More than one year after declaring racism a public health crisis in the wake of George Floyd’s murder, the Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Cuyahoga County has backtracked, substituting the word “racism” for “discrimination.”
“What we’re really fighting is discrimination based on ethnicity, color of skin, and national origin,” said Rev. Benjamin Gohlstin of Cleveland’s Heritage Community Baptist Church in Hough, chairman of the board. “Therefore, we found it necessary to remove the word racism, and insert the words discrimination and bigotry.”
Following a suggestion initiated by Gohlstin, the board unanimously passed an amendment to replace “racism” with “discrimination” in the resolution during its general board meeting on Nov. 17, 2021. The resolution title now reads, “Discrimination is a public health crisis.”
In that same amendment, the board also changed the name of the work group created by the original resolution. What had been the “Eliminating Structural Racism in Behavioral Heath Care” work group is now called the “Diversity, Equity and Inclusion in Behavioral Health Care” work group.
“Anthropologically and biologically, there is only one race — that’s the human race — on the face of the earth,” Gohlstin said. “We’re attempting to change the narrative from fighting racism, which is a losing battle if there’s only one race.”
This may seem like a semantic change, yet experts say the experience of Black Americans is rooted in race and racism, regardless of philosophical deliberations about it. While race may be a social construct in concept – in other words, it’s not scientifically true that there is a substantial genetic difference between races – it has been used in reality to justify oppression.
“You could certainly have a circular argument,” said Robert Solomon, the vice president of Case Western Reserve University’s Office for Inclusion, Diversity and Equal Opportunity.
“Race is a social construct. It really is a fiction. We are all the same, but we live in a society that is still based upon race, that is founded upon these notions of race. I think that it is optimistic to think that you can battle those things without recognizing that racism is real and that our society functions on it.”
One agency, the Northeast Ohio Black Health Coalition, a social justice organization dedicated to addressing health disparities in the Black community, attended a few meetings of the ADAMHS Board’s task force on eliminating structural racism. But they stopped going after the board removed the word ‘racism’ from their declaration.
“I think that the ADAMHS Board, since they provide the funding, they should be the group that is spearheading this movement of dismantling racism and access for minorities in Cleveland,” said Dawn Pullin, who served as Behavioral Health and Addictions Director at the Northeast Ohio Black Health Coalition until this month. “With changing that wording, I don’t believe that that’s sending that message across the board.”
Supporters say regardless of the language change, the county mental health board has taken strides. Right now, they’re offering trainings and working with a consultant to create a three-year strategic plan for implementing inclusive policies. Orion Bell, the CEO of the Benjamin Rose Institute on Aging, has been participating in the ADAMHS Board’s Diversity, Equity and Inclusion in Behavioral Health Care work group meetings since they started in 2020, and he attended one of the diversity training sessions in June 2021. The conversations about racism at the work group meetings have prompted him to start discussions at his organization about hiring more people of color, he said.
“Part of the value of it as an effort is that it’s multiple organizations talking about the issue, who bring a lot of diverse perspectives and experience to the table themselves,” Bell said. “There’s some benefit in understanding what everybody else means when they talk about diversity.”
What is racism as a public health crisis?
According to the Centers for Disease Control and Prevention (CDC), approaching racism as a public health crisis means recognizing that people face inequitable health outcomes as a result of their skin color. Racism in this context refers not only to acts of racial discrimination between individuals but also to systemic racism. Systemic racism, the CDC says, plays a substantial role in social and environmental factors that impact health, such as access to housing, education, employment and food.
“To build a healthier America for all, we must confront the systems and policies that have resulted in the generational injustice that has given rise to racial and ethnic health inequities,” the CDC wrote on its webpage entitled “Racism and Health.”
According to the Center for Community Solutions, white residents of Cuyahoga County are likely to live nearly six years longer than Black residents, on average. Black residents also face disproportionate mental health issues. In 2020, the ADAMHS Board served 3,483 mental health clients. Of those, 42.3% were Black and over 48% were white. For services related to substance use disorders, the board served 2,756 clients, of whom 36.8% were Black and 58.8% were white. The county as a whole, meanwhile, has a population that is 30.5% Black and 63.5% white.
Despite these issues, Black Americans have less access to mental health care. At the same time, Black Americans are more likely than white Americans to be imprisoned for crimes related to substance use disorders and other mental illnesses, despite using drugs at similar rates. It’s in prison systems, which generally aren’t equipped to provide adequate care, that Black Americans are most likely to access mental health care.
“I would think, particularly when we think about ADAMHS and the work that they’re doing, that a focus on the institutional aspect of racism is really key in the work that they’re doing,” Solomon said.
For Black Clevelander Chann Payton, learning how racism harms people in the behavioral health field was a personal process. Payton, a peer support supervisor at the local recovery agency People, Places and Dreams, said that throughout her years-long search for mental health care, she has faced microaggressions and judgments from multiple therapists.
“It’s such a weird phenomenon to have someone look at you, and you’re trying to bare your soul, and they’re looking at you and judging you,” she said. “It happened again and again.”
“Uncomfortable with the word racism”
Per Ohio law, the ADAMHS Board is responsible for creating a unified system of high-quality services and support for people who suffer from mental illnesses and substance use disorders. It does this by offering training programs, partnering with service providers, and allocating state funding to dozens of social service agencies. In 2022, it will distribute roughly $39.8 million to more than 70 agencies.
The process of changing the ADAMHS Board’s resolution began publicly at an “Eliminating Structural Racism” work group meeting Nov. 1, 2021. Gohlstin said he was “uncomfortable with the word racism,” according to the meeting’s minutes. In that same meeting, Scott Osiecki, the board’s chief executive, said the work group “is really a diversity, equity and inclusion group,” and that changing the name would clarify the group’s purpose.
Osiecki said in an interview that other board members and staff agreed with his and Gohlstin’s suggestions in internal discussions ahead of and during the Nov. 17, 2021, general meeting. The work group members – who represent a number of local social service organizations – agreed, too, he said.
Pullin was “livid” when she got an email about the change. She said the mostly white work group didn’t get to vote on it.
Gohlstin traced his perception of race partly to concepts he read in the book “My Grandmother’s Hands,” which approaches race as a socially constructed concept rather than a genetic reality. Support for this school of thought also can be found in the scientific and academic communities. The reasoning is that all human beings share a similar genetic code and that differences in that code do not equate with racial lines.
Critics say changing the resolution’s language is dangerous because racism is not the same as discrimination based on race. While discrimination is about individual acts, racism is about systems. Declining to recognize systemic racism risks perpetuating the harm it does to people of color, they say.
“What makes racism so harmful is that it is the combination of prejudice with social and institutional power to reinforce it,” Solomon said. “When you focus in specifically on overt acts of discrimination, then that ignores the broader context of racism.”
In essence, Solomon said, people can be affected by systemic racism, without being the target of direct acts of discrimination. Acknowledging that distinction is important because even seemingly neutral policies enacted in the context of a racist society can create inequitable outcomes, he said. One example is the 1944 G.I. Bill, which provided veterans money for housing and education; however, Black veterans could not take advantage of those opportunities because of racist lending practices and mistreatment at universities.
Equity in behavioral health and social services
The Centers, with several locations throughout Cleveland, is one agency on the front lines of the battle for equitable access to mental health services. It will receive nearly $1 million from the ADAMHS Board in 2022 to provide a host of social services throughout Cuyahoga County.
Cleveland’s neighborhoods with mostly Black populations lack easily accessible, locally based behavioral health services, said Martin Williams, the Centers’ chief of behavioral health programming. That’s a problem, he said, because Cleveland has long struggled with socio-economic and racial disparities and Black Clevelanders tend to live in the most impoverished areas.
Communities of color, whether the largely Black neighborhood of Hough or the heavily Latinx neighborhood of Clark-Fulton, face chronic disinvestment, which exposes residents to stress-inducing factors including limited employment opportunities and violence. That toxic stress causes a host of adverse mental health conditions, said Eric Morse, chief executive of The Centers.
“It’s causing people to die,” Morse said. “I’m a little disappointed that the ADAMHS Board backed off of this because it’s just another example of how there was this resistance to call out that there’s something different going on here … We need to call it out. Maybe we don’t know the solutions yet, but if we don’t name it, we’re not going to come up with solutions.”
Williams said social service providers, who have historically perpetuated systemic racism, need to address the issue head on and acknowledge that systemic racism exists.
“We need to have a mechanism that shows how racism harms health in medicine and behavioral health,” he said. “We need to have a professional competency that is really geared toward understanding the impact of racism on health. That needs to be in everyone’s learning.”
Education and trainings
Despite scrubbing the word racism from the resolution, ADAMHS Board officials say they remain committed to advocating for racial and ethnic equity in their field. “We really geared in on that education,” said Beth Zietlow-DeJesus, the board’s director of external affairs. “And then, as part of that, we realized that this is bigger. We need help paring it down.”
The ADAMHS Board hired a Cincinnati-based diversity, equity and inclusion consulting firm called Rice Education Consulting (REDCon) last fall. REDCon declined to comment for this article, but the board is paying the organization $69,000, Zietlow-DeJesus said, to facilitate meetings of the board’s Diversity, Equity and Inclusion in Behavioral Health work group and create a three-year strategic plan for implementing inclusive policies by June. The board’s contract with REDCon expires after 2022.
As part of their diversity, equity and inclusion initiative, the ADAMHS Board put out a survey this month seeking feedback on its policies so far. It also added questions to its funding application about diversity, equity and inclusion policies and the racial and ethnic makeup of applicants’ board members. The board works with agencies to create DEI policies, and its Behavioral Health Workforce Task Force works to increase diversity in the local behavioral health care field.
Cuyahoga County’s ADAMHS Board is not the only mental health board in Ohio to declare racism a public health crisis. The same board in Franklin County, which includes Columbus, also laid out concrete anti-racism goals in its resolution, integrated discussions about systemic racism into its core programming, and highlighted the ways systemic racism impacts health in its 2020 community needs assessment. Its strategic plan for the next four years also stresses the need to diversify service providers to fill gaps in care.
Similarly, the board in Summit County, which serves Akron, pledged $100,000 to “support activities designed to increase knowledge and promote understanding of the effects of systemic racism” when it passed its own resolution declaring racism a public health crisis in June 2020.
County mental health and drug addiction boards can’t force change, Zietlow-DeJesus said. They can only set an example and encourage agencies they fund and other partners to follow it. The ADAMHS Board has hosted 24 training programs related to race and diversity since originally declaring racism a public health crisis in 2020. More than 1,170 individuals, representing more than 40 different local agencies have participated in the board’s training programs.
Two of those trainings educated their combined 100 attendees — some of whom were local judges and attorneys, Zietlow-DeJesus said — about how racism plays into sentencing for people of color charged with drug offenses. As far as whether or not participants integrate what they learn, however, Zietlow-DeJesus said, “We’re not responsible for those outcomes.”
Pullin said that the work group meetings she attended lacked a clear direction and focus. She acknowledged that dismantling systemic racism in the behavioral health field is a difficult task, but she said it can be done through small steps. The board should require partner agencies to develop strong anti-racist policies as part of its grant-giving process, she said.
Osiecki said the board is working toward that by hiring three new compliance officers tasked with overseeing contract compliance, part of which involves compliance with diversity, equity and inclusion policies. Although the outcome of the board’s resolution at this point is unclear because the work is still underway, he defended it: “This is way more than words on paper. We really want to make a difference, especially in the behavioral health community, because that’s what we’re responsible for.”
This story was produced in partnership with Ideastream’s Connecting the Dots series as part of an ongoing initiative reporting on what declaring racism a public health crisis means for local governments and organizations. The Land seeks to foster accountability among those that pledged to address health disparities and document what progress has been made toward that end.
Michael Indriolo is a reporting fellow at The Land