What’s driving the alarming rise in suicide deaths among Black youth — and what can we do about it? In part two of our youth suicide prevention series, three experts examine findings from Pain in the Nation 2026 and explore how schools, health care systems, communities, and public policy can work together to create the conditions young people need to thrive.
Watch the episode on YouTube.
Featuring:
J. Nadine Gracia, MD, MSCE, President and CEO, Trust for America’s Health
Sandro Galea, MD, DrPH, Physician, Population Health Scientist, Author, Margaret C. Ryan Dean, Eugene S. and Constance Kahn Distinguished Professor in Public Health, WashU Bursky School of Public Health
Mallory Garnett, PhD, Clinical Psychologist, Nemours Children’s Health
Host/Producer: Carol Vassar
TRANSCRIPT:
Announcer (00:00):
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer (00:12):
Each week we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
MUSIC (00:30):
Let’s go well beyond medicine.
Carol Vassar, podcast host/producer (00:36):
Welcome everyone to the second of two episodes examining youth suicide in the United States as we recognize September as Suicide Prevention Awareness Month. Today, we’re examining findings from Pain in the Nation 2026. That’s a report from Trust for America’s Health. The report considers national trends in deaths from suicide, drugs, and alcohol. Now for our purposes, we’re going to focus specifically on what the evidence tells us about youth suicide and how it can help shape more effective prevention efforts. Joining me right now are Dr. J. Nadine Gracia, she is president and CEO of Trust for America’s Health, Dr. Sandro Galea, Dean of the Bursky School of Public Health at Washington University in St. Louis, and Dr. Mallory Garnett, a clinical psychologist with Nemours Children’s Health. Welcome to all of you. Dr. Gracia, I want to begin with you. Before we start examining some of the findings in detail, give us some high level overviews of what Pain in the Nation 2026 was looking to measure and how you did report that out.
J. Nadine Gracia, MD, Trust for America’s Health (01:49):
Well, thank you, Carol, for hosting this discussion, and it’s really an honor to join Dr. Galeo and Dr. Garnett for this important conversation. Just to take a step back with regards to Pain in the Nation, as you noted, it is a report that our organization Trust for America’s Health publishes every year really to shine a spotlight on the epidemics of alcohol, drug, and suicide deaths in the US. And not only does it demonstrate the data specifically across the nation and across states, but also provides recommendations and spotlights programs and policies that we know can actually help to prevent and reduce these tragic deaths. We’ve been doing this report now for almost 10 years. And in this year’s report, in the 2026 report, what we found is that for the first time since 1999, when these data were actually published, the combined rates of alcohol, drug, and suicide deaths declined significantly and for each of these causes of death. And the suggestion now is that for the preliminary data for 2025, that we’re seeing a stable trend as well with regards to these causes of death.
(03:08):
That is important and good news and something that should be celebrated. But what we know is it still means that we have more work to do because when we look at the total number of deaths, we’re still at a higher rate than we were in 1999. And that’s lives lost, that’s family members, that’s friends, that’s communities that suffer from losing these loved ones. And we also know that the impacts are not the same across all populations and all communities. So spotlighting this and stating that it’s really important that we continue our efforts to work towards preventing and addressing deaths due to suicide, alcohol, and drug overdose.
Carol Vassar, podcast host/producer (03:48):
And we are going to focus in on one of those communities a little bit later on. Dr. Gracia, what does the report tell us specifically about youth suicide in the US? I understand it’s down, but… Tell me more.
J. Nadine Gracia, MD, Trust for America’s Health (04:01):
Yeah, down is an important framing. So as a population group, youth between ages of zero to 17 have the lowest suicide mortality rate among age groups. But what’s important to understand, though, is that as we look at the data over the course of these past two decades, youth have actually had some of the most significant increases in suicide rates, increasing by almost 50%. What we also know is that suicide is the second leading cause of death for youth and young adults between the ages of 15 and 34, and that is very concerning to look at those trends and really understand what is leading to that, what are the factors that are contributing to that, and recognizing that this is an important public health issue that needs to be addressed among our youth.
Carol Vassar, podcast host/producer (04:56):
Dr. Galea, I want to go to you. How should we interpret that population-wide progress, progress in quotes, within that continuing crisis among youth in terms of suicide?
Sandro Galea, MD, WashU Bursky School (05:11):
Well, first of all, Carol, thank you for having me here. I think I will build on what Dr. Gracia said. I mean, progress is progress, and it is good and should always be noted and celebrated. Overall, the 3% decrease masks heterogeneity behind the progress. Number one, in absolute terms, most of the suicide rate is driven by middle-aged and older adults. So a drop there results in a relative drop that sounds impressive, but it’s not really saying much about the risk for a particular 14-year-old, number one. Number two, there are heterogeneities within means of that, particularly firearm suicides, for example, which has not changed at all. And I think that makes the point about the observation that death by suicide among young people is entirely preventable. But the reason that death by suicide is the second-highest cause of death among young people is because young people don’t die of many other things. And the fact that the second-highest leading cause of death is something that’s preventable, I think really should animate our focus on it and really calls for a public health preventive approach, which we can talk about more.
Carol Vassar, podcast host/producer (06:31):
I want to sharpen that lens on youth and go to Dr. Garnett. When you looked at this report through a pediatric lens, what stood out to you the most beyond the suicide deaths that Dr. Gracia and Dr. Galea have been talking about? What do you think, and what measures do you think can help us understand the mental health and well-being of children and adolescents today? You work with them all the time.
Mallory Garnett, PhD, Nemours Children’s Health (06:59):
Yeah, thanks again for having me here. I’m very honored to be a part of this panel to discuss this very important topic. In addition to the findings that Dr. Garcia and Dr. Galea have highlighted, one of the biggest things that stands out to me is the limited amount of state policy and programming to address these concerns from a preventative standpoint. So, for example, approximately 13 states out of the 50 have some sort of mandate that requires school officials to be aware of the signs and appropriate responses to suicidal behaviors or ideation in youth. Which, we think about how much time children are spending in school, we want the people who are around them for the majority of their day to be aware of these concerns. Another thing that jumped out to me was the lack of, or limited access to, statewide legislative mandates for suicide prevention. So only 12 states out of the 50 have a statewide office dedicated to focusing on suicide prevention and supports. And given these numbers that we’re seeing, although it looks like overall suicide deaths are going down, we see that for youth, with those increases, we need to be thinking about some of those statewide prevention services that we can have in place.
Carol Vassar, podcast host/producer (08:22):
Dr. Garnett, I’m going to pull on one of the threads that you mentioned in there, and that was identified schools, the report does so, as important settings for prevention and early intervention. What should schools be equipped to do when it comes to suicide prevention?
Mallory Garnett, PhD, Nemours Children’s Health (08:40):
Yeah, I think that schools should be equipped and empowered and, honestly, most importantly, funded to be able to provide mental health services for their students in the school settings. So that should include some sort of universal screenings for youth to check in on mental health and check in on concerns around depression and suicidal ideation and behaviors. In addition, schools should be equipped to provide youth with appropriate mental health supports to address some of the concerns that come about from these screenings.
Carol Vassar, podcast host/producer (09:14):
Dr. Gracia, I see you nodding your head. How can healthcare, public health, community organizations support the schools in this? And really, who should be responsible for coordinating all of that work? That’s a big job.
J. Nadine Gracia, MD, Trust for America’s Health (09:28):
Well, it is indeed, and I think the importance of the partnerships, multi-sector partnerships, is critical. Even to be able to describe progress, that progress, it wasn’t built overnight and it didn’t happen by accident. It’s really intentional efforts. As Dr. Garnett just spoke about schools as an important nexus, when we think about children’s health and well-being, you have to really take it from a holistic approach and understand that schools have a role to play. Public health, for example, through health departments, have a role to play in supporting, for example, providing evidence and data as it relates to proven programs that actually can help prevent and reduce suicide. It’s access to healthcare, mental health services, substance use services. It’s also recognizing the role of families and the broader community. Having a caring and loving adult in a child’s life matters significantly. And so to be able to actually address this through really a holistic lens to ensure that the spaces and places where children are born, where they go to school, where they learn, where they play, that all matters and that contributes to their overall health and wellbeing. And so those partnerships are critical, and they have to be sustained to really promote childhood health and wellbeing and prevent suicide.
Carol Vassar, podcast host/producer (10:42):
When we first started talking about doing this series, there’s another episode before this, one of the findings in this report really was alarming, and it’s probably the driving force behind our team wanting to examine this, and that was the suicide mortality rate among one population of youngsters, and that is black youth. This is an amazingly terrible statistic as far as I’m concerned. It increased 144% between 2007 and 2020. Dr. Galea, what might help us understand that increase?
Sandro Galea, MD, WashU Bursky School (11:22):
Yeah, as you correctly put it, Carol, this is a troubling increase. And I think the underlying numbers were it went from 1.5 per hundred thousand among black youth to 3.8. And these are youth between the ages of 10 and 17, which was the steepest increase of any group. So when you have an increase like that, this is not a trajectory that suggests an individual change. It suggests change in conditions. And if you look at this period, and we should be very clear, it’s hard to know what really drives death by suicide, but if you look at these periods, we’re talking about 2007 to 2020, we’re dealing with the aftermath of a recession that we know fell hardest on black families’ wealth and housing stability, exposure to community violence, the rise of digital availability of phones, experiencing a number of events that previously were distant much more directly in people’s own personal spaces, and under resourcing of mental healthcare.
(12:13):
And you add to that the literature, which is clear on this, that when black adolescents express anger, they are more often diagnosed as having a disorder, misrecognized as such rather than actually being given the treatment and the help that they need. So I think there are many number of factors that could explain this. It’s very hard to say which one of them it is. So I think you asked a little bit about how do we deal with this, how do we tailor it? I think it’s a little bit more than tailoring. I think it suggests that we need a universal intervention approach delivered across the whole population. And I think we need to make sure that we have an equitable investment in making sure that the groups most at high risk, in this case black youth, get the resources they need. And data like this should be a clarion call for that.
Carol Vassar, podcast host/producer (13:02):
Now, I’m wondering if we’re looking at the population of black youth, do we know if it’s young men or young women who are more likely to attempt death by suicide or God forbid, succeed at that?
Sandro Galea, MD, WashU Bursky School (13:15):
Well, it is both. We know from data, from multiple sources of data, that young women are more likely to attempt suicide while young men are more likely to succeed, which of course creates different levels of need in both populations.
Carol Vassar, podcast host/producer (13:31):
Now, I do want to interject quickly here to let you know that if you’re listening, if you’re watching and you or someone you know is in crisis, you’re feeling as though you do want to harm yourself or maybe harm someone else, there is a resource for you. 988; it’s toll-free. It’s available across the nation. It is the Suicide and Crisis Lifeline. You can call; you can text help to 988. And again, that is available no matter where you are in the US. Now I want to ask Dr. Gracia, the report calls for reducing adverse childhood experiences while increasing positive child experiences. What would it take to turn that recommendation into a concrete suicide prevention strategy for children and families?
J. Nadine Gracia, MD, Trust for America’s Health (14:18):
Well, thanks for that question. Dr. Galea actually was already referencing some of these underlying factors as we think about suicide. And when we talk about suicide, it’s not one singular cause. And really taking a look at this through a population lens, a public health lens, and understanding that it has to incorporate child, family, neighborhood, community, school to create a strategy that builds on these recommendations. And when we think about adverse childhood experiences, or ACEs, we are describing, for example, family economic stressors. Families are having a challenging time to make ends meet and put food on the table. Or if a child doesn’t have a stable place to live, if they don’t have caring adults in their lives or experiencing or witnessing violence or neglect, that all of these things can influence their health and well-being. It also stems into schools and neighborhoods and communities, and ensuring that we have access to these services.
(15:23):
I think when we have a greater focus on the positive childhood experiences in terms of building social connection in the home and the community and schools, when we think about how to actually advance policies that support economic supports for families, which we see actually there are policies. We saw policies, for example, during the pandemic that helped to actually cut childhood poverty in half. We saw policies that helped to support housing, that helped to support engagement in the workforce. So we know that these policies can work. We have to have the will and the leadership to actually invest in these types of policies and to sustain them beyond crises to ensure that families and therefore children really have the opportunity to thrive.
Carol Vassar, podcast host/producer (16:09):
Dr. Garnett, let’s talk about the role pediatric health systems can play beyond identifying and treating young people who are already in crisis. How can pediatric health systems, providers like yourself help strengthen the relationships, the stability, and ensure the protective conditions surrounding children that Dr. Gracia and Dr. Galea have been referring to?
Mallory Garnett, PhD, Nemours Children’s Health (16:32):
Yeah, I think we play a really important role because we have the training to understand what some of these warning signs can look like. We have the training to understand what these protective factors include. So I think one of our biggest roles is to help with breaking the stigma and breaking the silence around the experience of suicide ideation and behaviors. So for example, when we think about these different community connections, building social connections, pediatric health providers can help to bridge that gap by going into places where black youth and families are, like local community centers, boys and girls clubs, churches, barbershops, hair salons, and providing folks with information about what to look for and how to support youth and young people who are having these experiences.
Carol Vassar, podcast host/producer (17:18):
When we talk about suicide prevention, there’s the individual: somebody presents to you, Dr. Garnett, and says, “I’m having these thoughts,” and you know what to do. Let’s talk a little bit about the public health approach. Dr. Galea, what is it that we need to do to really examine this through a public health lens, and what larger conditions do we need to address to reduce youth suicide rates, bring them down?
Sandro Galea, MD, WashU Bursky School (17:48):
Yeah, I think the sense here builds a lot on what I’ve said earlier, what Dr. Gracia has said earlier. When you think of public health lens, everything about how you think about this changes. We learned this many decades ago: most cases in something like death by suicide are not coming from the small high-risk tail, but actually from the middle of the distribution. So most young people who die by suicide were not in treatment. They were not identified as high risk. So if we base our approach on a clinical lens, we miss the majority of people who actually may be at risk or may die by suicide.
(18:22):
So if we take a public health or population health approach, we ask a different question. We say, what is it that is creating the distribution the way it is? And the answer is not a clinical answer. The answer is the conditions in which children grow up, whether their family has economic security, whether they have stable housing, whether their school is a place where adults know their name, whether their neighborhood’s safe, whether they have the means of suicide readily available at hand in a moment of acute crisis, whether their digital environment is corrosive or connective. So I think the argument that I have made in a lot of my writing, and many have made in their writing, about context applies exactly here. Health is not about healthcare. Suicide is not principally a failure of psychiatry. It is really a failure of social conditions that we have built for young people to live in.
Mallory Garnett, PhD, Nemours Children’s Health (19:12):
Can I jump in here?
Carol Vassar, podcast host/producer (19:13):
Yes.
Mallory Garnett, PhD, Nemours Children’s Health (19:15):
Yeah, I have one though to piggyback off of Dr. Galea’s point about thinking about systemic and population health answers and resources. One big area we also want to draw attention to is a lack of research that specifically focuses on the needs of black youth when it comes to supporting them around suicidal ideas and behaviors. So when we think about research that investigates some of the protective factors or some of the risk factors that contribute to suicide in youth in general, a lot of those research studies don’t have a significant number of black youth enrolled in them to better understand where some of the pathways that can lead to these concerns. And even on the clinical side, in terms of identifying treatments and other preventative strategies, a lot of research does not focus in on some of the unique aspects that may relate to effective treatment in black families, like looking at the impact of racism and other protective factors such as racial socialization and cultural pride, and how those things can contribute to gains in treatment. So just making sure that the research base that we’re drawing from to develop these different preventative strategies and treatment strategies have diverse youth enrolled in them.
Carol Vassar, podcast host/producer (20:38):
That’s an excellent, excellent point. It sounds like it’s more than a matter of just having more black youth enrolled in the research. It goes beyond that, doesn’t it, Dr. Garnett?
Mallory Garnett, PhD, Nemours Children’s Health (20:48):
Yeah, definitely. So not just enrolling them in studies, but making sure that their needs and that their specific aspects of their experience are centered in the questions. So for example, I mentioned racial identity development and racial ethnic socialization. Those are strategies to look into the ways in which youth identity development can play a positive role in supporting children’s outcomes, helping to foster cultural pride to combat the stress associated with racism, and looking at the impacts of racism and how those contribute to suicide risk. And just making sure that not just enrolling black youth and their families, but kind of centering their needs and experiences as well.
Carol Vassar, podcast host/producer (21:37):
That’s a very important point. We’ve talked a lot about what can be done, what should be done. Dr. Gracia, the report warns that recent progress may be fragile as we look at the threats to the public health workforce, which has already diminished due to the pandemic, in terms of Medicaid coverage – where is that going – and research and community prevention programs. What could these losses mean specifically for youth suicide prevention?
J. Nadine Gracia, MD, Trust for America’s Health (22:11):
Well, I think importantly, one, we know that even this beginning gleam of progress that we are seeing, it didn’t happen overnight. It wasn’t by accident. This is built on years of investment and partnerships and commitment to addressing youth suicide. And importantly, when we talk about things like federal funding and the federal workforce and the cuts in federal funding that we’ve seen, what’s proposed for further cuts, as well as the workforce reductions, the impacts of that don’t just rest and sit in Washington, D.C., in federal agencies or, in the case of CDC, in Atlanta. It directly impacts communities and states across the country. When you look at funding levels, for example, CDC’s funding, 80% of its domestic budget actually goes to states and communities.
(23:06):
And so when you’ve experienced cuts like this in terms of federal funding, or if there’s instability in that funding, it means that you lose funding for community-based prevention programs. It means that you no longer have the counselors in schools, the mental health services in schools, the ability to do that type of detection to see are there clusters or changes in the trends in terms of suicide happening in communities, because those data and surveillance systems have been built over time, and when you weaken those systems, those systems are interconnected between the federal, state, and local levels. And that’s partnership with CDC along with SAMHSA, with states and localities to really be able to identify where there may be greater risk and to be able to target more resources into those areas to actually save lives.
(23:56):
So it really matters that we continue to have sustained investment in prevention because as a nation, when you look at the trillions of dollars that we spend on health spending every year, less than 5% of that goes to prevention and public health. And so now, when we see the fragility of funding at the federal level that then goes to states and local communities. And when we see the loss of expertise in the workforce and just the sheer numbers in terms of the workforce, it puts that progress at risk at a time in which we actually should be even strengthening our investment, strengthening that commitment so that we can save lives and really promote youth health and wellbeing.
Carol Vassar, podcast host/producer (24:38):
We’ve made incremental progress, but we can’t take our foot off the gas at this point. We continue to need those prevention programs and that community outreach and that better research. I want to ask a general question of the group. What are some policy initiatives right now that you think could further impact the nation’s suicide rate, particularly among youth, so that we can continue to make some of those gains and trend that scourge downward, ideally to zero?
Sandro Galea, MD, WashU Bursky School (25:09):
Well, I can start us off. How’s that? I think I would build on what I’ve been talking about earlier, about building the contexts that actually protect youth and protect youth mental health. I mean, I would start with Medicaid, with Medicaid and CHIP eligibility. I would expand school-based Medicaid. I would make sure that we sustain 988 lines, permanent funding, and make sure that we have mobile responses that are available. We can advance lethal means safety, secure storage laws, child access prevention statutes, and extreme risk protection orders. And I would put in a plug for our surveillance. I mean, right now we’re in a time when surveillance systems – YRBS and VDRS, state ACE modules have become, some have been stopped, some have been shut down. And without being able to evaluate trends and different initiatives, we actually don’t know what works. And then my last perhaps larger order suggestion would be to think about broader economic policy, suicide policy, housing stability, paid leave, refundable tax credits. These are all efforts that create stable, sustainable communities that fundamentally are going to protect communities from risk, including the risk of self-harm.
Carol Vassar, podcast host/producer (26:31):
That’s quite a list. Dr. Gracia, anything to add?
J. Nadine Gracia, MD, Trust for America’s Health (26:35):
I support what Dr. Galea said, and they are actually recommendations that are in our Pain in the Nation report because, broadly, what we’re describing is investing in the conditions that promote health. And when you invest in the conditions that promote health, it is around economic stability and economic supports. It is around looking at issues of housing and affordable, quality, safe, and healthy housing. It’s investing in schools and the services that can be provided in schools because, as Dr. Garnett talked about, children spend so much of their time in schools that we want to ensure that they have the resources and supports to ensure that they are inclusive, supportive, and healthy environments for students to thrive.
(27:16):
I would say on the issues around crisis intervention services, these types of programs and policies that we’re describing, they have the evidence to show that they work. And actually for 988, we’ve seen, for example, that since it was launched in 2022, suicide among young people between the ages of 15 to 34 who are the most likely to use 988, it actually was the suicide death rates were 11% lower than projected in that two and a half year period. And when you also look at the states, and Dr. Garnett alluded to this in terms of bolstering states that have the investment in 988 as well, the states where you see the highest uptake of using 988 also saw lower suicide death rates than states that had lower rates. So these are the types of programs and policies that we can be investing in.
(28:09):
We also need to ensure that when federal funding is approved and appropriated by Congress, that funding is getting to states and communities. There’s been disruptions, there have been delays in terms of the funding leaving and going from CDC or SAMHSA to getting to states and localities. We have to ensure that the funding is there because when a community-based organization or a public health department isn’t sure if that funding is coming, it’s very difficult to maintain the workforce in your department. It’s very difficult to have the counselors and the services continue to be available. And in order to make that impact and continue to see progress, it has to be stable, sustained investment and funding for these types of services and policies.
Carol Vassar, podcast host/producer (28:53):
Dr. Nadine Gracia is the President and CEO of Trust for America’s Health. We also heard from Dr. Sandro Galea, Dean of the Bursky School of Public Health at Washington University in St. Louis, and Dr. Mallory Garnett, a Clinical Psychologist, with Nemours Children’s Health.
Our gratitude to Dr. Gracia, Dr. Galea, and Dr. Garnett for sharing their insights on the public health approach to youth suicide prevention. Don’t forget, 9-8-8 is the National Suicide and Crisis Lifeline. If you or someone you know is experiencing a mental health crisis, simply call or text 9-8-8 to be connected to live support anytime of the day or night, any day of the year.
The Nemours Well Beyond Medicine Podcast features anything and everything that affects children’s health that happens outside of the clinical setting, and we want to hear from you as we develop episode ideas. Just head over to our website, nemourswellbeyond.org, and leave us a voicemail with your idea, or email it to [email protected]. Visit the website to also catch up on episodes you missed, leave a review, or sign up for our monthly e-newsletter. That’s nemourswellbeyond.org.
You can also get the podcast on your favorite podcast app, your smart speaker, or by visiting the Nemours YouTube page.
Our production team for this episode includes Susan Masucci, Cheryl Munn, Lauren Teta, and Alex Wall. Video production by Josh Hansborough. Audio editing and production by me. Join us next time as pediatrician and policy expert Dr. David Keller and I explore what it will take to move from fixing children’s health problems to creating the conditions—and making the investments—that help them thrive. I’m Carol Vassar. Until then, remember that together, we can change children’s health for good – well beyond medicine.
MUSIC:
Let’s go well beyond medicine.
