The Heart of It: Addressing Racism and Mental Health in America

If there’s one way to sum up this year, it’s change: change in how we connect, how we communicate, how we grieve, how we learn, and how we live. Yet, perhaps what is most important about this year is not what’s changed. Instead, it is how change has put a microscope on the deep inequality this country has failed to reckon with for far too long—inequality BIPOC and marginalized communities have lived through for centuries.

The detrimental adverse impact of racism extends beyond physical health. At Crisis Text Line, we know that mental health is physical health. The acute and sustained trauma marginalized communities experience (whether through ongoing systemic oppression or acute moments of violence) brings to bear the importance of addressing mental health when understanding the connection between racism and public health. 

This year was also marked by devastating racial violence. We know that prolonged exposure to systemic racism, whether through violent incidents or micro aggressions, contributes to chronic anxiety and other risk factors that worsen mental health in the long term. At Crisis Text Line, we aim to increase access to mental health support for all, and especially for our youth in need and Black, LatinX and other BIPOC communities that are disproportionately affected by healthcare disparities.” – Dr. Shairi Turner, MPH, Chief Transformation Officer

Dr. Shairi Turner, MPH, Chief Transformation Officer


The CDC recently released a statement identifying racism as a public health threat. The CDC explained, “The impact [of racism] is pervasive and deeply embedded in our society—affecting where one lives, learns, works, worships and plays and creating inequities in access to a range of social and economic benefits—such as housing, education, wealth, and employment. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.” Simply put, racism impacts the health of individuals, communities, and the country at large every day, and in every way. 

These social determinants of health are perhaps most visible in the ways COVID-19 has devastated communities of color. The CDC identified discrimination, access to healthcare, occupation, wealth, and housing as the primary risk factors for contracting COVID-19. This underlying inequality correlates with increasing infection, hospitalization, and death rates for BIPOC communities such that Native people had a COVID hospitalization rate 5.3 times that of white people. And, Black and Latine people had hospital rates about 4.7 times the rate of white people. Moreover, the physical implications only tell part of the story. Marginalized communities have not only been susceptible to contracting COVID, but also to experiencing intensified acts of racially motivated attacks. Particularly, hate crimes against the AAPI community increased 150% in 2020

At Crisis Text Line, we consider addressing the barriers to mental health support for marginalized communities critical to our mission to promote mental wellbeing for people wherever they are. Here are a few ways we’re working to bridge the gap in access to mental health support:

  1. Economic access. We know that far too many American families live paycheck to paycheck. Studies show that Black and Latine families are more likely than white families to experience food insecurity during the pandemic, making the idea of spending money on mental health care far out of reach. That’s why our service is free. We’ve collaborated with cell phone carriers so texts to our short code, 741741 are free of charge with most major carriers. If you have a plan with a different carrier, it works just like texting a friend: standard text message rates apply.
  2. 24/7 support. People are on the move. Many people don’t have a standard 9-5 job, flexible work schedules with time off, or free time after school. Nearly 50% of high school students hold a job while also managing school. People need support at times that work for them. That’s why we have Crisis Counselors available at all hours of the day—or night. So, if you’re running from school, to a job to support your family, to home to study for that AP exam, we got you—whenever works for you
  3. Expanding Mobile Crisis Units. Crisis Text Line’s goal is always to de-escalate crises. However, of the 1.4 million conversations our counselors had in 2020, there were 8,577 instances in which a texter was in a life-threatening situation,unable to be de-escalated via text, and required an in-person intervention by emergency services. We believe that pairing mental health and medical experts to be the lead responders with these emergency services, and with police officers when a weapon is involved, is the best practice to protect the lives of individuals in crisis. To support this work, we’re advocating for states to allocate American Rescue Plan funding to provide community-based mobile crisis intervention services.  
  4. Community collaboration. We believe that community leaders know best how to support their peers. So, we partner with organizations that provide vital community services, whitelabeling our service and helping connect their community to mental health support. Most recently, we’ve launched service partnerships with We R Native, Live Free 999, and Callen Lorde

We have a bold vision of a world where nobody feels alone—a world where Crisis Text Line doesn’t need to exist. We know that bridging the gap to care is just a stop gap for systemic problems that cause crisis. So, we’re on a mission to collaborate with communities to reduce individual and community crisis overall. Here’s how:

  1. The world’s largest mental health data set. When we build partnerships with community organizations, we not only provide our service, but also share our data. Our scrubbed, anonymized data is the largest real-time mental health data set in the world. For our texters, we know what issues are top of mind for texters, which geographic areas tend to experience different types of crisis, and which words more most likely to help texters deescalate. And, when we partner with organizations, we share specific data back with the organization with the goal of equipping them with the context to build programs that would reduce instances of crisis in their communities.
  2. Innovative Research. Beyond community partnerships, we also work with research institutions to understand how to improve our service and how to apply our learnings to the broader world. Recently, we completed a research partnership with Berkely that analyzed the language of crisis specific to people with military experience. This type of research allows us to collaborate across industries to understand how particular communities express pain in nuanced ways.
  3. Empathy MVPs. In our seven years, we’ve trained over 40,000 people in crisis counseling. Not all of those people are still active counselors on our platform, but all of them have the tools to bring skills from their time with us out to the world. Our Crisis Counselors are teachers, doctors, 911 operators, and community advocates. Their work makes a difference in 1-on-1 conversations with texters and makes waves far beyond a text exchange. 

As a society, we can treat infections and illness, build new hospitals, and invest in new scientific research. But, that work will do little to address the health disparity without addressing the root cause of poor physical and mental health. To promote the wellbeing of our nation, addressing racism must be the first step. At Crisis Text Line, we’re on a transformative journey to center equity in all aspects of our work. This work is a never-ending process of self-reflection and action. And, it takes time: time to heal, time to restore, and time to chart a new path. We’re committed. In order for us to achieve our mission, we must address racism. Truly, it’s the heart of the matter.  

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