepened and aligned with equity goals or allowed to recede as immediate pressures fade. Policy action at this juncture should be understood as preventative infrastructure, not reactive intervention. Strengthening school climate, expanding community-based violence prevention, regulating digital mental health tools, and building sustainable workforce pipelines are strategies that reduce harm before it escalates. These approaches acknowledge that mental health outcomes are produced by systems — not isolated moments of crisis. The path forward is neither abstract nor aspirational. It requires sustained, structural investment in Black youth mental health and accountability across federal, state, and local actors. The window for action is open, but it is not indefinite. Decisions made now will determine whether progress toward equity becomes durable or remains uneven and incomplete. Author Information Dr. Ashley M. Stewart, is a developmental scientist whose work examines the racialized experiences of Black youth, with particular attention to policy, digital contexts, and structural inequities. Her research centers on how social and institutional forces shape mental health outcomes and
educational experiences for Black young people. Drawing on critical and community-engaged methodologies, she analyzes policy discourse and its implications for Black communities. Most recently, she was the inaugural American Institutes of Research Health Equity Research Fellow at the Congressional Black Caucus Foundation. Her work bridges scholarship and policy to advance equity and support the wellbeing of Black youth References 1. Curtin, S. C., & Garnett, M. F. (2023). Suicide and Homicide Death Rates Among Youth and Young Adults Aged 10–24: United States, 2001–2021. Centers for Disease Control and Prevention. https:// doi.org/10.15620/cdc:128423 2. Sherer, J. (2026, January 15). Trump Administration Reverses $2 Billion Mental Health And Addiction Grant Cuts. Addiction Center. https://www.addictioncenter.com/news/2026/01/trumpadministration-reverses-grant-cuts/ 3. Executive Office of the President. (2025, January 29). Ending Radical and Wasteful Government DEI Programs and Preferencing. Federal Register. https://www.federalregister. gov/documents/2025/01/29/2025-01953/ending-radical-andwasteful-government-dei-programs-and-preferencing?utm_ source=chatgpt.com 4. Randall, P. V. (2025, November 24). No Data, No Justice: How Government Data Suppression Threatens Racial Equity. Race, Racism and the Law. https://racism.org/articles/law-andjustice/38-law-policies-and-race/12851-no-data-no-justice 5. CDC. (2024). Mental Health: Adolescent and School Health. U.S. Department of Health and Human Services. https://www.cdc. gov/healthy-youth/mental-health/index.html 6. Centers for Disease Control and Prevention. (2024). Youth Risk Behavior Survey Data Summary & Trends Report: 2013-2023. U.S. Department of Health and Human Services. https://www.cdc. gov/yrbs/dstr/pdf/YRBS-2023-Data-Summary-Trend-Report.pdf 7. CDC. (2024). Health Disparities in Suicide. U.S. Department of Health and Human Services. https://www.cdc.gov/suicide/ disparities/index.html 8. Stone, D. M., Cammack, A. L., & Carbone, E. G. (2025). Notes from the Field: Differences in Suicide Rates, by Race and Ethnicity
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and Age Group — United States, 2018–2023. MMWR. Morbidity and Mortality Weekly Report, 74. https://doi.org/10.15585/mmwr. mm7435a2 9. McKinnon, I. I., Krause, K. H., Suarez, N. A., Jones, T. M., Verlenden, J. V., Cavalier, Y., Cammack, A. L., Mattson, C. L., Njai, R., SmithGrant, J., Mbaka, C., & Mpofu, J. J. (2024). Experiences of Racism in School and Associations with Mental Health, Suicide Risk, and Substance Use Among High School Students—Youth Risk Behavior Survey, United States, 2023. MMWR Supplements, 73(4), 31–38. https://doi.org/10.15585/mmwr.su7304a4 10. Graham, A. K., Lattie, E. G., Powell, B. J., Lyon, A. R., Smith, J. D., Schueller, S. M., ... & Mohr, D. C. (2020). Implementation strategies for digital mental health interventions in health care settings. American Psychologist, 75(8), 1080. 11. Youth Mental Health Corps. (n.d.). Youth Mental Health Corps: Fostering Well-being in Schools and Communities. Retrieved April 12, 2026, from https://www.youthmentalhealthcorps.org/ 12. Business Wire. (n.d.). New Youth Mental Health Corps Launches in Maryland. Retrieved April 12, 2026, from https://www. businesswire.com/news/home/20260114049356/en/New-YouthMental-Health-Corps-Launches-in-Maryland 13. Center for the Study of Social Policy. (2025). Using Culture to Promote Youth Mental Health and Well-being: Lessons from community providers https://cssp.org/wp-content/ uploads/2025/05/CSSP-Using-Culture-to-Promote-YouthMental-Health-and-Wellbeing.pdf
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Policy action at this juncture should be understood as preventative infrastructure, not reactive intervention.
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