A Guide to Contextualizing the Reality of Systemic Racism and Black Suicidology – Part 2: Current Research and Treatments

In Part 1 of this series, we discussed the complex political and historical context of social unrest that influences the growing rates of Black youth suicide. We addressed how systemic racism is an umbrella under which the conditions of Black suicidology, high COVID-19 mortality rates for African Americans, and the current protest against police brutality are interconnected. In conclusion, we highlighted the importance of dismantling marginalization within the mental health system. In this second part of this three-part series, we will examine the current research and evidence-based treatments that address Black suicidology.

In general, death by suicide within the U.S. has continued to significantly increase.¹ When examining suicidal patterns by race/ethnicity, suicide rates are lower among African Americans. However, when we take a closer look, suicide among Black adolescents is increasing at an alarming rate.² The matter of concern is so disturbing that in 2018 a taskforce was pioneered by Representative Bonnie Watson Coleman (D-NJ) and leading experts engineered a bill that will help combat political and mental health factors that influence Black youth suicidology. H.R. 5469: Pursing Equity in Mental Health Act of 2019 has been introduced to the House and referred to the subcommittee of Health. The main objectives of the bill are as follows:

1. strengthen school-based mental health resources for children and teens,
2. provide mental health awareness to minorities through community outreach,
3. address racial and ethnic minority gaps in research, and
4. address racial disparities in mental health treatment.³

It is immensely important for mental health providers to contextualize the growing trend of suicide among Black adolescents, which does not only encompass suicide, but also factors in self-harm, suicidal ideation, and hospitalization. As we take a comprehensive snapshot of Black suicidology, systematic patterns of marginalization, biases, and inadequacies emerge that contribute to systemic racism.

As I have noted in Part 1, we cannot address Black suicidology without addressing the whole system. The influences of generational poverty, employment biases, housing segregation, environmental racism, and academic disparities play a crucial part in the efficacy of treatment directed at Black communities.

Research on Black Suicidology

Throughout human history, people have been intrigued by the nuances of psychology, including suicidal behavior. The contemporary written literature begins around the late 19^th century. Sociologist Émile Durkheim was among the early suicidologists who published his theories. Durkheim theorized suicide as an outcome of social isolation rather than a psychological disfunction.⁴ Durkheim’s research, primarily a European, male-focused sample, conceptualized suicide as an act exerted by the forces of external factors. This approach neglected the understanding of internal, individualistic behaviors that factor into suicide.

As we transition to more contemporary theories, the paradigm shifts to a greater collective comprehension of individualized behavior. Psychiatrist Aaron Beck centers cognitive behavior within suicidology. He interprets suicide within the framework that individuals with higher degrees of hopelessness—an emotional state referring to negative perceptions of oneself and/or positionality—are tied to more lethal means of suicidality.⁵ Cognitive Behavioral Therapy (CBT) was created by Beck to treat suicidal clients using a technique that modifies cognitive process. In comparison to Durkheim, Beck’s theory of suicide does address the emotional difficulties linked to psychological disturbances within cognition.

The interpersonal theory of suicide, coined by psychologist Thomas Joiner, conceptualizes suicidal behavior as a complex mental health problem induced by external and internal conflicts, specifically the correlation of:

1. thwarted belongingness—the psychological necessity of connectedness,
2. perceived burdensomeness—feelings of exclusion from one’s social group(s), and
3. capability for suicide—the accessibility to lethal means, increases the desirability for suicide.⁶

The study of suicide is interdisciplinary and has an extensive philosophical history. However, the magnitude of theory has provided a European, patriarchal lens that centers Whiteness as the default subject. While suicide has been considered a White male problem, the patterns we currently observe stress the importance of integrating the “other”. While we understand that racial/ethnic differences are not attributable to psychological or cognitive differences, social and cultural differences may impact a client’s suicidality.

There is limited literature/research on the phenomenon of African American suicidality. However, suicide research is beginning to be diversified due to the growing attention to Black youth suicide centralized by Black researchers, lawmakers, and mental health professionals.

Another factor in the discrepancies of suicidal research among Black participants is the communal distrust of the mental health field. African Americans, and other minority groups, have historically been subject to unethical, inhumane experiments ranging from scientific racism that naturalizes the inferiority of Black people to forced sterilization. ^7,8 In the current state, it is comprehensible and valid that these communities may hesitate to participate in modern research.

Suicide research has contributed to the marginalization of suicidal Black clients by neglecting to examine the complex and unique social/cultural factors that impact Black people experiences. In addition, minorities might be hesitant to participant in studies due to the historical centering of racism within mental health.⁹

In addressing these concerns, here are a few things to keep in mind when conducting research:

1. Re-valuate the Research Question.
   If your objective is to study a diverse sample, check that the research question(s) reflects that purpose.
2. Expand Recruitment Techniques.
   While recruiting participants from university settings (i.e., college campuses, university hospitals) are possibly more convenient, these settings may not be helpful in collecting a more diversified sample. If applicable, think about networking directly with local community clinics, non-profits, religious institutes, and organizations. These groups tend to be the pillars of community engagement and trust.
3. Integrate Diversity among Researchers.
   Diversifying the scientific community is equally important as including minority participants in research efforts. Providing diversity inclusion within academia is not merely an act of diversity for the sake of diversity, rather providing opportunities for people of color to share their expertise with other professionals within leadership roles.
4. Highlight the Importance of Research.
   Sometimes scientific jargon is dense, and to the non-scientist can be intimidating. If applicable, highlighting the importance of your study to the participants may be helpful in bridging the trust divide. What is the big picture? Why is this important? Adding the individual, community, and social importance of research integrates a humanistic approach to science.

Treatments for Black Suicidology

In this section, we will discuss the efficacy of two main evidence-based treatments that have been shown to efficiently treat suicidal behavior: CBT and Dialectical Behavioral Therapy (DBT). We will also examine relevance of CAMS as a therapeutic framework in treating Black suicidology.

Cognitive Behavioral Therapy (CBT)
As a cognitive-centered intervention CBT focuses on modifying the mental processes that influence suicidal thoughts. Fundamentally, at its core, CBT is a behavioral modification technique.¹⁰ CBT training that directly addresses suicidal cognitions and behaviors have shown to be very effective in treating suicidal clients.¹¹ There is limited information on the efficacy of CBT treatment specific to Black suicidal behavior. The available empirical findings concentrate on depressive disorders, post-traumatic stress disorder (PTSD), and substance abuse. The findings show a mixture of support on integrating multicultural specific interventions.¹¹

Dialectical Behavioral Therapy (DBT)
Dr. Marsha M. Lineman, designed DBT as an evidence-based practice to treat chronically suicidal clients. An off shoot of CBT, DBT is a mindful-based, behavior modifying treatment that centers the client-therapist relationship to alter processes such as emotional regulation and build coping mechanisms.¹³ DBT has shifted to primarily treat Borderline Personality Disorder (BPD). While there are a multitude of research that supports the efficacy of DBT with BPD clients that express suicidal behavior, the limited literature that discusses African Americans, centers on Black adolescent males diagnosed with Conduct Disorder or display aggressive tendencies.^{14, 15}

The Collaborative Assessment and Management of Suicidality (CAMS)
CAMS is a therapeutic framework that centers on a collaborative, client-focused approach to treating suicidal clients. It is administered with other treatments, and research supports its validity in supplementing suicide-related therapy.¹⁶ Research indicates that CAMS has significant potential in multicultural clients, though the efficacy of CAMS Treatment™ on African American suicidology is limited.¹⁷

There are a handful of evidence based, suicide-focused treatments. CBT and DBT appear to be highly beneficial to suicidal clients due to their direct modification of suicidal thoughts. The inclusion of client-centered therapeutic frameworks may contribute to increasing support for minority clients. There is a balancing act between sticking to the foundation of these therapies and integrating multicultural awareness.

Based on these possibilities, here are few suggestions to consider when treating Black clients:

1. Provide Affordable & Accessible Treatment.
   There are not enough treatments accessible and affordable to low-income, disadvantaged communities. Some reasons for this deficiency are due to factors outside of the mental health field. However, they can be addressed through the client-therapist relationship.
2. Acknowledge Cultural Differences.
   It is essential within the client-therapist relationship to acknowledge the cultural and social disparities that influence the client’s suicidal behavior. As the mental health provider, it is important to not dismiss or ignore their concerns.
3. Affirm: The Client is the Expert on their Experiences.
   My key ideology when addressing clients is to affirm the expertise of the client. Affirming that their experience is valid is crucial in building trust and rapport.
4. Establish Space for Black Mental Health Providers.
   As in research, creating a diverse workforce of mental health providers should be normalized. Black therapists are situated in a unique space where they might have an insider understanding on the complex challenges of treating suicide within Black communities.

Conclusion

The study of suicide and suicidal behavior has an extensive history, yet there is a limitation on the understanding of impacts on Black clients. Whiteness has played a central role in our understanding of suicide, but current research illustrates an alarming uptake in suicidal behavior by Black children and teens. In strengthening research and treatment, we must consider our clients’ experiences and the impact of systemic racism on institutions.

In Part 1, we analyzed the context of systemic racism and its psychological toll on Black consciousness. In this Part 2, we reviewed current research and treatment centered on Black suicidology. Now what?  In the comprehensive conclusion to this series, we will address where we go from here with an in-depth look at the necessary measures needed to strengthen treatment for suicidal Black youth.

1. https://www.cdc.gov/nchs/data/databriefs/db330-h.pdf
2. https://www.nyu.edu/about/news-publications/news/2019/december/BlackYouthSuicideRatesRising.html
3. Suicide by Émile Durkheim
4. https://www.ncbi.nlm.nih.gov/books/NBK223847/
5. Why do People Die by Suicide by Thomas Joiner
6. Medical Apartheid by Harriet A. Washington
7. https://www.smithsonianmag.com/science-nature/disturbing-resilience-scientific-racism-180972243/
8. Eliminating Race-Based Mental Health Disparities by Dr. Monnica Williams, Dr. Daniel Rosen, & Dr. Johnathan Kanter
9. https://beckinstitute.org/get-informed/what-is-cognitive-therapy/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780394/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547560/
12. https://www.dbtselfhelp.com/DBTinaNutshell.pdf
13. https://www.sciencedirect.com/science/article/abs/pii/S1359178914000147
14. https://psycnet.apa.org/fulltext/2014-49443-001.html
15. Managing Suicidal Risk: A Collaborative Approach by David A. Jobes
16. Choi, J.L., Rogers, J.R., & Werth Jr, J.L. (2009). Suicide risk assessment with asian american college students: A culturally informed perspective. The Counseling Psychologist, 37, 186-218.