In the spring of 2020, Jamal Clay, a gifted young man who grew up in the south suburbs of Chicago, died by suicide. He was 19 years old. Jamal’s loved ones describe him as creative and talented, a leader in different youth-focused organizations in his community who supported and cared for those he loved. He was just as brilliant as he was kind.
Still, Jamal made his first suicide attempt during his middle school years. His family fought to get him the best mental health treatment possible, though they struggled to find the right therapist who could fully understand and care for his experiences as a young Black boy coming of age in a world that tells boys they are not allowed to show weakness or pain.
I met Jamal’s mother, Rafiah Maxie-Cole, just a few months after his death. Shortly after Rafiah founded Soul Survivors of Chicago, a nonprofit that raises awareness about suicide prevention, particularly within Black communities.
Suicides and suicide attempts have increased dramatically among Black children and youth in particular, and it seems that Black clinicians are well positioned to offer desperately needed mental health services.
But at a time when they are arguably needed most, Black social workers face stringent barriers to earning full clinical licenses. Nationally, Black social workers report experiencing racial bias in the test-taking process that is required to earn the clinical license needed to administer independent therapeutic services. This crisis calls for new solutions, and Illinois is trying one that sounds promising. A new state law provides alternative paths to obtaining clinical licensure, and other states would benefit from closely watching this approach.
Earning the full clinical social work license (commonly referred to as the LCSW) is an important professional milestone. It gives social workers greater autonomy by permitting them to head their own private practice and to train the next generation of mental health clinicians. All other social workers must work under the direct supervision of a licensed clinical mental health professional.
In August 2022, the Association of Social Work Boards (ASWB) released a public report describing the LCSW exam pass rates. Their findings revealed differences in first-time pass rates for master’s level clinicians across demographic groups. For example, between 2018 and 2021, fewer than half of Black applicants (45%) passed the LCSW exam on their first try. Conversely, 83.9% of white, 79.9% of multiracial, and 72% of Asian social workers passed after one attempt. Disparities also persist when comparing the eventual pass rates, as 90% of white social workers go on to successfully pass the LCSW exam, while only 57.7% of Black test takers do. It costs $260 each time an applicant registers for the exam. Black social workers are therefore on average spending more time and money working to gain full clinical licensure in order to support and serve communities that are in need. They are also missing out on opportunities to earn higher salaries made available to those in supervisory roles who are required to have the full clinical license.
Through my work as a suicide prevention researcher and professor at the University of Chicago, I have opportunities to talk with Black parents whose children are currently at risk for suicide. I have also connected with Black families whose loved ones have already died by suicide and are now living with overwhelming feelings of grief and guilt. In both circumstances Black families are desperately looking to find Black mental health professionals who are accessible and trained to help them process their devastation and pain.
I also see these realities reflected in my own research in which Black youth experience barriers to receiving potentially lifesaving mental health treatment. In 2022 I led a study in which my colleague and I analyzed existing data from more than 7,700 adolescents in the U.S. We restricted our study sample to include responses only from youth who reported that they had previously attempted suicide at some point in their life. We found that only 36% of Black youth in the U.S. with a history of lifetime suicide attempt received mental health treatment in the past year, compared with 52% of white youth who had gone to a therapist within this same time frame. Moreover, Black and Native American/Alaska Native youth in our study were significantly more likely than white and Asian youth to be insured via Medicaid or the Children’s Health Insurance Program (CHIP). This finding in particular has direct implications for states that have recently begun to remove hundreds of thousands of residents from the Medicaid programs, thus limiting access to health care for millions of people across the country.
Notably, the data in our study were collected from 2004-2019, and gaps in mental health treatment have only worsened since the start of the pandemic. Data from the Centers for Disease Control and Prevention confirm that between 2018 and 2021, suicides increased 19.2% among Black Americans, 26% among American Indian/Alaska Native individuals, and 6.8% among Hispanic/Latinx communities. Suicides among white U.S. residents, however, decreased during this time period.
Could many of these suicides have prevented if there were more Black mental health professionals available to offer services in Black communities? What about Native American/Alaska Native and Latinx communities? While I am not yet able to answer this question with the data made available to me, I still believe that these matters require our immediate attention and should elicit great concern. It is evident that there is an urgent need to provide affordable and accessible mental health treatment that reaches Black Americans, and really all people at risk for suicide, exactly where they are. Removing barriers to gaining clinical licensure is just one step on the path forward.
Policymakers should also consider following the example set forth by clinical social workers like Cassandra Walker and Brit Holmberg, who spearheaded efforts to construct and carry forth the passage of an Illinois bill in 2023. The legislation, which went into effect Jan. 1, 2024, offers alternative options for obtaining clinical licensure, like earning additional supervision hours, in the event that an applicant does not pass the exam upon first try.
To be clear, LCSW applicants will still be required to first earn at least 3,000 hours of clinical supervision under the direction of the licensed clinical social worker (or other mental health professional) before taking the exam. However, those who do not pass the exam will now have the opportunity to either retake the exam, or complete an additional 3,000 hours of clinical supervision providing direct services.
While I’m grateful for the advocacy efforts and the faithful commitment of all the social workers who diligently fought for this change, I still wish that it had not come to this point. Clinicians should not have had to fight so hard and for this long in order to ensure that equitable approaches to licensure were put into place.
Other states should follow Illinois’ lead in forming alternative routes to licensure, which will hopefully allow more mental health professionals to provide services to those in need. If not, delays in obtaining clinical licensure will only deepen the divide between those who already have access to treatment and those who do not. Allowing these disparities in access to persist may prove deadly and will ultimately contribute to the loss of even more promising Black lives.
Janelle Goodwill is a Neubauer Family Assistant Professor at the University of Chicago Crown Family School of Social Work, Policy, and Practice. Her research focuses on preventing suicide and promoting positive mental health outcomes for Black Americans across the life course.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.