Jasmin Pierre was 18 when she tried to end her life, overdosing on whatever pills she could find. Diagnosed with depression and anxiety, she survived two more attempts at suicide, which felt like the only way to stop her pain.
Years of therapy brought progress, but the 31-year-old Black woman's journey is now complicated by a combination of stressors hitting simultaneously: isolation during the pandemic, a shortage of mental health care providers and racial trauma inflicted by repeated police killings of Black people.
"Black people who already go through mental health issues, we're even more triggered," said Pierre, who lives in New Orleans. "I don't think my mental health issues have ever, ever been this bad before."
Health experts have warned of a looming mental health crisis linked to the coronavirus outbreak, and the federal government rolled out a broad anti-suicide campaign. But doctors and researchers say the issues reverberate deeper among Black people, who've seen rising youth suicide attempts and suffered disproportionately during the pandemic.
Mental health advocates are calling for more specialized federal attention on Black suicides, including research funding. Counselors focusing on Black trauma are offering free help. And Black churches are finding new ways to address suicide as social distancing has eroded how people connect.
"There has been a lot of complex grief and loss related to death, related to loss of jobs and loss of income," said Sean Joe, an expert on Black suicides at Washington University in St. Louis. "There's a lot of hurt and pain in America going on right now, and you only are getting a sense of depth in the months ahead."
Suicides overall have increased. Roughly 48,000 people in the U.S. died by suicide in 2018, with the rate increasing 35% since 1999, according to the Centers for Disease Control and Prevention. Suicide is the 10th leading cause of death among all ages. For ages 10 to 19, it's second after accidents.
The rates of suicides and suicide attempts for Black adults have trailed white and Native American adults. But newer research shows an alarming rise in Black young people trying to take their own lives.
Suicide attempts rose 73% between 1991 and 2017 among Black high school students while suicidal thoughts and plans for suicide fell for all teens, according to a study published in November in the journal Pediatrics. The findings, including troubling suicide trends among Black children, prompted the Congressional Black Caucus to issue a report in December deeming the situation a crisis.
Experts say the reasons are a complex mix requiring more study.
Suicide risk factors include a diagnosis like depression or trauma or having a parent who committed suicide. Many factors are amplified for Black families, who often face higher poverty rates, disproportionate exposure to violence and less access to medical care.
The pandemic has heightened the disparities.
Black people are dying from COVID-19 at higher rates, leaving them to grieve more in isolation with restrictions on funerals and gatherings. Added to the mix is a national reckoning with racism after George Floyd's killing.
"Dealing with racism and stereotypes and all the inequity that we have to face, it's bandaged up," said Arielle Sheftall, an author of the Pediatrics study. "It feels like the bandage is ripped off and everybody is looking at it and staring at it, and we are bleeding profusely."
Part of the problem is the study of suicide remains largely white, with little race research. There's also been a misconception of suicide as only a "white problem."
Michigan psychologist Alton Kirk was among the first to study Black suicides in the 1970s, outlined in his 2009 book, "Black Suicide: The Tragic Reality of America's Deadliest Secret."
"When I first started, a lot of Black people were in denial about suicide," he said. "We had suffered enough. We survived slavery and segregation and all this other stuff. They almost saw it as being a weakness."
While many attitudes have changed, obstacles to health care persist.
For one, there aren't enough mental health professionals. Also, treatment has traditionally been based on white experiences, potentially leaving some clinicians unprepared.
Each time there's a publicized episode of police brutality against Black people, calls to the Trevor Project's suicide-prevention lines spike immediately. The organization focuses on LGBTQ youth, including addressing racial disparities.
"You're already starting at a different point because you spent your life fighting back racism," said Tia Dole, the organization's chief clinical operations officer. "People are walking around with a half-filled tank of emotional resources because of their identity."
For suicide attempt survivors, navigating the pandemic means more uncertainty.
Kiauna Patterson, who graduated from Pennsylvania's Edinboro University this year, tried to end her life in 2018 as she felt pressure from school and working three jobs to help support family.
Since losing university health care, she meditates daily and focuses on her goal of becoming a doula.
"You don't really know what's going on or what's going to happen," she said. "You're taking each day, just one at a time, to try and grasp some type of control or calmness."
Pierre, who uses her experiences to counsel others, doesn't want people struggling alone. She created The Safe Place, a free Black-oriented mental health app that's seen more signups during the pandemic.
Others are also trying to fill care gaps.
Donna Barnes, who runs the National Organization For People of Color Against Suicide, plans a free online counseling course. After losing her son to suicide in 1990, she noticed a lack of resources for Black families and started the group.
"It took me four years before I could smile again," Barnes said. "It wasn't easy. My friends and family didn't know what to do with me."
Trinity United Church of Christ, an influential Black church once attended by former President Barack Obama, has met increased need in Chicago with Zoom chats and calls.
The Rev. Otis Moss III used a recent podcast to discuss his sister's suicide, which occurred before his wedding in the 1990s.
He called it an effective medium as people remain isolated with services canceled. Moss said it took years to talk openly share about his sister's schizophrenia and to stop blaming himself.
"It is an appropriate time to let people know there are many people who are walking the same road they are walking," he said. "I found how to punch holes in the darkness and witness light shine through."
Sophia Tareen is a member of The Associated Press' Race and Ethnicity Team. Follow her on Twitter: https://twitter.com/sophiatareen.