 | | Dr. Sarah Vinson reviews a case with colleagues at Morehouse School of Medicine in Atlanta, where she is interim chair of psychiatry.Bee Trofort for The New York Times |
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ATLANTA — Dr. Brittany Stallworth was in fifth grade when she received her first suspension. She and four girlfriends had worn lime-green shirts to school to celebrate the birthday of one of the girls, whose favorite color was green. |
"We were accused of promoting gang activity," Dr. Stallworth recalled recently. They were among just a handful of Black children in their private school outside Detroit. Later that day, at home, her parents warned her: "You have to understand how people are going to interpret things, how you are going to be perceived." |
Two decades later, Dr. Stallworth is a resident in psychiatry at Morehouse School of Medicine, where she is part of a team of mental health specialists, led by Dr. Sarah Vinson, that focuses on the needs of low-income children and teenagers of color, groups often overlooked in the ongoing adolescent mental health crisis. |
Every Tuesday, the team runs a clinic from the 15th floor of an elegant high-rise in downtown Atlanta. There, they conduct tele-health visits with young patients and then, among themselves, discuss symptoms, diagnoses and the medications, if any, to prescribe. |
 | | Dr. Brittany Stallworth during a client review session. "Brittany was a Black girl and a Black woman before she was a Black doctor," Dr. Vinson said.Bee Trofort for The New York Times |
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Such dedicated care — with patients seen in depth, over years — is unusual for all but the most fortunate. According to a study published in 2017 in JAMA Psychiatry, one-fourth of communities in the top 25 percent income bracket in the United States have a practicing mental health specialist. In contrast, among the poorest income quartile, only eight percent of the lowest-income communities have such a practice. Across the country, the burden is often shouldered by school counselors and time-strapped primary-care doctors. |
The shortage of child and adolescent psychiatrists is most acute in low-income communities of color, according to a study published in September in the American Journal of Preventive Medicine, which concluded that "decisive action is urgently needed." Among Black adolescents, self-reported suicide attempts rose 80 percent from 1991 to 2019, far outpacing increases in other racial groups, according to a 2021 paper that drew from 183,500 high school students in the United States. |
The lack of specialized and long-term care has contributed to poor teens of color being underdiagnosed or misdiagnosed. Black children and adolescents are more likely to be diagnosed with a disorder involving hostility or aggression than their white counterparts are, even when their symptoms are similar, according to an analysis published in 2019 in the journal Families and Society. And they are less likely to be diagnosed with "internalizing" disorders, such as depression and anxiety. |
"What you're seeing is that behavior that looks disruptive may be post-traumatic stress or depression," said Dr. Warren Ng, president of the American Academy for Child and Adolescent Psychiatry and a psychiatrist at the Columbia University School of Medicine. This misperception may be the result of prejudice but also of the simple fact that, on average, teenagers of color spend less time being seen by the right mental-health professional. Diagnoses are being made by "people with different levels of training and also different levels of cultural training," Dr. Ng said. |
For adolescents, such a misdiagnosis can be a fork in the road, leading to the wrong care, improper medication, school detention or misperception by a justice system that is inclined to view adolescents labeled hostile as inherently threatening. |
Dr. Vinson, the interim chair of psychiatry at Morehouse School of Medicine, assumed leadership of the Tuesday clinic in 2019; their work addresses the inequity. All of the doctors currently on the team are Black, but she emphasized that a psychiatrist does not need to be a person of color to effectively treat adolescents of color. Still, she said, "lived experience" helps. "Brittany was a Black girl and a Black woman before she was a Black doctor," Dr. Vinson said of Dr. Stallworth. "She brought that experience into the role as a physician." |
As important or more, Dr. Vinson added, was the time spent through practice and discussion, learning to take into account the societal forces, including structural racism and bias, that form the emotions and behaviors of children and adolescents. |
"When you look at all these things, you can see that this is not something inherently wrong with the child but that could be an explainable, understandable response," Dr. Vinson said. "When you don't take the time to do this stuff, or learn it, you just end up throwing labels on a kid." |
 | | Dismissal time outside a high school in Atlanta. Only eight percent of communities in the poorest quartile in the United States have a practicing mental health specialist.Bee Trofort for The New York Times |
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The boy who nearly burned |
On a recent Tuesday morning, Dr. Vinson listened as the other doctors described their cases. Dr. Stallworth began: She had just finished a video session with a middle-school boy who has been a clinic patient for almost four years. Several years prior, his mother set fire to the family's house, with him in it. |
At the time, a clinician at a different organization diagnosed the boy, then 9, with oppositional defiance disorder, a condition characterized by chronic hostility and lack of cooperation, Dr. Vinson said. The boy's family subsequently met with her, and she was dubious. Over several exams, she had observed symptoms beyond irritability: The boy slept poorly and, during the day, he sometimes banged his head against the wall. |
Dr. Vinson suspected the boy was diagnosed with O.D.D. partly because he had reacted testily to the other clinician during examination. She was also concerned that the clinician improperly prescribed him an anti-psychotic medication and a mood stabilizer — medications, she said, "that have really substantial side effects and are used only when absolutely necessary." |
Eventually the Morehouse team changed the boy's diagnosis to anxiety and post-traumatic stress disorder, and prescribed him Zoloft, an antidepressant with anti-anxiety properties, and Clonidine, a sleep aid. He has been in biweekly talk therapy since 2019, interrupted briefly by Covid, with his counselors advised by the Morehouse team. |
During the recent Tuesday exam, the boy's grandmother reported to Dr. Stallworth that his teacher said he had been acting out in class, having outbursts and speaking sharply to the teacher. Dr. Stallworth talked with the boy at length, and the grandmother told her that the boy's "mood is good" at home. The boy sometimes banged his head in his sleep, the grandmother noted, but she felt it was involuntary rather than self-harm and did not wake him. |
"I think the grandma's bar is really low," Dr. Stallworth said to the group, referring to the caregiver's relatively upbeat assessment. |
Dr. Stallworth recommended a slight increase in the Zoloft dosage, and Dr. Vinson agreed, urging close supervision of the boy. "He can change up real fast," she said. "He can go from being this good kid to getting arrested." |
 | | Dr. Darron Lewis during a case review. He is completing a fellowship specializing in child and adolescent psychiatry.Bee Trofort for The New York Times |
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Dr. Darron Lewis, who is completing a fellowship specializing in child and adolescent psychiatry and serves as Dr. Vinson's aide-de-camp, said, "It's not that he's a bad kid." |
"His reaction might be a little bigger than someone else's reaction," he said. "And some might see that reaction as dangerous and call the cops. He's not a criminal, nothing like that." |
Read the rest of the story here. |
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