James Donaldson on Mental Health - Misdiagnosis of Mood Disorders in Black Teenagers

What we know about it, and how parents can help kids get the right diagnosis

Writer: Tonya Russell

Clinical Expert: Heather Bernstein, PsyD

What You'll Learn

- Why might Black kids who have a mood disorder get the wrong diagnosis?
- What are the signs that a child might have an underlying mood disorder?
- How can parents help kids get the right diagnosis?
- Quick Read
- Full Article
- Challenges in diagnosing mood disorders
- Misdiagnosis among Black kids
- The role of bias
- How to avoid misdiagnosis

Mood disorders are a category of mental health disorder that includes depression, bipolar disorder, and other disorders with similar symptoms. Symptoms of mood disorders can be difficult to recognize. Research shows that kids of color, specifically Black kids, may be more likely than white kids to get the wrong diagnosis when they show signs of a mood disorder. They might get written off as misbehaving. Or they might be wrongly diagnosed with a different disorder like conduct disorder or schizophrenia.

One important cause of misdiagnosis of kids of color may be unconscious bias on the part of clinicians. Kids of different races who have the same symptoms might get different treatment. For example, a clinician might assume that a Black child who won’t participate in class is just misbehaving. But if a white child shows the same symptoms, they might get diagnosed with depression.

Cultural differences can also lead to misdiagnosis. If a clinician doesn’t know what kinds of behavior or emotional expression are normal for a child’s culture, they might miss signs of mood disorders. In some cases, Black people might be less willing to share information with a white clinician due to fear of being judged or punished. And with less information, the diagnosis is less likely to be accurate.

Despite the risk of misdiagnosis, it’s still very important for Black kids to get care when they’re dealing with a mental health challenge. Parents can help by knowing common signs of mood disorders. And if you’re concerned that your child may have a mood disorder, look for a clinician who has experience working with kids who share your child’s racial identity. Clinicians should also consider the role of racism and other systemic stresses when evaluating the child. By taking time to get to know your child and the bigger picture of their life, a clinician can make an accurate diagnosis and get them the help they need to thrive.

The adolescent years can be tough, especially for teens dealing with mental health challenges, who often struggle to be heard and to feel like themselves. Mood disorders usually begin in the teenage years, but their symptoms can be hard to interpret, and kids may be overlooked or misdiagnosed. This is especially true for children of color, who research suggests are less likely to get an accurate diagnosis when they show signs of a mood disorder.

Challenges in diagnosing mood disorders

Mood disorders are a category of mental health disorder that includes depression, bipolar disorder and other disorders with similar symptoms. The National Institute of Mental Health estimates that about 14.3% of teens have a mood disorder, and girls are almost twice as likely to develop them as boys. Many factors influence the development of a mood disorder. These can be genetic, but they can also be environmental, with trauma being a significant trigger. This trauma can come from sources including strife at home, a significant death, bullying and even neighborhood violence.

Symptoms of mood disorders can be difficult to recognize. While people usually think of sadness as the main characteristic of depression, anger, irritability and behavior problems can also be signs of underlying mood disorders. For example, when a kid who acts out a lot in school doesn’t get a careful evaluation, they might be written off as just misbehaving or seeking attention when they’re really dealing with depression.

If they do get mental health care, they may get the wrong diagnosis. In particular, if a child with a mood disorder shows a lot of disruptive behavior or anger, a clinician who misses the signs of the underlying disorder might misdiagnose them with conduct disorder. Conduct disorder is a pattern of behavior in which a child intentionally hurts other people and acts out in extreme ways. Being diagnosed with conduct disorder can have serious consequences, including challenges finding clinicians who will work with the child and increased risk of incarceration. And when kids get the wrong diagnosis, they miss out on appropriate treatment for the disorder they do have, which leads to worse outcomes in the long term.

Misdiagnosis among Black kids

While kids of any race can receive the wrong diagnosis, research suggests that people of color and particularly Black people are less likely to be diagnosed with mood disorders than white people, even when their symptoms are the same.

One study found that Black male teenagers receiving psychiatric care were more likely to be diagnosed with schizophrenia than any other group, while white adolescents were more likely to be diagnosed with depression. Black teenagers of any gender were also more likely to be diagnosed with conduct disorder than white teenagers. Studies of Black adults have found that they are much more likely than white adults to be diagnosed with psychotic disorders including schizophrenia, even when they show clear signs of severe depression. Another study suggests a similar pattern of misdiagnosis for Black people with bipolar disorder.

More research is needed to clarify these apparent patterns and their causes. But in the meantime, it’s helpful for clinicians and parents alike to be aware of these trends and take care to ensure that teenagers of color get the correct diagnoses they need to thrive.

The role of bias

While there can be many causes of a misdiagnosis, one important factor may be unconscious bias on the part of clinicians.

Even when patients’ issues are the same, there can be a disparity in how youth of color are diagnosed when compared to white youth. “Research shows that when clinicians are given descriptions of the same symptoms labeled with different racial groups, there tends to be a bias to provide certain groups with certain diagnoses and other groups with other diagnoses,” says Heather Bernstein, PsyD, a clinical psychologist. For example, she explains, clinicians may unconsciously assume that a Black child who won’t participate in class is being defiant, while they might diagnose a white child with the same symptoms with depression.

Psychotherapist Jaynay C. Johnson, LMFT, runs a practice focused on helping Black teenagers navigate depression and suicidal ideation, and she explains exactly how that bias can be insidious. In addition to facing more scrutiny for apparent misbehavior, she explains, children of color face the added challenge of dealing with stresses that the white people often diagnosing them don’t understand. For example, a Black girl who gets into a fight may be labeled a behavior problem when really her actions stem in part from the stress of dealing with racism. Johnson explains that “a lot of people aren’t understanding systemic racism and microaggressions and how that can make a Black child frustrated. Instead, they may label it as anger.” She notes that in her Philadelphia practice, she’s often seen Black children be diagnosed with conduct disorder when they’re instead battling depression and anxiety.

Johnson adds that different cultural norms can also contribute to misunderstandings of children’s behavior. “The adults interacting with kids at school often don’t understand their culture,” she says. “So when children are acting within their culture, a lot of people will say that they’re behaving abnormally.” This behavior could include preferring to speak a language other than English, using certain verbal expressions, or even laughing at times that seem inappropriate. In cases like these, even kids with signs of possible mood disorders may be written off as just misbehaving, instead of getting the mental health support they need.

Language barriers are another factor that can contribute to misdiagnosis. Lack of trust in clinicians or medical systems can also lead to misunderstanding when, for instance, parents or children of color might withhold pertinent information out of fear of being judged or persecuted.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How to avoid misdiagnosis

Despite the risk of misdiagnosis, it’s still very important for kids of color to get care when they’re dealing with a mental health challenge. If you think that depression or another mood disorder might be troubling your child or be behind behavior that’s getting them in trouble, the best thing you can do for them is seek an accurate diagnosis and appropriate treatment. And if you think your child has been misdiagnosed or written off by an authority figure, getting a second opinion can help.

You can learn more here about what mood disorders often look like in teenagers, and you can read more here about ways to tell if your child’s anger might be due to depression.

When you do seek help or a second opinion, working with the right clinician can make a big difference. Finding a clinician of color can help with the issues of bias and cultural awareness discussed above, but it’s not the only way to get an accurate diagnosis and quality care. Less than 15 percent of psychologists are people of color, so finding a non-white clinician can be a challenge. White clinicians can also be well-equipped to help your child, especially if they have experience working with other kids with similar symptoms and cultural backgrounds. It’s appropriate to discuss potential clinicians’ experience and training before choosing to work with them.

“Asking about the clinician’s level of cultural competence is a fair question, and it’s important for both the child and the caregiver,” says Dr. Bernstein. “You want to feel comfortable with the individual that they are seeing, and to know that that person has sufficient training and understands how intersecting identities are going to affect both who your child is and the type of treatment that’s going to be the most effective.” For instance, you could ask about the clinician’s understanding of the struggles faced by youth who share your child’s racial identity, or about their experience working with people from communities similar to your own.

Here are a few more ways to tell whether the clinician you’re working with is likely to give your child an accurate diagnosis:

- They consider systemic stressors. Research shows that experiencing racism leads to increased stress levels and adverse health outcomes. Clinicians should be aware of the way that this kind of stress impacts kids and their behaviors, as well as the way that systemic racism can create obstacles in kids’ lives. “We should be looking at what else could be going on in their lives,” says Johnson. “I think that sometimes we aren’t acknowledging that there may be systemic or poverty issues contributing to their symptoms.”
- They look at the whole picture. Medical issues like diabetes orchronic pain — which could both impact mood — should also be taken into account, as well as the social determinants of health. For example, a grumpy, argumentative child may be hungry, and Black children are more likely to live in food deserts than their white peers. Also, in high crime areas, trauma is more likely to be a cause of a child’s symptoms.
- They listen to your child without jumping to conclusions. An accurate diagnosis relies on getting information directly from the child as well, not just from teachers or other authority figures, who may misinterpret their behavior.
- They take their time. “Make sure that you’re working with a clinician who is open to not just putting a stamp on the diagnosis,” says. Dr. Bernstein. “The clinician should be willing to continue gathering information before making that diagnosis, and to really understand the child’s experience and take a more holistic view.”
- They use evidence-based methods based on up-to-date research. Dr. Bernstein notes that clinicians whose practice is based on well-researched tools will be better equipped to give appropriate diagnoses to kids of any race.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-misdiagnosis-of-mood-disorders-in-black-teenagers-3/

What we know about it, and how parents can help kids get the right diagnosis

Writer: Tonya Russell

Clinical Expert: Heather Bernstein, PsyD

What You'll Learn

- Why might Black kids who have a mood disorder get the wrong diagnosis?

- What are the signs that a child might have an underlying mood disorder?

- How can parents help kids get the right diagnosis?

- Quick Read

- Full Article

- Challenges in diagnosing mood disorders

- Misdiagnosis among Black kids

- The role of bias

- How to avoid misdiagnosis

Mood disorders are a category of mental health disorder that includes depression, bipolar disorder, and other disorders with similar symptoms. Symptoms of mood disorders can be difficult to recognize. Research shows that kids of color, specifically Black kids, may be more likely than white kids to get the wrong diagnosis when they show signs of a mood disorder. They might get written off as misbehaving. Or they might be wrongly diagnosed with a different disorder like conduct disorder or schizophrenia.

One important cause of misdiagnosis of kids of color may be unconscious bias on the part of clinicians. Kids of different races who have the same symptoms might get different treatment. For example, a clinician might assume that a Black child who won’t participate in class is just misbehaving. But if a white child shows the same symptoms, they might get diagnosed with depression.

Cultural differences can also lead to misdiagnosis. If a clinician doesn’t know what kinds of behavior or emotional expression are normal for a child’s culture, they might miss signs of mood disorders. In some cases, Black people might be less willing to share information with a white clinician due to fear of being judged or punished. And with less information, the diagnosis is less likely to be accurate.

Despite the risk of misdiagnosis, it’s still very important for Black kids to get care when they’re dealing with a mental health challenge. Parents can help by knowing common signs of mood disorders. And if you’re concerned that your child may have a mood disorder, look for a clinician who has experience working with kids who share your child’s racial identity. Clinicians should also consider the role of racism and other systemic stresses when evaluating the child. By taking time to get to know your child and the bigger picture of their life, a clinician can make an accurate diagnosis and get them the help they need to thrive.

The adolescent years can be tough, especially for teens dealing with mental health challenges, who often struggle to be heard and to feel like themselves. Mood disorders usually begin in the teenage years, but their symptoms can be hard to interpret, and kids may be overlooked or misdiagnosed. This is especially true for children of color, who research suggests are less likely to get an accurate diagnosis when they show signs of a mood disorder.

Challenges in diagnosing mood disorders

Mood disorders are a category of mental health disorder that includes depression, bipolar disorder and other disorders with similar symptoms. The National Institute of Mental Health estimates that about 14.3% of teens have a mood disorder, and girls are almost twice as likely to develop them as boys. Many factors influence the development of a mood disorder. These can be genetic, but they can also be environmental, with trauma being a significant trigger. This trauma can come from sources including strife at home, a significant death, bullying and even neighborhood violence.

Symptoms of mood disorders can be difficult to recognize. While people usually think of sadness as the main characteristic of depression, anger, irritability and behavior problems can also be signs of underlying mood disorders. For example, when a kid who acts out a lot in school doesn’t get a careful evaluation, they might be written off as just misbehaving or seeking attention when they’re really dealing with depression.

If they do get mental health care, they may get the wrong diagnosis. In particular, if a child with a mood disorder shows a lot of disruptive behavior or anger, a clinician who misses the signs of the underlying disorder might misdiagnose them with conduct disorder. Conduct disorder is a pattern of behavior in which a child intentionally hurts other people and acts out in extreme ways. Being diagnosed with conduct disorder can have serious consequences, including challenges finding clinicians who will work with the child and increased risk of incarceration. And when kids get the wrong diagnosis, they miss out on appropriate treatment for the disorder they do have, which leads to worse outcomes in the long term.

Misdiagnosis among Black kids

While kids of any race can receive the wrong diagnosis, research suggests that people of color and particularly Black people are less likely to be diagnosed with mood disorders than white people, even when their symptoms are the same.

One study found that Black male teenagers receiving psychiatric care were more likely to be diagnosed with schizophrenia than any other group, while white adolescents were more likely to be diagnosed with depression. Black teenagers of any gender were also more likely to be diagnosed with conduct disorder than white teenagers. Studies of Black adults have found that they are much more likely than white adults to be diagnosed with psychotic disorders including schizophrenia, even when they show clear signs of severe depression. Another study suggests a similar pattern of misdiagnosis for Black people with bipolar disorder.

More research is needed to clarify these apparent patterns and their causes. But in the meantime, it’s helpful for clinicians and parents alike to be aware of these trends and take care to ensure that teenagers of color get the correct diagnoses they need to thrive.

The role of bias

While there can be many causes of a misdiagnosis, one important factor may be unconscious bias on the part of clinicians.

Even when patients’ issues are the same, there can be a disparity in how youth of color are diagnosed when compared to white youth. “Research shows that when clinicians are given descriptions of the same symptoms labeled with different racial groups, there tends to be a bias to provide certain groups with certain diagnoses and other groups with other diagnoses,” says Heather Bernstein, PsyD, a clinical psychologist. For example, she explains, clinicians may unconsciously assume that a Black child who won’t participate in class is being defiant, while they might diagnose a white child with the same symptoms with depression.

Psychotherapist Jaynay C. Johnson, LMFT, runs a practice focused on helping Black teenagers navigate depression and suicidal ideation, and she explains exactly how that bias can be insidious. In addition to facing more scrutiny for apparent misbehavior, she explains, children of color face the added challenge of dealing with stresses that the white people often diagnosing them don’t understand. For example, a Black girl who gets into a fight may be labeled a behavior problem when really her actions stem in part from the stress of dealing with racism. Johnson explains that “a lot of people aren’t understanding systemic racism and microaggressions and how that can make a Black child frustrated. Instead, they may label it as anger.” She notes that in her Philadelphia practice, she’s often seen Black children be diagnosed with conduct disorder when they’re instead battling depression and anxiety.

Johnson adds that different cultural norms can also contribute to misunderstandings of children’s behavior. “The adults interacting with kids at school often don’t understand their culture,” she says. “So when children are acting within their culture, a lot of people will say that they’re behaving abnormally.” This behavior could include preferring to speak a language other than English, using certain verbal expressions, or even laughing at times that seem inappropriate. In cases like these, even kids with signs of possible mood disorders may be written off as just misbehaving, instead of getting the mental health support they need.

Language barriers are another factor that can contribute to misdiagnosis. Lack of trust in clinicians or medical systems can also lead to misunderstanding when, for instance, parents or children of color might withhold pertinent information out of fear of being judged or persecuted.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How to avoid misdiagnosis

Despite the risk of misdiagnosis, it’s still very important for kids of color to get care when they’re dealing with a mental health challenge. If you think that depression or another mood disorder might be troubling your child or be behind behavior that’s getting them in trouble, the best thing you can do for them is seek an accurate diagnosis and appropriate treatment. And if you think your child has been misdiagnosed or written off by an authority figure, getting a second opinion can help.

You can learn more here about what mood disorders often look like in teenagers, and you can read more here about ways to tell if your child’s anger might be due to depression.

When you do seek help or a second opinion, working with the right clinician can make a big difference. Finding a clinician of color can help with the issues of bias and cultural awareness discussed above, but it’s not the only way to get an accurate diagnosis and quality care. Less than 15 percent of psychologists are people of color, so finding a non-white clinician can be a challenge. White clinicians can also be well-equipped to help your child, especially if they have experience working with other kids with similar symptoms and cultural backgrounds. It’s appropriate to discuss potential clinicians’ experience and training before choosing to work with them.

“Asking about the clinician’s level of cultural competence is a fair question, and it’s important for both the child and the caregiver,” says Dr. Bernstein. “You want to feel comfortable with the individual that they are seeing, and to know that that person has sufficient training and understands how intersecting identities are going to affect both who your child is and the type of treatment that’s going to be the most effective.” For instance, you could ask about the clinician’s understanding of the struggles faced by youth who share your child’s racial identity, or about their experience working with people from communities similar to your own.

Here are a few more ways to tell whether the clinician you’re working with is likely to give your child an accurate diagnosis:

- They consider systemic stressors. Research shows that experiencing racism leads to increased stress levels and adverse health outcomes. Clinicians should be aware of the way that this kind of stress impacts kids and their behaviors, as well as the way that systemic racism can create obstacles in kids’ lives. “We should be looking at what else could be going on in their lives,” says Johnson. “I think that sometimes we aren’t acknowledging that there may be systemic or poverty issues contributing to their symptoms.”

- They look at the whole picture. Medical issues like diabetes orchronic pain — which could both impact mood — should also be taken into account, as well as the social determinants of health. For example, a grumpy, argumentative child may be hungry, and Black children are more likely to live in food deserts than their white peers. Also, in high crime areas, trauma is more likely to be a cause of a child’s symptoms.

- They listen to your child without jumping to conclusions. An accurate diagnosis relies on getting information directly from the child as well, not just from teachers or other authority figures, who may misinterpret their behavior.

- They take their time. “Make sure that you’re working with a clinician who is open to not just putting a stamp on the diagnosis,” says. Dr. Bernstein. “The clinician should be willing to continue gathering information before making that diagnosis, and to really understand the child’s experience and take a more holistic view.”

- They use evidence-based methods based on up-to-date research. Dr. Bernstein notes that clinicians whose practice is based on well-researched tools will be better equipped to give appropriate diagnoses to kids of any race. https://standingabovethecrowd.com/?p=16568

Our free Symptom Checker can help you determine if your teen might have depression

- Take our depression test

- Is any online depression test reliable?

- What are the signs of depression in teens?

- Physical signs of depression

- Early signs of depression in teens

- Anxiety and depression

- What are the kinds of depression?

- How is depression tested and diagnosed?

- How much does our online depression test cost?

Depression is a common mental health challenge in teenagers and even in some children. It can be hard to spot because teenagers are typically moody and because depression can look different in teens and kids than it does in adults. 

Take our depression test

If you’re looking for a free depression test, you can use our Symptom Checker to help you determine if your teen might have depression. By answering a few simple questions about your teen’s behaviors, you’ll receive a personalized list of behaviors and traits. If they correspond with the symptoms and behaviors associated with depression, it will let you know. If your answers to the quiz suggest another disorder, you’ll see that, too.

The Symptom Checker was developed in partnership with expert clinicians and is aligned with the Child Mind Institute’s rigorous editorial standards.

Is any online depression test reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. But if you’re looking for an online depression test to get started, our Symptom Checker can help you know if the behaviors you notice in your teen could be signs of depression — or something else. You’ll also find links to articles where you can learn more and help you prepare for a conversation with a professional who can diagnose your teen.

What are the signs of depression in teens?

The biggest sign of depression is a change in mood. A depressed teen will feel sad or irritable for no reason and lose interest in things they normally enjoy. These changes will last at least two weeks. Other symptoms include:  

- Being easily annoyed 

- Feeling hopeless 

- Trouble concentrating 

- Trouble making decisions 

- Struggling in school 

- Low self-esteem or saying negative things about themselves 

- Having trouble talking to friends 

- Thinking about or attempting suicide 

To identify signs and symptoms of depression in teens, try using our free Symptom Checker.

Physical signs of depression

Since children, and especially teens, do not always share how they are feeling — or may even go out of the way to hide how they are feeling —it can be hard for parents to identify depression. But some signs of depression are visible. Physical signs of depression include:

- A change in eating habits — eating conspicuously more or less

- A change in weight — either gaining or losing weight

- A change in sleeping habits — sleeping either more or less than usual

- Having low energy or seeming tired all the time

- Spending a lot of time alone in their room, avoiding friends

- Seeming listless or lazy

Early signs of depression in teens

The key to spotting depression in teens and preteens is to be alert for changes in behavior. For example:

- Being irritable when they are typically easygoing

- Getting into fights or breaking rules at school when they’ve never done that

- Becoming highly sensitive to mistakes or criticism, when they used to shrug it off

- Withdrawing from things they used to enjoy, like skipping classes or dropping sports

- Frequent stomachaches and headaches

Anxiety and depression

It’s common for a teenager to struggle with both anxiety and depression. Scientists think it may be because the regions of the brain affected by anxiety and depression are close together, and mutually affected. But one disorder can also lead to another.

When depression leads to anxiety, it may be because the negative state of mind results in uncertainty. If you’re not feeling good about yourself — or don’t feel confident, secure, or safe — anxiety may take root.

It’s also possible that a very anxious teenager begins avoiding many of the things they used to enjoy, so their life becomes extremely limited — and that leads to depression.

If a teenager has both anxiety and depression, it’s important to seek professional help for both disorders. Untreated, they lead to serious problems, including self-injury (or cutting), substance abuse, and suicidal thinking (or behavior).  

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What are the kinds of depression?

The most prevalent depressive disorders include: 

- Major depressive disorder: Severe symptoms that last between two weeks and several months 

- Persistent depressive disorder (also called dysthymia): Less severe symptoms that last for a year or more 

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed with major depressive disorder twice as often as boys are.  

How is depression tested and diagnosed?

If you’re looking to learn more about your teen’s symptoms via an online depression test, try our Symptom Checker. However, our test cannot diagnose depression, it can only help you identify possible signs of depression.

Depression can only be diagnosed by a mental health or medical professional. To make the diagnosis, the clinician will speak to the teen, family members, and other adults in the teen’s life.  

To be diagnosed with major depressive disorder, a teenager must be depressed most of the time for at least two weeks and have several of the symptoms listed above. Their symptoms must be a change from their typical behavior.  

To be diagnosed with persistent depressive disorder, a teen must be depressed or annoyed most of the time for at least one year. They must also have at least two of the symptoms getting in the way of their daily life.

How much does our online depression test cost?

The Symptom Checker is a free to use depression test that can help you identify possible signs of depression.

Frequently Asked Questions

Is any online depression test for teens reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. Our depression test cannot diagnose your teen but it can help you know if the behaviors you notice in your teen could be signs of depression — or something else.

How do I know if my child has depression?

What are the symptoms of depression?

How is depression tested? https://standingabovethecrowd.com/?p=16566

Our free Symptom Checker can help you determine if your teen might have depression

- Take our depression test

- Is any online depression test reliable?

- What are the signs of depression in teens?

- Physical signs of depression

- Early signs of depression in teens

- Anxiety and depression

- What are the kinds of depression?

- How is depression tested and diagnosed?

- How much does our online depression test cost?

Depression is a common mental health challenge in teenagers and even in some children. It can be hard to spot because teenagers are typically moody and because depression can look different in teens and kids than it does in adults. 

Take our depression test

If you’re looking for a free depression test, you can use our Symptom Checker to help you determine if your teen might have depression. By answering a few simple questions about your teen’s behaviors, you’ll receive a personalized list of behaviors and traits. If they correspond with the symptoms and behaviors associated with depression, it will let you know. If your answers to the quiz suggest another disorder, you’ll see that, too.

The Symptom Checker was developed in partnership with expert clinicians and is aligned with the Child Mind Institute’s rigorous editorial standards.

Is any online depression test reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. But if you’re looking for an online depression test to get started, our Symptom Checker can help you know if the behaviors you notice in your teen could be signs of depression — or something else. You’ll also find links to articles where you can learn more and help you prepare for a conversation with a professional who can diagnose your teen.

What are the signs of depression in teens?

The biggest sign of depression is a change in mood. A depressed teen will feel sad or irritable for no reason and lose interest in things they normally enjoy. These changes will last at least two weeks. Other symptoms include:  

- Being easily annoyed 

- Feeling hopeless 

- Trouble concentrating 

- Trouble making decisions 

- Struggling in school 

- Low self-esteem or saying negative things about themselves 

- Having trouble talking to friends 

- Thinking about or attempting suicide 

To identify signs and symptoms of depression in teens, try using our free Symptom Checker.

Physical signs of depression

Since children, and especially teens, do not always share how they are feeling — or may even go out of the way to hide how they are feeling —it can be hard for parents to identify depression. But some signs of depression are visible. Physical signs of depression include:

- A change in eating habits — eating conspicuously more or less

- A change in weight — either gaining or losing weight

- A change in sleeping habits — sleeping either more or less than usual

- Having low energy or seeming tired all the time

- Spending a lot of time alone in their room, avoiding friends

- Seeming listless or lazy

Early signs of depression in teens

The key to spotting depression in teens and preteens is to be alert for changes in behavior. For example:

- Being irritable when they are typically easygoing

- Getting into fights or breaking rules at school when they’ve never done that

- Becoming highly sensitive to mistakes or criticism, when they used to shrug it off

- Withdrawing from things they used to enjoy, like skipping classes or dropping sports

- Frequent stomachaches and headaches

Anxiety and depression

It’s common for a teenager to struggle with both anxiety and depression. Scientists think it may be because the regions of the brain affected by anxiety and depression are close together, and mutually affected. But one disorder can also lead to another.

When depression leads to anxiety, it may be because the negative state of mind results in uncertainty. If you’re not feeling good about yourself — or don’t feel confident, secure, or safe — anxiety may take root.

It’s also possible that a very anxious teenager begins avoiding many of the things they used to enjoy, so their life becomes extremely limited — and that leads to depression.

If a teenager has both anxiety and depression, it’s important to seek professional help for both disorders. Untreated, they lead to serious problems, including self-injury (or cutting), substance abuse, and suicidal thinking (or behavior).  

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What are the kinds of depression?

The most prevalent depressive disorders include: 

- Major depressive disorder: Severe symptoms that last between two weeks and several months 

- Persistent depressive disorder (also called dysthymia): Less severe symptoms that last for a year or more 

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed with major depressive disorder twice as often as boys are.  

How is depression tested and diagnosed?

If you’re looking to learn more about your teen’s symptoms via an online depression test, try our Symptom Checker. However, our test cannot diagnose depression, it can only help you identify possible signs of depression.

Depression can only be diagnosed by a mental health or medical professional. To make the diagnosis, the clinician will speak to the teen, family members, and other adults in the teen’s life.  

To be diagnosed with major depressive disorder, a teenager must be depressed most of the time for at least two weeks and have several of the symptoms listed above. Their symptoms must be a change from their typical behavior.  

To be diagnosed with persistent depressive disorder, a teen must be depressed or annoyed most of the time for at least one year. They must also have at least two of the symptoms getting in the way of their daily life.

How much does our online depression test cost?

The Symptom Checker is a free to use depression test that can help you identify possible signs of depression.

Frequently Asked Questions

Is any online depression test for teens reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. Our depression test cannot diagnose your teen but it can help you know if the behaviors you notice in your teen could be signs of depression — or something else.

How do I know if my child has depression?

What are the symptoms of depression?

How is depression tested? https://standingabovethecrowd.com/?p=16566

James Donaldson on Mental Health - Depression Test for Teens

Our free Symptom Checker can help you determine if your teen might have depression

- Take our depression test
- Is any online depression test reliable?
- What are the signs of depression in teens?
- Physical signs of depression
- Early signs of depression in teens
- Anxiety and depression
- What are the kinds of depression?
- How is depression tested and diagnosed?
- How much does our online depression test cost?

Depression is a common mental health challenge in teenagers and even in some children. It can be hard to spot because teenagers are typically moody and because depression can look different in teens and kids than it does in adults. 

Take our depression test

If you’re looking for a free depression test, you can use our Symptom Checker to help you determine if your teen might have depression. By answering a few simple questions about your teen’s behaviors, you’ll receive a personalized list of behaviors and traits. If they correspond with the symptoms and behaviors associated with depression, it will let you know. If your answers to the quiz suggest another disorder, you’ll see that, too.

The Symptom Checker was developed in partnership with expert clinicians and is aligned with the Child Mind Institute’s rigorous editorial standards.

Is any online depression test reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. But if you’re looking for an online depression test to get started, our Symptom Checker can help you know if the behaviors you notice in your teen could be signs of depression — or something else. You’ll also find links to articles where you can learn more and help you prepare for a conversation with a professional who can diagnose your teen.

What are the signs of depression in teens?

The biggest sign of depression is a change in mood. A depressed teen will feel sad or irritable for no reason and lose interest in things they normally enjoy. These changes will last at least two weeks. Other symptoms include:  

- Being easily annoyed 
- Feeling hopeless 
- Trouble concentrating 
- Trouble making decisions 
- Struggling in school 
- Low self-esteem or saying negative things about themselves 
- Having trouble talking to friends 
- Thinking about or attempting suicide 

To identify signs and symptoms of depression in teens, try using our free Symptom Checker.

Physical signs of depression

Since children, and especially teens, do not always share how they are feeling — or may even go out of the way to hide how they are feeling —it can be hard for parents to identify depression. But some signs of depression are visible. Physical signs of depression include:

- A change in eating habits — eating conspicuously more or less
- A change in weight — either gaining or losing weight
- A change in sleeping habits — sleeping either more or less than usual
- Having low energy or seeming tired all the time
- Spending a lot of time alone in their room, avoiding friends
- Seeming listless or lazy

Early signs of depression in teens

The key to spotting depression in teens and preteens is to be alert for changes in behavior. For example:

- Being irritable when they are typically easygoing
- Getting into fights or breaking rules at school when they’ve never done that
- Becoming highly sensitive to mistakes or criticism, when they used to shrug it off
- Withdrawing from things they used to enjoy, like skipping classes or dropping sports
- Frequent stomachaches and headaches

Anxiety and depression

It’s common for a teenager to struggle with both anxiety and depression. Scientists think it may be because the regions of the brain affected by anxiety and depression are close together, and mutually affected. But one disorder can also lead to another.

When depression leads to anxiety, it may be because the negative state of mind results in uncertainty. If you’re not feeling good about yourself — or don’t feel confident, secure, or safe — anxiety may take root.

It’s also possible that a very anxious teenager begins avoiding many of the things they used to enjoy, so their life becomes extremely limited — and that leads to depression.

If a teenager has both anxiety and depression, it’s important to seek professional help for both disorders. Untreated, they lead to serious problems, including self-injury (or cutting), substance abuse, and suicidal thinking (or behavior).  

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What are the kinds of depression?

The most prevalent depressive disorders include: 

- Major depressive disorder: Severe symptoms that last between two weeks and several months 
- Persistent depressive disorder (also called dysthymia): Less severe symptoms that last for a year or more 

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed with major depressive disorder twice as often as boys are.  

How is depression tested and diagnosed?

If you’re looking to learn more about your teen’s symptoms via an online depression test, try our Symptom Checker. However, our test cannot diagnose depression, it can only help you identify possible signs of depression.

Depression can only be diagnosed by a mental health or medical professional. To make the diagnosis, the clinician will speak to the teen, family members, and other adults in the teen’s life.  

To be diagnosed with major depressive disorder, a teenager must be depressed most of the time for at least two weeks and have several of the symptoms listed above. Their symptoms must be a change from their typical behavior.  

To be diagnosed with persistent depressive disorder, a teen must be depressed or annoyed most of the time for at least one year. They must also have at least two of the symptoms getting in the way of their daily life.

How much does our online depression test cost?

The Symptom Checker is a free to use depression test that can help you identify possible signs of depression.

Frequently Asked Questions

Is any online depression test for teens reliable?

If you think your teen may have depression, it’s important to get a diagnosis from a medical or mental health professional. Our depression test cannot diagnose your teen but it can help you know if the behaviors you notice in your teen could be signs of depression — or something else.

How do I know if my child has depression?

What are the symptoms of depression?

How is depression tested?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-depression-test-for-teens/

James Donaldson on Mental Health - 988 suicide hotline is getting more calls than ever. Many states have no clear plan to fund it

By Michael Marks, Harvest Public Media

Editor’s note: If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

Brent Brewer has a passion for helping his fellow farmers and ranchers handle the stress that comes with agricultural work. He’s known around Oklahoma as someone you can call if you’re struggling with your mental health.

“This is a hobby of mine,” said Brewer, who farms and raises cattle in Grant County, Oklahoma. “To help people navigate through tough times and to try to get their legs back underneath them.”

Rural populations, particularly farmers, have a higher suicide rate than the general public. The unique stresses of working in agriculture can exacerbate symptoms of depression and anxiety – particularly when the economic situation is dire for farmers, like it is now.

Brewer is happy to hear anyone out, but he’s also quick to refer them to professional resources, including 988, the National Suicide & Crisis Lifeline.

“I divert a lot of my calls. I like the 988 people to take them,” Brewer said.

But Brewer is also worried about whether the resource will get the financial support it needs to keep helping his neighbors.

Since it started taking calls in 2022, demand has increased for 988 nationwide.

“We have been seeing a month over month increase in utilization of 988. And so we are also working pretty hard to keep up,” said Monica Kurz, chief administrative officer for Health Source Integrated Solutions in Kansas, one of the state’s 988 call centers.

The 988 system was designed to give people in crisis an easy-to-remember number that’s available 24 hours a day via call, text and chat. Every state has its own set of call centers with trained operators.

Kurz says the service is a necessity for rural Kansans.

“We know that in our rural and frontier counties in Kansas, folks might be traveling hours to get to their nearest mental health clinic. And this is a way to access services right away without that kind of distance barrier,” she said.

The federal government, which initiated the program four years ago, has largely paid for service. But the program was designed for states to eventually fund 988 on their own. Few states have plans in place to continually fund the critical service though. And as demand outpaces funding, some call centers are finding it hard to keep up.

“When you increase demand, you have to increase capacity to meet that demand,” said Jonathan Purtle, an associate professor at the New York University School of Global Public Health who studies 988 funding. “And to increase capacity, you need money.”

No sustainable funding 

Responding quickly to an incoming call or text to 988 is essential, says Kurz of Kansas 988. Her goal is for the center to respond to a call within 20 seconds.

Kansas call centers were about six seconds slower than that last year, on average, but faster than the national average of 34 seconds, according to the most recent federal data available.

A caller frustrated with a long wait time might hang up. Plus, if they spend two minutes on hold, the call is re-routed from a local facility to a national backup center.

In-state operators often have a better understanding of local circumstances. This can be especially helpful for rural users.

“I think about some of the situations that we've had with fires out west in Kansas,” said Kurz. “And I don't know that someone who's sitting in a backup center has any idea of some of the stress that some of our western Kansas communities have been under when I think about things like those fires.”

A backup operator also may not be able to connect someone with local resources, said Lauren Moyer, chair of Missouri’s 988 task force.

“If someone is really struggling with substance use, and needs connected to a residential substance use bed in the moment, somebody from another state is not going to have access to that information,” Moyer said.

Having enough money to hire and train operators is critical to answering calls in a timely manner, experts say.

The federal government paid for the launch of 988, but states were expected to pick up the tab eventually. The federal bill that established the program recommended that states collect fees on telecommunication products, which is how 911 is largely funded.

“There’s no sustainable funding source for 988,” said Purtle, the NYU researcher. “The federal law…kind of suggests, ‘Hey states, here’s an idea about how you can fund it.’ And that idea is 988 telecom fees.”

Only a dozen states have created these fees, though. Missouri and Kansas are not among them, although their legislatures have dedicated revenue to the program out of their general funds.

Moyer of Missouri 988 worries about whether that’s sustainable.

“You know general revenue support, it’s its own line item and that’s not guaranteed long-term,” she said.

‘The big thing is people’

Other states, like Texas, have yet to dedicate any state funding to 988 and are still relying solely on federal grants.

Jennifer Battle is vice president of the Harris Center in Houston, which fields 988 calls. She testified to the Texas House Public Health Committee in 2025 that the state’s call centers receive around 200,000 calls a year. Of those, 85% are resolved on the phone, without the need for additional resources like a mobile crisis unit.

“As impressive as these numbers are that we’re able to serve with the current federal funds, these funds only allow for us to be able to answer on average 84% of the 988 calls that originate in Texas,” Battle told lawmakers.

On average, operators at 988 call centers in Texas responded to contacts in 43 seconds last year, longer than average wait times nationally.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

In Oklahoma, which has also seen steep increases in demand for 988 since the program’s inception, lawmakers haven’t approved fees to support it, either. According to State Rep. Kevin Norwood, a Republican from the Tulsa area, there’s little appetite in the state legislature for a new tax.

“Before I became a legislator, that idea was introduced and it gained no traction,” he said.

Norwood is now sponsoring a bill that would create a trust fund for 988 and ensure earmarked money is only used for the hotline.

“When I jumped into it I was like, ‘Okay, we need to make it where it’s not just a short-term fix. Where it would be long-term and sustainable,’” Norwood said.

Texas has followed a similar path. Lawmakers there have been unable to pass a telecommunications fee. In 2025, the state also established a trust fund, but the balance is currently zero.

Though it’s a “signal of effort,” said NYU researcher Jonathan Purtle, without actual investment in these state trust funds, the move is largely ineffective.

“Those trust funds are a strategy, but if there’s not funds in the trust fund, it’s not going to have that much of an impact,” said Purtle.

Purtle is near the end of a five-year study analyzing the funding of 988 systems in all 50 states. So far he’s found those with long-term, dedicated funding for staff are generally more efficient.

“The big thing is people, right? The staffing, the people who work in these call centers is the main thing,” he said.

He may have a new data point in the near future, as Missouri legislators consider a bill that would establish a 988 telecommunications fee.

Moyer of the state’s task force says there’s a “strong likelihood” the fee will be approved, providing long-term support for the hotline.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-988-suicide-hotline-is-getting-more-calls-than-ever-many-states-have-no-clear-plan-to-fund-it/

By Michael Marks, Harvest Public Media

Editor’s note: If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

Brent Brewer has a passion for helping his fellow farmers and ranchers handle the stress that comes with agricultural work. He’s known around Oklahoma as someone you can call if you’re struggling with your mental health.

“This is a hobby of mine,” said Brewer, who farms and raises cattle in Grant County, Oklahoma. “To help people navigate through tough times and to try to get their legs back underneath them.”

Rural populations, particularly farmers, have a higher suicide rate than the general public. The unique stresses of working in agriculture can exacerbate symptoms of depression and anxiety – particularly when the economic situation is dire for farmers, like it is now.

Brewer is happy to hear anyone out, but he’s also quick to refer them to professional resources, including 988, the National Suicide & Crisis Lifeline.

“I divert a lot of my calls. I like the 988 people to take them,” Brewer said.

But Brewer is also worried about whether the resource will get the financial support it needs to keep helping his neighbors.

Since it started taking calls in 2022, demand has increased for 988 nationwide.

“We have been seeing a month over month increase in utilization of 988. And so we are also working pretty hard to keep up,” said Monica Kurz, chief administrative officer for Health Source Integrated Solutions in Kansas, one of the state’s 988 call centers.

The 988 system was designed to give people in crisis an easy-to-remember number that’s available 24 hours a day via call, text and chat. Every state has its own set of call centers with trained operators.

Kurz says the service is a necessity for rural Kansans.

“We know that in our rural and frontier counties in Kansas, folks might be traveling hours to get to their nearest mental health clinic. And this is a way to access services right away without that kind of distance barrier,” she said.

The federal government, which initiated the program four years ago, has largely paid for service. But the program was designed for states to eventually fund 988 on their own. Few states have plans in place to continually fund the critical service though. And as demand outpaces funding, some call centers are finding it hard to keep up.

“When you increase demand, you have to increase capacity to meet that demand,” said Jonathan Purtle, an associate professor at the New York University School of Global Public Health who studies 988 funding. “And to increase capacity, you need money.”

No sustainable funding 

Responding quickly to an incoming call or text to 988 is essential, says Kurz of Kansas 988. Her goal is for the center to respond to a call within 20 seconds.

Kansas call centers were about six seconds slower than that last year, on average, but faster than the national average of 34 seconds, according to the most recent federal data available.

A caller frustrated with a long wait time might hang up. Plus, if they spend two minutes on hold, the call is re-routed from a local facility to a national backup center.

In-state operators often have a better understanding of local circumstances. This can be especially helpful for rural users.

“I think about some of the situations that we've had with fires out west in Kansas,” said Kurz. “And I don't know that someone who's sitting in a backup center has any idea of some of the stress that some of our western Kansas communities have been under when I think about things like those fires.”

A backup operator also may not be able to connect someone with local resources, said Lauren Moyer, chair of Missouri’s 988 task force.

“If someone is really struggling with substance use, and needs connected to a residential substance use bed in the moment, somebody from another state is not going to have access to that information,” Moyer said.

Having enough money to hire and train operators is critical to answering calls in a timely manner, experts say.

The federal government paid for the launch of 988, but states were expected to pick up the tab eventually. The federal bill that established the program recommended that states collect fees on telecommunication products, which is how 911 is largely funded.

“There’s no sustainable funding source for 988,” said Purtle, the NYU researcher. “The federal law…kind of suggests, ‘Hey states, here’s an idea about how you can fund it.’ And that idea is 988 telecom fees.”

Only a dozen states have created these fees, though. Missouri and Kansas are not among them, although their legislatures have dedicated revenue to the program out of their general funds.

Moyer of Missouri 988 worries about whether that’s sustainable.

“You know general revenue support, it’s its own line item and that’s not guaranteed long-term,” she said.

‘The big thing is people’

Other states, like Texas, have yet to dedicate any state funding to 988 and are still relying solely on federal grants.

Jennifer Battle is vice president of the Harris Center in Houston, which fields 988 calls. She testified to the Texas House Public Health Committee in 2025 that the state’s call centers receive around 200,000 calls a year. Of those, 85% are resolved on the phone, without the need for additional resources like a mobile crisis unit.

“As impressive as these numbers are that we’re able to serve with the current federal funds, these funds only allow for us to be able to answer on average 84% of the 988 calls that originate in Texas,” Battle told lawmakers.

On average, operators at 988 call centers in Texas responded to contacts in 43 seconds last year, longer than average wait times nationally.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

In Oklahoma, which has also seen steep increases in demand for 988 since the program’s inception, lawmakers haven’t approved fees to support it, either. According to State Rep. Kevin Norwood, a Republican from the Tulsa area, there’s little appetite in the state legislature for a new tax.

“Before I became a legislator, that idea was introduced and it gained no traction,” he said.

Norwood is now sponsoring a bill that would create a trust fund for 988 and ensure earmarked money is only used for the hotline.

“When I jumped into it I was like, ‘Okay, we need to make it where it’s not just a short-term fix. Where it would be long-term and sustainable,’” Norwood said.

Texas has followed a similar path. Lawmakers there have been unable to pass a telecommunications fee. In 2025, the state also established a trust fund, but the balance is currently zero.

Though it’s a “signal of effort,” said NYU researcher Jonathan Purtle, without actual investment in these state trust funds, the move is largely ineffective.

“Those trust funds are a strategy, but if there’s not funds in the trust fund, it’s not going to have that much of an impact,” said Purtle.

Purtle is near the end of a five-year study analyzing the funding of 988 systems in all 50 states. So far he’s found those with long-term, dedicated funding for staff are generally more efficient.

“The big thing is people, right? The staffing, the people who work in these call centers is the main thing,” he said.

He may have a new data point in the near future, as Missouri legislators consider a bill that would establish a 988 telecommunications fee.

Moyer of the state’s task force says there’s a “strong likelihood” the fee will be approved, providing long-term support for the hotline. https://standingabovethecrowd.com/?p=16564