(NEW YORK) — Quintin Lamarr first began having thoughts of suicide when he was around 16 years old.

Now 26 and an advocate and volunteer with the National Alliance on Mental Illness, Lamarr told ABC News that about a year and a half of those suicidal thoughts culminated in a mental health crisis that led to his hospitalization. During that time, he said, he was dealing with continued grief over the death of his father along with more recent bullying he faced as a gay Black teenager growing up in Milwaukee.

He didn’t find the support he needed at school, he said, and as the only child of a single mother who was busy trying to provide for the household he ended up spending a lot of time alone.

“I just felt like I had no community. I had no love. I had no protective energy around me,” Lamarr said. “It just felt like ‘nobody wants me here.'”

His experience is shared, at least in part, by many other young Black people.

The suicide rate among Black youth has been increasing along with the number of suicide attempts and the severity of those attempts, according to the most recent Youth Risk Behavior Survey from the Centers for Disease Control and Prevention, released in 2019.

That report, tracking suicide trends among students ages 14-18 over the previous 10 years, found that of the 8.9% who reported attempting suicide, Black youth were among the populations with the highest rates of reporting attempts, accounting for 11.8%. By contrast, white youth accounted for 7.9% of those reported attempts and Hispanic youth accounted for 8.9%.

The study found there was an even greater difference in reported attempts by race among female students: Black female students accounted for 15.2% of those reporting attempts, white female students made up 9.4% of that population, and Hispanic female students accounted for 11.9%.

A separate report from the American Academy of Pediatrics tracking suicidal behavior in youth from 1991 to 2017 found that Black youth experienced significant increases in suicide attempts over that period. And among Black kids ages 5-12, the suicide rate was found to be twice that of their white counterparts in 2017.

“What we’ve been seeing over time, and it’s been over a long period of time, is a significant increase in the number of Black boys dying by suicide,” said Dr. Tami D. Benton, psychiatrist-in-chief at the Children’s Hospital of Philadelphia and president-elect of the American Academy of Child and Adolescent Psychiatry.

Experts told ABC News the disproportionately rising rate has a variety of underlying causes, including lack of access to mental health care, lack of awareness around symptoms of mental illness, social stigma and medical and structural racism.

More broadly, experts said, Black children and teenagers deal with some of the same mental health stressors as other young people — including anxiety and depression — and see some of the same challenges in getting caregivers to recognize what is really going on.

“A lot of people are just now learning that the unfortunate reality for a lot of Black youth is that they are dying,” said Dr. Christine Crawford, associate medical director for NAMI. “And a lot of that has to do with the fact that mental health conditions are often underdiagnosed or are not adequately treated for the conditions that they have.”

Dr. Jeffery Greene, an adolescent medicine specialist at Seattle Children’s Hospital, said that while lack of access to care is a contributor, the growing Black youth suicide rate is “multifactorial.”

“Of course, just the stigma of being labeled as someone with depression or anxiety limits the ability to get patients in to see their provider,” Greene said. “The racial injustices in this country over the last few years becoming so overt has also contributed. And, honestly, my personal feeling is in talking to teenagers, it seems like there’s a feeling of lack of hope for the future.”

Racism plays a role

Crawford said the utilization of mental health services among Black youth is lower than among other groups. There are several reasons for this, Crawford said, including “clinician bias and racism,” which can get in the way of diagnosis and become a barrier to treatment.

Structural and systemic racism also play a role, Crawford explained, as Black youth are more likely to attend schools and live in communities that are under-resourced and unable to provide mental health support.

“We need to acknowledge the fact that racism does lead to some of this and contributes to some of the bias. But that’s a hard thing to talk about — a hard thing for people to accept,” Crawford said. “But once people acknowledge the fact that it has an impact on what it is we’re seeing in mental health with children, especially Black children, that’s the only way that we’re able to strive for change.”

“We have to recognize the problem in order to adequately solve it and address it,” she said.

Racism in daily life also presents complications, with a study from the CDC released earlier this year showing that reports of experiencing racism were higher among students with poor mental health.

“We do know that the trauma that is experienced by racism can certainly result in mental health symptoms,” Crawford said. “We do see that people who have experienced various forms of racism, such as microaggressions, such as discrimination, are more likely to experience pretty significant psychological distress.”

Lamarr, the advocate, said that the bullying he faced as a boy — not just for his race but his sexuality — contributed to his own struggles.

“I’ve always had insecurities about things, just because growing up — being dark-skinned, being flamboyant, living in my truth, being part of the LGBT community, you always are criticized,” Lamarr said. “There was always a sense that I was holding back or I wasn’t always fully myself.”

Importance of historical context

In addition to social factors influencing mental health struggles for Black youth, Crawford said, it is possible that their symptoms are dismissed by health care providers.

“There’s often a tendency, especially for some white clinicians, to automatically assume that a child is presenting a certain way because they’re Black and because they’ve experienced a lot of trauma. But all of that can be true and they can also be experiencing symptoms of depression,” Crawford said. “We need to make sure that we’re taking both things into account — some of the external environmental societal factors that may be exacerbating mood symptoms — and we also need to know that there are treatments that exist to provide support for depression.”

Crawford cites a history in psychiatry of dismissing Black people’s mental illness symptoms.

“We do know that depression was a condition that was not diagnosed in Black people because the field didn’t think that Black people’s minds were sophisticated enough to experience an abstract condition such as depression,” she said.

It’s important, Crawford said, “to appreciate this historical context and how we’re continuing to see the ramifications of all of that in the present day.”

Depression can look different in kids

Age as well as race is a factor in mental health — indeed, the two can intersect. Symptoms of depression can present differently in children, including Black youth, than they do in adults.

Benton, the president-elect of the American Academy of Child and Adolescent Psychiatry, explained that most frequently Black children are diagnosed with “externalizing disorders,” which are characterized by “acting-out behavior.”

“The assumption is not that Black youth can be depressed or suicidal. It’s that they tend to act out more than acting on themselves,” Benton said. “And that’s just not true.”

Sometimes depression in children is not recognized by parents because of differing presentation, Crawford explained, and there can be a misconception that depression stems solely from external problems and stressors.

“I try to remind my families, my caregivers, that depression — major depressive disorder — is a medical condition,” Crawford said. “It doesn’t necessarily have to be because something bad happened to you, and therefore you are depressed and therefore you are very sad and crying in the corner.”

She said for some people, and especially kids, they feel depressed because “it’s a biological condition.”

Crawford said that depression for this group may look more like irritability than sadness. Children with depression may also demonstrate quick mood fluctuation. Refusal to attend school, lack of interest in typical activities and excessive sleeping are other warning signs.

“These are symptoms of depression that can look different in kids [and] that are often misinterpreted as being something else by their caregiver,” Crawford said.

The pandemic effect

Since 2020, as America’s children have been feeling the effects of the COVID-19 pandemic and the resulting social isolation and disruptions, mental health has been even more of a concern for health care providers and experts.

“I’m seeing that the symptom presentation [of anxiety and depression] is certainly more severe. I’m seeing that there’s a 31% increase in emergency room visits for our youth,” Crawford said. “And that often is reflective of the fact that these kids are presenting in a state of crisis, and having thoughts of suicide is certainly a mental health-related emergency.”

As for access to care, Crawford said, “We’re all booked. The waitlist to see a psychiatrist is incredibly long. The same thing is true for our therapists or social workers.”

She said the growing demand for services has been encouraging because more people are reaching out for care. “But it’s also quite concerning, because there’s certainly not enough of us to meet this growing demand. There’s only 8,300 child psychiatrists in the entire country. And that’s not enough to meet this demand that has been just kind of amplified by the pandemic.”

Decreasing the stigma — and recognizing warning signs

Greene, the Seattle Children’s doctor, said he hopes efforts to decrease the stigma around mental health will enable more young people to access care and receive a diagnosis, if one needs to be made. An increase in identification of mental illness would also help, he says.

Lamarr’s own struggles as a teen resulted in his mom calling the police and having him admitted to a hospital.

Such a crisis can be any situation where a person’s behavior may cause them to harm themselves or others, according to NAMI. It may also present as someone being unable to care for themselves.

Warning signs can include the inability to perform daily tasks (like bathing or brushing teeth) as well as mood swings, isolation and abusive behavior to oneself and others, according to NAMI.

After Lamarr’s hospitalization, he told ABC News, things began turning around.

He spent three days in the hospital before starting outpatient treatment and an anger management class, and he eventually transferred to a new school program.

“I was 16 at the time and I remember thinking ‘I need to get out of here. I need to start over, start fresh, try again,'” he said.

Learning how to talk about his feelings during treatment was key, he said.

“It turns out sometimes all you need is just the outlet to let off steam or to just open up, or to just be honest or be candid or vent,” Lamarr said. “Sometimes when we have so much pent-up frustration or we have so much pent-up anger or we have so much grief or so much pent-up emotion, that we really don’t get to release. … We always are constantly trying to be strong — we break.”

“And that’s all it was for me to be honest,” he said. “It was just so much just pent up, so much going on, so much that I never really truly dealt with. I never knew how to deal with grief.”

Protective factors for Black youth

In addition to decreasing stigma and increasing access to care, Benton said there are protective factors for Black children that can help maintain mental health. Strong positive ethnic identity is one, she said.

There’s a lot of research to support that as a protective factor, Benton said, “If you’re Black, and you feel good about yourself, and you feel you identify your Blackness as a positive thing, it’s protective of all kinds of things.”

Other protective factors, she said, include support from families and communities, community engagement, strong school connectedness and focus on academics.

She also said that among Black youth, “church was a big factor. So people who were engaged in a church community and had that sense of connectedness tended to do better.”

Mental health as public health

In terms of creating better mental health outcomes among Black youth, Benton said it’s about prevention and many of the determinants of future challenges are social.

“The reality is poverty, violence, poor schools, the absence of adequate mental health resources for people who need it — all of those factors contribute to what we’re seeing with kids right now,” Benton said.

The impact on young children, she said, primarily among minority groups and those who are growing up economically disadvantaged, is “disproportionate.”

“It will not likely be the case that we will decide we’re going to redistribute everybody’s wealth and nobody’s going to be poor anymore,” Benton said. “I don’t think that’s the solution — though that could be helpful.”

The major issue, Benton said, is making sure kids have access to adequate nutrition, a place to sleep without fear, regular pediatric healthcare, social-emotional learning in schools and engagement with nature.

“We all know that those environmental factors actually change the way that people feel and the way they think, and it contributes to emotional health. So I think addressing many of those social factors is really the key,” Benton said. “And you don’t need to do that at a psychiatrist or psychologist’s office. You can do that at home, at the Y, on a sports team — the people that are most effective in prevention are people at schools and people in the community.”

“More of a public health approach is what we need around mental health,” she added.

As for Lamarr, “It’s been a journey to get to the point where I really feel like I deserve to be here,” he said. “I’m here for a reason. I have a story to tell. I’ve made it out of the darkness. And now I can be a help, really, to other people.”

If you are struggling with thoughts of suicide or worried about a friend or loved one, call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] for free, confidential emotional support 24 hours a day, seven days a week.

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