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This article is part of Community Strategies for Systemic Change, a series co-produced by the Local Initiatives Support Corporation (LISC) and NPQ. In the series, urban and rural grassroots leaders from across the United States share how their communities are developing and implementing strategies—grounded in local places, cultures, and histories—to shift power and achieve systemic change.

The culture I come from relies a lot on storytelling to cement our learning and culture. I was born in Cabo Verde (Cape Verde) and started working in public health there as a clinical psychologist. I was responsible for mental health in what was, at the time, one of the world’s poorest countries. Because many of my patients were without homes and had been brought to the police station following their involvement in some type of public disturbance, I often found myself talking to police, people in the court system, and businesspeople.

I could see those patients in my office, give them some medication, and see them again at their follow-up appointment a month later, their situation basically unchanged—or I could do something different. I began to think about how, starting with those community conversations and partnerships that developed, public health officials might work with neighborhood residents to build a system out of nothing.

From Cabo Verde to the United States

Fast forward to my family’s move to Portugal, where my mother was born, then to the United States, where, in 1998, I found a job with the Rhode Island Department of Health (RIDOH) as an education and outreach coordinator. There I was, talking to parents about lead poisoning, doing what we do so readily in public health: telling people what to do.

Every day, after educating them about the dangers of lead poisoning, I sent families back to homes full of lead paint, because at the time, our public health response did not include necessary environmental changes, like home repairs. Nor did it include asking people what they thought were the sources of their health problems—let alone listening to their stories. I found myself in a country with so many resources and so much expertise, experiencing the same challenges I had faced in Cabo Verde, where I had almost no resources whatsoever.

A few years later, I worked as a minority health coordinator, focusing on racial and ethnic minority populations in Rhode Island—on people like me, who come here with dreams and hopes to do better but often find themselves without the resources or opportunities they need. Along with my team, I was still telling people what to do. We provided information on how to be healthy but never challenged ourselves, as public health professionals, to create the social and environmental conditions that alleviate structural barriers to health and allow people the opportunity to act on that information.

If you don’t have decent, affordable housing, a livable income, places to safely walk and exercise, or access to affordable fruits and vegetables, what opportunities do you have to make healthy choices? Yet, we continuously tell people to be healthy in the face of structural barriers—we tell them that their health is their individual responsibility, without making the structural changes needed to enable people (and their community members) to overcome systemic barriers to health.

By the early 2010s, when we looked at the metrics produced by Healthy People, the federal government’s data-driven blueprint for public health goals, the numbers showed us that, for the first time in public health history, life expectancy for children had dropped; it was lower than when we were children. How did we have it so wrong? And how could we be so complacent about the status quo?

Developing a New Approach: The Health Equity Zone Concept

So, we challenged ourselves to do something different. We asked ourselves, “What else can we do if indeed we fundamentally believe that positive health outcomes—positive life outcomes—result from good jobs, good education, safe housing, healthy, affordable foods, and safe, prosperous communities? How can we develop an intentional strategy to realize such outcomes—strategies that empower communities to actively improve their quality of life?”

At the time, ideas were percolating about how to promote health outcomes in a radically different way, and related movements were building in other parts of the country and the world. Public health professionals and community developers—along with community activists—were having “aha” moments about the linkage between social determinants of health and terrible, systemic health outcomes for people of color and those living on low incomes. The passage of the Affordable Care Act in 2010 also pushed public health officials to think about these connections.

All this fed into the vision for Rhode Island’s Health Equity Zones (HEZ). Launched by the state in 2015, HEZ is an approach to prevention that leverages place-based, community-led solutions to address social determinants of health. Each of 15 designated zones is a contiguous area—ranging in geographic size from a few city blocks to an entire county. Each is designed to address public health needs in communities with higher-than-average health risks.

The populations of these zones range from 5,500 people to 178,000 in the largest HEZ, the capital city of Providence. Some zones overlap. For example, two smaller HEZs are neighborhood based and also part of the larger Providence citywide HEZ. Each HEZ has a “backbone” community organization—a trusted, local group that people can turn to and which is responsible for promoting HEZ’s approach and assessing how effective the interventions are.

Lead partner agencies vary because the needs of different HEZs vary. One HEZ lead is a community health center with multiple sites. Other lead organizations include a domestic-violence survivor support nonprofit, a city government, an affordable housing developer, and a school district.

This system requires the state government to honor and respect the expertise of those who live and lead in each community. Rhode Island’s Health Department isn’t alone in this kind of thinking and commitment. At about the same time that Rhode Island launched the HEZ initiative, Maryland began implementing its own health empowerment zones. Connecticut and Delaware have also created similar community-rooted collaboratives.

In Rhode Island, we were also inspired by a new model of public safety work being carried out in Providence. These were “safety partnerships” of residents, local community development organizations, and community-minded law enforcement staff (with financing support from the Local Initiatives Support Corporation), who were effectively collaborating to brainstorm and carry out strategies to reduce the crime rate.

Like those safety partnerships, each HEZ builds and maintains an inclusive, resident-led, community-based collaborative. Together, partners conduct a baseline assessment of the community to identify and prioritize health inequities. They create an action plan to address the disparities’ root causes. Then, HEZ members evaluate the outcomes of the interventions.

At the heart of the HEZ structure lies a commitment to listening to residents’ stories. From conversations with residents, HEZ leaders, many of whom are community residents themselves, learned that new mothers needed breast-feeding support, that diabetes and healthy eating were top of mind for others, that people wanted more job opportunities close to home, and that many were seeking support for trauma and mental health concerns.

A common issue among older residents was the difficulty of getting out of their homes and a resultant lack of social connection, especially in winter. In response, HEZ backbone organizations created community-service programs where teens help elderly neighbors on snowy days by shoveling out their walks and drives. It was a simple solution, but practical, conceived of and carried out by neighbors themselves.

In the Central Falls/Pawtucket HEZ, nearly a third of residents live in poverty, and one in three are recent immigrants. The area suffers high rates of teen pregnancy, early-childhood obesity, and infant mortality. On an early “listening tour” of the area, conversations didn’t focus specifically on health—people talked about their worries about income and jobs, lack of access to healthy foods, and the need for better transportation. To tackle food insecurity in various HEZs, collaborators have launched farmer’s and local neighborhood markets, community gardens, healthy cooking/nutrition classes, food pantries, meals for residents in need, diabetes and healthy eating programs, and special programs, like a women of color breastfeeding support group.

Some HEZs have also adopted strategies that target the physical environment, promoting bike lanes, improving vacant properties, and planting trees and green space. Others focus on behavioral health, disease prevention, and education. Still others are promoting access to nutritious food, transportation, health services, and job training.

Preliminary Signs of Success

We have data on Rhode Island’s HEZ up to the beginning of the COVID-19 pandemic in 2020. Five years is not a long time, but early data shows encouraging outcomes. In Pawtucket, addressing lead paint and unsafe housing conditions reduced childhood lead poisoning by 44 percent. And after instituting a range of food initiatives, there was a 40 percent increase in redemption of SNAP (Supplemental Nutrition Assistance Program or “food stamps”) at farmers’ markets in the West Warwick HEZ and a 36 percent increase in access to fruits and vegetables in the Central Providence HEZ.

Meanwhile, in the West Elmwood HEZ, improving educational outcomes for parents and young children has been a prime goal. The HEZ teamed up with a local community development corporation’s initiative to support parents with young children to earn postsecondary credentials and secure career-track employment while preparing their children for successful futures. Fifty-one families and 64 children have participated in the program, with 15 parents receiving secondary credentials. All told, families have received 95 coaching sessions.

There are statewide outcomes, too: healthcare access data, for instance, show a 30.3 percent decrease in the number of adults not seeking medical care between 2015 through 2020.

Still, it can be hard to tease out a direct correlation between intervention and impact when it comes to the social determinants of health. Moreover, success measurement metrics vary depending on the goals of each local initiative, many of which have not yet matured enough to show quantifiable impact. And then, of course, COVID-19 came along and exacerbated longstanding inequities.

COVID-19 also showed us just how vital the HEZ infrastructure was for many of our most vulnerable Rhode Islanders. HEZ networks helped speed the distribution of protective equipment, testing, vaccines, and emergency food and financial support, among other resources. Indeed, HEZ outreach efforts seem to have contributed to more equitable COVID-19 vaccination rates in Rhode Island. While national data demonstrated notable racial disparities among people who received at least one dose of COVID-19 vaccine (64 percent of whites had received a first vaccine and 59 percent of Black Americans, as of July 2022), a more equitable distribution was evident in COVID-19 vaccination rates in Rhode Island, with only a one percentage point difference in first dose of COVID-19 vaccination rates between Black and white Rhode Islanders (presently 76 percent white, 78 percent Black).

According to the vaccination clinic operations team for Rhode Island’s COVID-19 response, the mobilization of HEZ collaboratives was integral to getting vaccines to as many people in disproportionately burdened communities as they did.

A Three Legged-Stool: Voice, Choice, and Equity

Three words recur in the stories I share about this work, because I see how they guide communities’ visions for health equity zones: voice, choice, and equity.

Voice, because government has an obligation to listen to residents. Every individual, family, and community has its own story, lived experiences, resources, and strengths. Public officials do not know best.

A new participatory budgeting effort, which is engaging two of our HEZs to determine priorities for nearly $1 million in federal funds for work to improve health outcomes, is yet another example of how we can help ensure residents exercise voice and agency in how government dollars are spent. When we truly listen to that voice, we can nurture choice, building systems that afford people and communities the opportunity to do better, the choice to be healthier. And if we listen, if we respond to the voices and fix broken systems, then we can achieve equity.

These are the kinds of actions that will help ensure that every person has a chance to live their highest potential—regardless of race, class, sex, gender, disability status, or ZIP code.

Bottom line: the HEZ initiative is not just a program. It is infrastructure, and it is a movement that challenges people to prioritize equity, sit together, and change public health for the better.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

Click here to download accompanying slides

Increasingly, people of color are becoming leaders of national community development organizations. When they do so, they face not only the challenge of taking the helm in historically white-led organizations, but the challenge of leading in times when more is demanded of leaders. What strategies are being used to address these challenges? And how are notions of what it means to be a leader being redefined?

For this conversation, our panelists are:

• Tony Pickett is CEO of the Grounded Solutions Network, a Black-led national nonprofit based in Washington, DC, which supports inclusive housing policies, community land trusts and multiple other housing models with lasting affordability.
• Dr. Akilah Watkins is former president and CEO of the Center for Community Progress, which works to works to transform vacant properties into neighborhood assets. She will also soon be president and CEO of Independent Sector, a national nonprofit association.
• Seema Agnani is the executive director of National CAPACD, a progressive coalition of nearly 100 community-based organizations that serve Asian American and Pacific Islander communities, spanning across 21 states and the Pacific Islands.

This webinar explores:

• What do inclusive models of leadership for racial and economic justice look like?
• Why is radical empathy” critical to effective leadership?
• What does collective leadership look like?
• What are some leading challenges you face in redefining leadership?
• What is the role of partnerships in this work?
• What are tangible examples of new leadership practices?
• How do you invest in leadership and develop leaders?

Resources:

Seema Agnani, “AAPI Women Leaders Speak Out: We Are Not Your Flavor of the Month,” NPQ, May 25, 2021.

Michael Bochnovic and Courtney Knox, Championing Leaders of Color in Housing Equity and Community Development, Washington, DC:  Center for Community Progress, April 2022. 

Amy Costello and Frederica Boswell, “Facing ‘Existential Threat,’ Nonprofit Leaders Look to Cope and Make Change,” NPQ, April 16, 2020.

Steve Dubb, “What Does Community Development for Liberation Look Like?” NPQ, April 27, 2022.

Steve Dubb, “Housing Justice Leaders Assess How to Build Power for the Long Haul,” NPQ, May 25, 2022.

Tony Pickett, “Envisioning Radical Empathy for Community Land Ownership and Prosperity,” NPQ, December 8, 2021. 

Marietta Rodriguez, Dr. Akilah Watkins, Lisa Rice, and Tony Pickett, “America’s Infrastructure Needs: Community Development Leaders Weigh In,” NPQ, October 27, 2021.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

This article is part of Community Strategies for Systemic Change, a series co-produced by the Local Initiatives Support Corporation (LISC) and NPQ. In the series, urban and rural grassroots leaders from across the United States share how their communities are developing and implementing strategies—grounded in local places, cultures, and histories—to shift power and achieve systemic change.

Since January 2020, I’ve had the honor of leading the United Northeast Community Development Corporation (UNEC), a neighborhood-based community development corporation founded and led by residents of Northeast Indianapolis, a center of Black life in this Midwestern city for generations. At present, one of UNEC’s most critical projects is to convene a multi-partner collaboration in the city’s Northeast Corridor neighborhoods to transform our local food system.

I bring to this work the passion and perspective of lived experience. My family has deep roots in Northeast Indianapolis. I lived here as a young child and do again today. In the intervening years, I spent many happy times here with my grandparents and extended family. I also come from a family of grocery workers and managers. When I was little, my dad managed a large local grocery. “Ashley, go straighten the labels” was his way of keeping me busy as I watched him work.

Folks in well-to-do white suburbs of Indianapolis don’t have to circulate petitions or mount statistical arguments to coax a supermarket chain to open.

I’ve observed the inner workings of a complex food system that, when it functions well, nourishes our bodies, families, and cultures. I saw how my father was able to bring the community into the store, forging fond and sturdy bonds between people as they sought the sustenance that everyone needs. I have also seen how, when tied to neighborhood institutions, the food system can afford the dignity of living-wage work and a chance to build lasting community and family wealth.

The Costs of Neighborhood Disinvestment

What I describe above is the food system at its best, but this system is often not at its best. Over the years, I’ve seen corporate food giants pack up and leave our neighborhoods. Folks in well-to-do white suburbs of Indianapolis don’t have to circulate petitions or mount statistical arguments to coax a supermarket chain to open its doors in their communities. The stores’ expected profit per square foot makes that a no-brainer.

Meanwhile, the answer to our own vigorous recruitment efforts is too often no. Grocery store chains say there aren’t enough households, or there’s too much risk of theft, or that neighborhood residents don’t have sufficient income to pay for the food the stores stock.

Historic disinvestment and racist assumptions shape this dynamic, just as they shape the inability of small, Black- and Brown-owned businesses to access capital and the devaluation of Black- and Brown-owned homes.

A Positive Vision of Food Sovereignty

Frankly, it is tiring to plead with outsiders to sell their products here. Unwilling to wait for others to save their community, residents of Northeast Indianapolis have enthusiastically come together to create the Equitable Food Access Initiative (EFAI).

The core idea that grounds the initiative is food sovereignty. At a practical level, this means focusing on hyperlocal solutions to food insecurity and lack of access. This includes organizing to produce our own food—food that’s healthy and varied, pleases community palates, and uplifts Black culinary traditions.

In the richest country on earth, our community ought to have quality, affordable food and see the income and wealth generated by our consumption circulate within the community, rather than being extracted by some distant corporate entity.

These ideals and beliefs are built into how EFAI works. Seeking to address the root causes of food insecurity in its own backyard, the Anthem Foundation (a philanthropic arm of the major Indianapolis-based health insurance company, Anthem, Inc.), funded the initiative with a $2.45 million grant to LISC Indianapolis. On the city’s northeast side, our collective of residents and organizations, including UNEC and local food growers, submitted the winning proposal in a request-for-proposals process, launching an intensive three-year planning and implementation process.

We meet monthly with a food-justice committee along with representatives of seven other areas of Indianapolis and citywide leaders. UNEC employs a full-time community builder tasked with representing the food initiative across Northeast Corridor neighborhoods. It also employs 10 part-time neighborhood food advocates, who are gathering diverse resident perspectives on what matters and where to begin.

Developing a Community Food Action Plan

The community planning effort seeks to create a local food action plan, which the coalition intends to complete by year-end. To ensure the plan will have teeth, the Northeast Corridor-based collective is empowered to decide which projects to pursue and fund. Just over a year into the planning process, we have already arrived at a consensus to double down on assets that are already here—to expand the capacity of Black and Brown food growers and producers; create stronger connections with local retailers, restaurants, and other food vendors; and educate residents, especially young people, about the food system while preparing them to work gainfully and fruitfully within it.

Building this local capacity may seem like a process-oriented nicety, but it’s much more than that. A market analysis of how the food system operates in the Northeast Corridor, completed in June 2022, makes it crystal clear that business as usual won’t work here. The three zip codes that make up the corridor are home to some 36,000 people. Approximately 20,000 of them live in a food desert, meaning they have no full-service grocery market within a mile of home. They’re also poorly served by public transit. Residents can’t just throw money at this problem by using delivery services or driving to another part of town; about half of area households earn less than $35,000 a year.

Let’s say you’re a senior or a mom with little kids in tow. Are you going to carry a bag of fresh produce for more than a mile? Are you going to take the bus? It’s often impossible. Of the 83 stores selling food in our area, only 11 sell fresh vegetables. More than half are convenience stores.

Everyone understands that while the funding only lasts three years, growing a healthy local food system is a generational project.

In a region known for its corn and soybean fields—the breadbasket of Indiana—neighborhood residents pick up fried foods at corner stores and walk to gas stations that are happy to collect SNAP (Supplemental Nutrition Access Program, also known as food stamps) dollars for a loaf of bread priced much higher than at stores in the suburbs. Such lack of access is an injustice that feeds poor health outcomes, including higher rates of chronic diseases, such as diabetes.

So, we’ve been identifying assets, both human and infrastructural, that others might not see or even imagine when they read headlines focused on crime and poverty on the Northeast side. Black excellence abounds here.

Here are a few examples:

• In the heart of Northeast Indianapolis, we have Elephant Gardens, named for the noble animal that takes care of its own. This family-owned market garden grows veggies, herbs, and flowers for sale in its Mobile Farmacy and offers kits (“Buddy Buckets”) to seed home kitchen gardens. Joyce Randolph is the great-grandmother of the family, embodying the knowledge and culture of generations. Her daughter, Vivian Muhammad, carries on the tradition; the expression, “food sovereignty,” is often on her lips. With an early implementation grant, our food-equity initiative is helping Elephant Gardens install equipment to extend its growing season and boost production.
• Another local leader is Danielle Guerin, who founded and leads a nonprofit called the Soul Food Project. She grew up in the neighborhood, spent time in Africa working on food security, and found a calling to address the same issue here at home. Growing produce in three urban farms and selling it in a community-supported agriculture (CSA) model, Guerin also teaches our children about growing food and living well more generally, covering topics like financial literacy and college applications. She’s a bridge to our next generation, and our initiative is already investing in her work, funding intern positions and allowing the Soul Food Project to codify its empowering model in curricula that other neighborhoods can use.
• LaShauna Triplett is a lead mentor at the Mackida Loveal & Trip Outreach Center, whose mission is to ensure local kids receive the guidance, tutoring, and nurturing they need to learn and grow. When I first met Triplett, the COVID-19 pandemic was hammering our northeast neighborhoods, plunging them into even more dire food insecurity. Throughout the crisis, Triplett and her outreach center handed out thousands of pantry boxes each week, illustrating the power of local capacity. The center is currently enhancing its presence in the food-sovereignty space by clearing an overgrown vacant lot and planting it with vegetables to be given away and, where needed, delivered to local residents.
• Autumn Lowry is a master gardener, foodie, and consummate connector of people. Her nonprofit, the Plant to Plate Project, is cultivating a rich, lovely community farm in a lot next to a shuttered public school that’s been acquired by a local pastor for educational and community programming. In her Sustainable Saturdays, Lowry teaches community members the ins and outs of raised beds, composting, and such. She also aims to build a greenhouse and engage other local growers to develop a local food system “from the ground up,” as she puts it—offering low-cost, delicious homegrown products to local restaurants and food vendors.

The food initiative’s resources have helped fund these efforts. But the initiative is not just a funder. It is co-governed, co-designed, and co-developed by people like Muhammad, Guerin, Triplett, and Lowry. And everyone understands that while the funding only lasts three years, growing a healthy local food system is a generational project.

Meanwhile, increased awareness of how social determinants of health influence life prospects has spurred some stakeholders to invest in our northeast neighborhoods’ food system, reinforcing the effects of the local efforts described above. For instance, the public hospital system, Eskenazi Health, is working with Meals on Wheels to deliver medically tailored meals to neighborhood seniors and people with disabilities. The county public health department is increasing resources for Fresh Bucks, which doubles available SNAP dollars for shoppers buying produce at participating farmers’ markets. And Bloomington-based medical device maker Cook Medical, which plans to establish a new manufacturing facility in the Northeast Corridor, is also working with partners to open a full-service grocery here in 2023. The new store, to be named Indy Fresh Market, will be run by two local Black entrepreneurs, who aim to ultimately become the store’s owners through a lease-to-own plan; a recent study suggests that the grocery could grow to employ 39 people full time.

Building Our Community for the Future

While I was overjoyed by media reports about plans for the incoming grocery store, I couldn’t help but glance at reader comments. And I’m not going to lie—there were more than a few ignorant and plainly racist disparagements of our community’s potential.

We have been misunderstood here in the Northeast Corridor. Our hope is that by developing a robust neighborhood food system, the community can not only build on its strengths, but also tell its own stories—feeding the spirit of community along with our bodies.

This reminds me of a lesson my grandfather taught me over the years. I lived with him in his Northeast Indianapolis home as he aged; he joked that he needed a roommate, but the truth is, he had much to offer me before he passed at the age of 88 that I had to offer him. He emphasized that we shouldn’t give up on the place that holds our history. You don’t need to move here or there to find the good things in life or do meaningful work. Instead, as granddaddy always said, just come on home.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

The following is a transcript of the video above, from our webinar on “Remaking the Economy: Owning Our Future.” View the full webinar here.

Rodney Foxworth: My piece is really speaking to those who are maybe uncomfortable thinking about the opportunity for ownership, the opportunity for control, the opportunity for power—and what they can actually do to assert their collective vision. One of the things I recognized is that there’s a mindset shift that needs to occur. Esteban [Kelly] had mentioned some things in terms of what the role of philanthropy can be. I have addressed that in my piece as well. One of the things that’s really a baseline is unrestricted resourcing and capital to be provided to organizations, because that can be a place for institutions to be able to build an opportunity for some power, to build some equity, for ownership or control. There has to be a baseline, organizations having a mindset to be comfortable with asking and demanding and situating themselves for that type of conversation.

What I found is that, because of so many issues, historic and our own personal experiences—being a person of color, my team being majority people of color, particularly women of color—oftentimes, there’s just things that we’re perpetuating. Like these systems—do we even deserve to have power, control, and ownership? That’s actually something that we don’t say and articulate, but it’s something that we live in. It’s a significant thing to recognize that there’s some brass-tacks steps that need to be taken for us…opportunity changes individuals, right? There’s some opportunity for that to happen.

I actually think there’s a significant piece here on mindset shifts, both in terms of capital from the foundation community, but as institutions, as nonprofits. How do we perceive ourselves? Do we see ourselves as worthy of having power, control, and ownership? For us, it’s been a pretty long journey over the last several years building up enough of an economic resource that we can start to begin to invest and build alongside other institutions to create these sort of reciprocal economies, and be able to create shared value economically between each other so that we can actually be able to continue to build. But the biggest piece for that…is first accepting that we actually deserve to have power, control, and ownership.

This article originally appeared in the Nonprofit Quarterly. See the original article here.

In Michigan, a 15-year-old girl was sentenced to juvenile detention for violating her probation because she did not complete her online homework during the pandemic. This young person required special education services while coping with ADHD and—like many young people when schools abruptly closed—struggled with the transition to online learning. Despite these factors, a judge deemed her a “threat to community” and stripped her of the foundational support she received from her school and community.

In Brooklyn, an 18-year-old trauma victim was rushed by her family to a local emergency room one evening after they learned she survived multiple rapes that day. Although she was diagnosed with a severe intellectual disability at the age of four and was incapable of giving consent, the attending ER physician deemed otherwise by refusing to provide a rape kit, and responding police officers repeatedly asked the young woman whether she had invited the assaults. That same night, while in distress, she—along with her family—traveled several miles to another local ER that responded with the proper course of treatment, including a forensic exam.¹

In Rochester, a nine-year-old girl suffering from a mental health crisis who verbalized suicidal thoughts was pepper sprayed by the police officers that responded to her family’s call to 911 for support. At the scene, as the young girl cried out to her father for help, she was told “you’re acting like a child” by officers, who then placed her in handcuffs, exacerbating her trauma rather than de-escalating it.

“This isn’t how the police should treat anyone, let alone a nine-year-old girl,” was the response of Governor Cuomo, and many others, after body camera footage of the Rochester incident was released. Yet, these stories represent the unfortunate reality of the ongoing mistreatment and criminalization of young people experiencing mental health challenges—not just in New York and Michigan—but across the nation.

Youth Incarceration and the Criminalization of Mental Illness  

People coping with a mental illness are “three times more likely than the general population to interact with police and more likely to be arrested.” According to the National Alliance on Mental Illness (NAMI), the criminal legal system in the US incarcerates people with serious mental illness about 2 million times each year.

Youth in the juvenile system have a high prevalence of mental disorders and severe psychosocial stressors. In fact, nearly 75 percent of youth arrested each year have experienced traumatic victimization either before the arrest or while in juvenile detention. Further, approximately 50 percent of youth involved in the juvenile legal system develop posttraumatic stress disorder (PTSD).

Structural racism and patriarchal misogyny leave youth of color, particularly Black girls, disproportionately impacted. Last year, the Annie E. Casey Foun­da­tion conducted a survey of juvenile legal systems across the country. Its analysis captured “trends from 144 jurisdictions in 33 states, rep­re­sent­ing more than 30% of the nation’s youth pop­u­la­tion (ages 10–17).” The survey findings revealed that the pop­u­la­tion of Black youth in juvenile detention has steadily increased and, during the pandemic, reached the highest level it has ever been, while the population of detained white youth declined. Indeed, from May 2020 to February 2021, the overall percentage of youth sentenced to detention rose by more than six percent, an increase largely dri­ven by incarceration rates of Black and Lati­nx youth. Although the population of white, non-Latinx youth fell by six percent, the pop­u­la­tion of Black and Lati­nx youth grew 14 and two percent, respec­tive­ly.

Meanwhile, girls under the age of 18 are the fastest growing population in the juvenile legal system. Four out of five girls in juvenile detention suffer from a mental health disorder. Black girls are disproportionately represented within this system; more than 40 percent of girls in youth detention are Black. The stories shared in the opening of this article are that of young Black women and girls.

Other studies show an overrepresentation of LGBTQ+ youth in the juvenile legal system. A 2015 report on gender injustice—entitled Gender Injustice: Systems-level Juvenile Justice Reforms for Girls and produced in partnership with the National Women’s Law Center—notes that 40 percent of girls in juvenile detentions across the country identify as lesbian, bisexual, gender non-conforming, or transgender. Overall, researchers estimate that 20 percent of youth in the juvenile justice system are lesbian, gay, bisexual, gender nonconforming or transgender, although they make up less than 10 percent of the nation’s population.²

The juvenile legal system is ill-equipped to accommodate LGBTQ+ detainees, leading to threats and trauma. The report recounts a 2014 case involving the Connecticut Department of Children and Families (DCF) and a 16-year-old transgender girl of color, named “Jane Doe” to protect her identity. DCF petitioned the court to place Jane in Connecticut’s adult women’s prison as the state does not have a separate facility for girls under the age of 18. Jane, who had been abused and sexually trafficked, was charged with delinquency. Though this is a minor charge, under DCF’s direction, she was placed in a maximum-security facility that houses women convicted of serious crimes. While detained, she was further “isolated in order to comply with federal laws mandating the separation of youth and adults.” In response to “a months-long public outcry, Jane was moved to a treatment facility in a neighboring state and then to isolation in a secure facility for boys, in denial of her gender expression as a girl.” While detained, Jane experienced further trauma—abuse, she says, by DCF employees.

Jane’s story is unfortunately far from unique. As the Gender Injustice report notes, over the course of an 18-month period in Connecticut alone, “nearly 250 girls were placed in this [maximum security] adult women’s prison, many of them—like Jane—for violations of probation, running away, or fighting.”

A National Emergency

Amid these systemic challenges, we are seeing unprecedented—and increasing—rates of mental disorders among young people in the US. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association released a joint statement declaring a national child and adolescent mental health emergency. They note, “worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19, and the ongoing struggle for racial justice represents an acceleration of trends observed prior to 2020.”

Young people in the US are experiencing increasing exposure to trauma, whose effects are exacerbated by the COVID-19 pandemic. School closures and online instruction, social isolation, and the death of loved ones have compounded the complex challenges facing young people today. Such stress and trauma exposure are driving high rates of mental illness, with ADHD, anxiety, behavioral challenges, and depression being some of the most common diagnoses among youth.

According to a data analysis led by the Centers for Disease Control and Prevention (CDC), approximately six million young people aged three to 17 years old were diagnosed with ADHD and anxiety in 2019. Within this same age group, nearly three million young people were diagnosed with depression—one of the leading causes of disability among adolescents and a major contributor to the overall global burden of disease.

Moreover, since 2006, suicide rates have more than doubled among young people ages 10-14. To date, suicide is the second leading cause of death of people in this age group. Despite these staggering rates, only one in two youth with a mental health disorder receives treatment. This data does not account for undiagnosed cases.

The World Health Organization (WHO) notes that half of all mental health disorders start by the age of 14 years, yet most cases go undetected and untreated. According to the University of Michigan’s Health Lab, as many as one in seven young people currently suffers from an undiagnosed mental health disorder. Criminalization of mental health disorders only widens the mental healthcare gap for young people.

We can seize this moment by deepening our understanding of the forces driving the staggering rates of incarceration among youth with mental illness, listening to the young people most impacted by it, supporting their leadership, and letting their voices shape policy and systems change.

According to the Office of Juvenile Justice and Delinquency Prevention, approximately 424,300 youth were arrested in 2020. A significant number of these arrests were driven by mental illness and our society’s responses to it: a congressional study concluded that every day, approximately 2,000 youth are incarcerated  because community mental health services are unavailable. Yet, juvenile detention and correctional facilities exacerbate mental health challenges due to overcrowding, lack of available mental health treatment and services, solitary confinement, and separation from support systems such as family and friends.

A Path Forward

In a 2022 report, Surgeon General Dr. Vivek Murthy notes, “if we seize this moment, step up for our [young people] and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.”

We can seize this moment by deepening our understanding of the forces driving the staggering rates of incarceration among youth with mental illness, listening to the young people most impacted by it, supporting their leadership, and letting their voices shape policy and systems change. The National Black Women’s Justice Institute (NBWJI) has done just this. NBWJI Executive Director Dr. Sydney McKinney notes,

The link between unmet mental health needs and Black girls’ involvement in the juvenile legal system is undeniable. Therefore, dismantling pathways to confinement for Black girls requires a commitment to building and expanding the landscape of gender-responsive and culturally-affirming mental health services for Black girls and gender-expansive youth. Too often we look to adults for the answers when we should be asking [young people, particularly] Black girls what will best support their mental health and wellness.

Given increasing rates of youth mental health disorders, the systemic criminalization of mental illness, and the disproportionate burden shouldered by young people of color, particularly Black girls, NBWJI joined forces with the Children’s Partnership to form a youth-led policy council, the Hope, Healing, and Health Collective (H3 Collective). Dr. McKinney recounts, “We created a space and opportunity for Black girls and other youth of color to be the experts we know they are.”

NBWJI reports that 15 youth leaders and grassroots organizations with expertise in “community-based, trauma-informed care; healing-centered community engagement; and youth organizing” convened to develop policy recommendations for meaningfully addressing youth mental health challenges and the systemic barriers to accessing “culturally-responsive and gender-affirming treatment.”

According to NBWJI, “our work intentionally centers the experiences of Black and Latina girls, Indigenous youth and LGBTQ+ youth of color, who data show are disproportionately at risk for depression, anxiety, suicidal ideation and self-harming behaviors.” As such, the H3 collective conducted six listening sessions with youth from across the US to explore four key questions:

1. Where were BIPOC youth seeking mental, emotional, and/or social support before the pandemic?
2. How did the COVID-19 pandemic affect how BIPOC youth addressed their mental health and wellness?
3. What barriers impacted BIPOC youth’s access to mental, emotional, and/ or social supports before and during the pandemic?
4. What can clinical mental health services learn from community-based strategies to improve the quality and effectiveness of services they offer BIPOC youth?

The findings from these listening sessions and subsequent policy recommendations are detailed in a recent publication entitled Youth-Centered Strategies for Hope, Healing, and Health. The report calls for an expansion of access to quality, affordable mental health care and the creation of policies that ensure that, instead of surveilling and disciplining BIPOC youth coping with mental illness and their often distressed families, the state offers such youth treatment. Dr. McKinney states:

US prisons and jails are filled with people who are trauma survivors, particularly Black women and girls. And those experiences paved the paths that led to their criminalization and confinement. [Those impacted] need opportunities and support with healing from the harm they have endured, not the punishment and violence the criminal legal system subjects them to.

As such, the H3 collective outlines several policy recommendations to reduce systemic harm and support young people in their healing as they cope with mental illness. The report calls for an expansion of treatment from professionals in the field—in schools and communities—that reflect the race, cultural, and community experiences of youth. Their recommendations include an increase in the number of therapists of color providing care and the creation of supportive “safe spaces” for all youth, particularly girls, transgender youth, and youth with immigration status concerns.

Further, the collective demands an expansion of the scope of mental health services, investment in the capacity of youth leaders to provide peer support, and prioritization of the civic engagement of youth from historically marginalized communities. Ultimately,

In considering what serves young people well, it is imperative that we address these systemic barriers and develop innovative strategies, leaving space for healing outside of and in tandem with the traditional mental health system. We must be expansive in our thinking about what supports and strengthens youth mental health—inclusive of community-based strategies that mobilize, organize and build power among marginalized youth—if our youth are to thrive.

How do we stop the criminalization of mental illness and create systems that enable all youth to thrive? Mental health is a human right, and our youth should be supported instead of criminalized as they experience mental health challenges.

The WHO defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.” In other words, mental health is not the mere absence of disease; “it is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.” We must create conditions conducive to mental health and reform our responses to mental illness because—as the WHO states—mental health is “crucial to [our society’s] personal, community and socio-economic development.”

Now that youth mental health has been declared a national emergency, how might we galvanize efforts that center youth’s voices—including those of girls, youth of color, and LGBTQ+ youth—to develop practical solutions for meaningful change? How do we stop the criminalization of mental illness and create systems that enable all youth to thrive? Mental health is a human right, and our youth should be supported instead of criminalized as they experience mental health challenges. As demonstrated by NBWJI, a critical step forward is listening to young people and letting their voices serve as guideposts in the development and implementation of policies and programs that support young people’s mental health and well-being. Our future depends on it.

Notes

1. Susan Seligson, “ER Care for Sexual Assault Victims,” BU Today (27 September 2011), https://www.bu.edu/articles/2011/er-care-for-sexual-assault-victims/.
2. Francine Sherman and Annie & Black, Gender Injustice: System-Level Juvenile Justice Reforms for Girls (Portland, OR: The National Crittenton Foundation, 2015).

This article originally appeared in the Nonprofit Quarterly. See the original article here.