Melissa Harris-Perry: Thank you for joining us on The Takeaway. I'm Melissa Harris-Perry.

I just want to make a quick note here that this segment deals with topics of depression, suicide, and suicidal ideation, so take care of yourself and listen with caution.

Stephen "tWitch" Boss was a man who held joy, it seemed, in the palm of his hand. In the flow of his movements as a dancer, his joy radiated out, manifested as a deep love that reflected back to him. We were witness to this love during his days as a DJ on The Ellen DeGeneres Show before a studio audience, Ellen turned to him and said--

Ellen DeGeneres: tWitch, you want to know my favorite thing that we've added?

Stephen "tWitch" Boss: Favorite thing? No.

Ellen DeGeneres: It's you.

[applause]

Ellen DeGeneres: I love you.

Melissa Harris-Perry: tWitch was a man on the rise, and he shared his hard-earned wisdom with honest but compassionate critiques of other dancers following in his syncopated footsteps on So You Think You Can Dance.

Stephen "tWitch" Boss: Alexis, you own this. You commanded this stage. This was your moment right now. Keaton, I'm so proud of what you did. I also know what it is to learn ballroom within a week and have a ballroom dancer as your partner saving your life.

Melissa Harris-Perry: We felt like we knew him, but we didn't know was about the immense weight that he held in his heart. On December 13th of this year, the man known and loved as tWitch died by suicide. Shortly before his death, videos shared on his TikTok show a man deeply in love with the physicality of movement, and someone deeply in love with his wife, family, and seemingly, his life. It seemed like he had it all until suddenly it didn't.

Why did his death come as such a shock to so many? What does it say about our understanding of those battling suicidal ideation, and even our understanding of what mental suffering is and what it looks like? Here with me now is Michael Lindsey, dean and Paulette Goddard professor at the NYU Silver School of Social Work. Michael, welcome back to the show.

Michael Lindsey: Thank you for having me, Melissa.

Melissa Harris-Perry: Also here is Kiara Alvarez, a Bloomberg assistant professor of American Health at Johns Hopkins Bloomberg School of Public Health. Kiara, thank you for being here.

Kiara Alvarez: Thank you for having me.

Melissa Harris-Perry: Michael, let's just start with Stephen "tWitch" Boss. It was relatively short time ago that he died by suicide. It was a shock even for those of us who didn't know him but felt like we did. What does it tell you? What can you tell us about our own sense of shock in this moment, what that reveals about our understanding around suicidality?

Michael Lindsey: What it reveals is that, obviously, we never know the extent to which someone is struggling with a mental health concern, suicidality or whatever the case may be. We just don't always have a sense of what is happening with someone who's struggling with those issues. The reality is that, most often, it is the case that one who is struggling with those issues is really trying to make sense of life as "normal" and trying to achieve some sense of normality just to cope with those struggles or even to mask those struggles because perhaps they don't want to be a burden to someone, or it could be the case that they have made outreach and that outreach has been met with stigma or other forms of resistance or denial of those challenges. It's just sobering to think that so many people are struggling and trying to cope by masking it, and seemingly, have no place to take those burdens or struggles.

Melissa Harris-Perry: Kiara, I want to delve in a bit on Michael's point here about the masking. I wonder if there are particular pressures for that kind of masking for celebrities, for those in the public eye. I'm thinking here of the response to the death by suicide of Robin Williams, of Anthony Bourdain, of others who, again, seem to have it all. I have this rule myself, "Just don't complain on social media, Melissa, because nobody cares."

In this broadest sense, when I say nobody, not my community, but nobody cares when a person who seems to be successful seems to be hurting because you'll often get the kind of response that is, "Hey, but you have this job," or "This money," or "This success, you don't really have a right to be hurting."

Kiara Alvarez: I think this is such an important point because I think we do have an assumption in our society that in some way mental health struggles, thoughts of suicidal ideation are linked to what your external circumstances are to the idea that if your life seems to be going well to other people, if you have access to more resources, that you should be fine, that you should be able to talk yourself out of these concerns. I think your point is a very good one, that there are these pressures on people that are in the public eye, that are celebrities, where they're really being judged for this on a very large scale.

At the same time, I think it also really is something that we see on a day-to-day scale in our own lives, certainly in the lives of many children and families that I've worked with, where in particular for a Black, Latino, and Indigenous people, there are these unique challenges that come with being from either a family or a cultural group that has gone through generational suffering because there has been a value placed on survival and on enduring, and that has been an important aspect of what has gotten you as an individual to this point in life today.

There can be a feeling sometimes of, "I shouldn't feel this way," or "If I tell my family I feel this way, the struggles they've been through to get me to this point, they're going to feel that it wasn't worth it." There can really be a sense of shame about experiencing mental health concerns and a sense that it's an important responsibility to your family and community to continue on, and as Michael said, to mask what's happening in order to be able to continue achieving, to continue presenting a good face to the world.

I think, really, [unintelligible 00:06:49] of all of understanding that mental health is not something that you can just talk yourself out of, it's not something that you can fix with external rewards and appearances, that it's really something that we have to be able to sit with how people are feeling and where they are in life rather than judging them for what we think they should be feeling.

Melissa Harris-Perry: I'm wondering, as you make this point, Kiara, around racial and ethnic communities, it's also true, Michael, that we, for decades, even when we saw an uptick in maybe depressive symptoms among people of color, death by suicide was very low, particularly compared to things like, for example, access to education, income, things that we might think would make life harder, and yet, those who were taking their lives by suicide were actually more likely to be young, more likely to be white, more likely to be male. Now some of that has shifted. We're seeing a rise in in death by suicide by people of color. Is that right?

Michael Lindsey: That is correct. What's really even more sobering is that we're starting to see a rise in both suicide behaviors and completed suicides among Black youth, and certainly Kiara and I and others have been a part of the effort to document what is happening. For example, between 1991 and 2017, suicide attempts increased by 73% for Black youth, while at the same time, our data reflected that it did not increase for any other group.

Certainly, Black girls have seen an uptick in suicide. Some other work that we've done has documented that Black girls, the rate of suicides over the last 20 years has increased highest among Black girls than any other group, or particularly for Black youth in terms of the rising rates in suicides. It is certainly a challenge for us to fully appreciate and understand what children are going through, because as Kiara and you have alluded to, so often in communities of color, there has been a lot of stigma about acknowledging mental health challenges or even suicide.

Without a place to really take those challenges in terms of being able to get relief or support for them, it seems that kids are turning inward and really struggling with the challenges in terms of self-harm behaviors. Some of our other work has really documented that Black youth in particular really want their loved ones, folks in their network friends, other associates to really bring it out, to have that place to be that repository of all the challenges and struggles with which they're dealing with, but yet sometimes we ignore it. We get caught up in the busyness of our lives, if you will, trying to make ends meet.

Often there's this adage, "I don't have time to be stressed or burdened or saddled by any of these issues," and I think kids are really, really struggling with where to take those challenges and burdens.

Melissa Harris-Perry: I'm wondering, Kiara, how much of that is in part related to the new sets of challenges, struggles, concerns that have emerged through the context of this pandemic, things that the adults in the lives of these young people have never even dealt with themselves?

Kiara Alvarez: Absolutely. I think even pre-pandemic, a lot of what we hear from parents is about the amount of stressors that they're experiencing, the time to be able to focus on just quality time with family if you're working in multiple jobs or in demanding settings, things like that. These are already major struggles for parents, and often I think we do expect that parents, for example, will be just the person that manages what the child needs. They'll get them the appointment, they'll take them to the doctor, they'll do all of these things, but it's a real struggle for parents as well to see their children having mental health concerns, to see their children suffering. They want to help, it impacts them emotionally, and so they often don't necessarily have the space for that or the support for that.

During the pandemic, as you note, these were brand new challenges, immense stress and burden on parents, and we certainly saw the additional burden for Black and Latino communities, particularly low-income communities, of not having these adjustments to their lives, but actually having to continue to work in essential roles, being in situations where they were really having to figure out how to care for their children without having any other aspect of their life change, not getting the financial support they needed.

The compounding stressors that people have experienced, and certainly the compounded grief of all the losses due to COVID and that we have somewhat expected youth to then get back to their lives, to continue going to school, and we haven't processed even as a society what this collective trauma really means. I do think we are seeing that on an individual level and on a family level.

I think in many ways, we have to credit the youth of today for being honest about those things; for speaking out, for being open about their emotions and about their mental health. I think there's a lot we can learn from them about that. At the same time, they really need our support as adults to be able to manage what they're experiencing.

Melissa Harris-Perry: Michael and Kiara, let's pause for just a moment. We're going to be right back after this break. Remember, if you or someone you know is having thoughts of suicide, please give a call to the national hotline and you can talk with a professional. The number is just 988. Just dial 988. It's The Takeaway.

[music]

Melissa Harris-Perry: We're back and we're still talking with Michael Lindsey, professor of social work at NYU, and Kiara Alvarez, assistant professor of American Health at Johns Hopkins about how we can help to address mental health disparities in Black and Latino communities and why addressing these disparities means being more inclusive of struggles outside of depression and anxiety.

Michael, I want to come to you on that. There is this notion, I'll never forget the first time I read Dr. King writing about being maladjusted and saying that he actually hoped to be maladjusted in the world if maladjustment meant not accepting segregation, not accepting white supremacy, not accepting all of these ways that we are meant to be unequal and crushed by systems.

On the one hand, I want individual people to reach out for help, and I want to understand, especially for folks of color, what it means to be told we just have to adjust and learn how to be happy in a system that might be profoundly and deeply unfair.

Michael Lindsey: Yes, no, I think that's a really, really important point. We can't really fully fathom or truly understand the extent to which microaggressions or other forms of discrimination, oppression, the struggle to make ends meet, or having the reality of your humanity constantly challenged, whether that's through media or other stories we hear about what it means to be a person of color or a person from an historically marginalized group.

It does weigh in on your psyche in terms of making you question who you are, making you question the reality of your experiences. I argue, rather provocatively, that perhaps anyone who is from an historically marginalized community or BIPOC community should have access to those kinds of supports and services on a frequent basis just to make sense and meaning of those challenges to help us navigate a truly caustic world with respect to the reality of our lived experiences.

Melissa Harris-Perry: Kiara, I'm going to let you weigh in on that as well, and maybe in part on the challenge, I'm thinking if we all did have access, who would be providing this service? It can be pretty tough, especially in some communities, to find folks to talk to who just get it.

Kiara Alvarez: Absolutely. I think that's why many of us are really also advocates of looking to what communities are already doing and seeing ways that communities are caring for themselves, for each other through anything from more formal non-profit agencies that are grassroots and local to just people that are natural helpers or leaders in their communities and thinking about the various ways that you can get that support to them to be able to support people and challenges with mental health to connect them to the services that they need.

I agree with you that then we really run into this problem of what are those services? Because we know that people of color are less likely to be able to get ongoing mental health support, more likely to be needing to access things like a psychiatric emergency department for a crisis. We know that people of color are very much underrepresented in our clinical specialties like social work, psychology and psychiatry. It is a really major challenge. We really see these services that have not been built for our communities.

Ultimately, another major challenge is that in some cases, the places, the structures that we could see as being protective-- For example, we do focus a lot on schools as a site for suicide prevention at the level of an entire community. That's very important. I do some of that work myself. At the same time, we also know that for youth-of-color schools can be a very punitive environment, a place where they're identified for behavior problems rather than mental health problems, a place where they experience racism. These are challenges as well with our institutions that really have to be changed to address the racism, the discrimination, the exclusion that's already built into them.

Otherwise, as you're saying, we can't get everyone necessarily an individual therapist, and they may not need that, but we need to have systems and a society that is supportive of mental health and that is able to then get people to the more specialized services they need when they need them.

Melissa Harris-Perry: Michael, as we're looking at structures here, I'm also wondering about the availability of firearms and the ways that we can talk about suicidal ideation, even self-harm behaviors transforming into completed death by suicide when we simply have more private firearms in homes.

Michael Lindsey: That's a great point. Our most recent data is actually reflective of the fact that, particularly for 18 to 24-year-old Black males, the uptick in terms of suicide by firearms, it's really, really concerning. It reflects that we need to be thinking about means restriction. We talk about that a lot in suicide prevention, how do we ensure that homes are protected from the opportunities one might have to engage in suicide behavior or policies, I think, that need to be in place to help restrict access to firearms, and really to provide the requisite support that folks who are struggling with these challenges?

Everything that Kiara really laid out so eloquently about thinking about traditional and non-traditional ways by which we can meet the need, fixing systems that are broken in terms of increasing access become so important in the larger landscape of really addressing the issue, but I think means restriction and safety planning are really core features of what families and schools and other folks who are close to kids and others who are thinking about or engaging in the behaviors can really be helpful in helping to secure.

Melissa Harris-Perry: I'd also love to hear from both of you just a final note on, not in any way to put this on individuals or on communities, but what are the things we might be able to do for our friends, for our families? There's that kind of checking on your strong friend, and I'm thinking specifically about right now at the holidays, are there steps that we can take to help to protect the people we love in our communities?

Michael Lindsey: I think that we can just lean in a bit more with our loved ones, and even starting with ourselves, securing our mask before we help others and being able to express to loved ones, friends things that are of concern to us, not holding those challenges in, but being able to talk to someone. I think also, we should be checking in on our loved ones, and as I mentioned, leaning in a bit more around their challenges.

So often we will ask someone how are they doing, not much how are they feeling. I think with kids in particular, it's really important to give them the space and the opportunity to express their feelings and things that are of concern or things that are even a relation to them that make them happy, but being able to tap into that emotional connection and being able to articulate it is really, really important.

Kiara Alvarez: I agree. I think that's important, and I think that that last point about being open to that full range of emotions, because that really models the idea that we can have conversations about any of these things. I think something we often really aim to reinforce to people is asking directly, using the word suicide, asking people that you're concerned about if they are thinking about killing themselves or if they are having thoughts of death. As difficult as that feels, because we've really been trained as a society not to use those words or to talk around it, really what we know from the research is it does not increase people's risks and it's helpful because it reduces stigma.

I often will suggest too that people practice that on their own if they feel like that's a difficult conversation for them to have that you're ready if needed. Very importantly, really being able to have these open conversations and to practice really sitting with people's feelings and creating space for them to share those feelings, resisting that sort of natural urge to problem-solve or to let tell them know that it's going to be okay because that's not where the person is at in the moment.

I think often when we skip to a problem-solving, when we skip to this point of trying to make a person feel better, that's really more about us than it is about them and it can really send a message that this is not a person I can have this conversation with.

We want to create those opportunities that over time you are somebody that another person can go to and that you're really thinking about how you show up for people, that if what they need from you is not to sit down and have a conversation, but maybe they need someone to drop off food, or to be in their home with them during a difficult time, or to send a check in that they don't necessarily respond to, understanding what that means for the people in your life for the ways they want to see your support and for the ways that they might want to reach out to you if they need yours is very important.

Melissa Harris-Perry: Kiara Alvarez is Bloomberg assistant professor of American Health at Johns Hopkins Bloomberg School of Public Health, and Michael Lindsey is dean and Paulette Goddard professor of Social Work at the NYU Silver School of Social Work. Thank you both for joining us today.

Michael Lindsey: Thank you for having me.

Kiara Alvarez: Thank you for this conversation and to everyone that was listening today as well.

Melissa Harris-Perry: Please, if you are having thoughts of suicide or if someone who is struggling with this, please call 988. It's the national crisis hotline where a professional is always there and standing by to help.

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