In the months after the murder of George Floyd in 2020, local, state and federal health authorities declared racism a threat to public health. Those declarations, like Floyd’s death itself, left individuals and institutions across the country struggling to understand racism's effect on their communities and missions and what should be done about it.
That complex debate has reached Cuyahoga County’s Alcohol, Drug Addiction and Mental Health Services Board (ADAMHS) – which declared racism a public health crisis less than a month after Floyd was killed only to seemingly backtrack more than a year later, issuing a second resolution that replaced the word “racism” with “discrimination.”
At its November meeting, the board passed an amendment to the resolution, changing the title to “Discrimination is a public health crisis.”
That change has enraged some activists and concerned others who believe that to fight the impacts of racism people have to call it what it is. But the chairman of the ADAMHS Board says the issue is more complex.
“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, who suggested the change. “Therefore, we found it necessary to remove the word ‘racism,’ and insert the words ‘discrimination’ and ‘bigotry.’”
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 became 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,” said Gohlstin, who is Black. “We're attempting to change the narrative from fighting racism, which is a losing battle if there's only one race.”
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, according to the National Institute of Health. Declining to recognize systemic racism perpetuates the harm it does to people of color, according to critics.
“What makes racism so harmful is that it is the combination of prejudice with social and institutional power to reinforce it,” said Robert Solomon, vice president of Case Western Reserve University’s Office for Inclusion, Diversity and Equal Opportunity. “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.
This is not the first time an anti-racism declaration has been repealed. In October, the Ohio State Board of Education rescinded its anti-racism resolution in October; two board members, including the board president resigned.
“Uncomfortable with the word ‘racism’”
The process of changing the Cuyahoga County ADAMHS Board’s resolution began publicly at an “Eliminating Structural Racism” work group meeting on Nov. 1, 2021. Gohlstin said he was “uncomfortable with the word ‘racism,’” the meeting's minutes show.
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 a general meeting a few weeks later. The work group members – who represent a number of local social service organizations – agreed, too, he said.
But Dawn Pullin, formerly of the Northeast Ohio Black Health Coalition, was “livid” when she got an email about the change. She said the work group, which is mostly white, didn’t get to vote on the change.
“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 Pullin. “With changing that wording, I don't believe that that's sending that message across the board.”
The coalition stopped attending board task force meetings on eliminating structural racism after the board removed the word ‘racism’ from their declaration.
Equity in behavioral health and social services
Cleveland’s neighborhoods with mostly Black populations lack easily accessible, locally-based behavioral health services, said Martin Williams, chief of behavioral health programming at The Centers agency. 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.
In 2020, Black people in Cuyahoga County were disproportionately likely to seek mental health services from the ADAMHS Board. That year more than 42% of the board’s clients were Black while Black people made up less than 31% of Cuyahoga County residents.
Studies have shown that nationwide, Black Americans have less access to mental health care and are more likely than their white counterparts to be imprisoned for crimes related to substance use disorders and other mental illnesses, despite using drugs at similar rates to whites.
Communities of color, like 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.”
Social service providers, who have in some cases perpetuated systemic racism, need to address the issue head-on and acknowledge that systemic racism exists, Williams said.
“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.”
Clevelander Chann Payton, a peer support supervisor at the local recovery agency People, Places and Dreams, agrees. Payton, who is Black, said that she endured microaggressions and judgments from multiple therapists during the years she spent looking for mental health care.
“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.”
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 is paying a Cincinnati-based diversity, equity and inclusion consulting firm $69,000 to facilitate its Diversity, Equity and Inclusion in Behavioral Health work group and create a three-year strategic plan for implementing inclusive policies by June.
Rice Education Consulting (REDCon) declined to comment for this article. The board’s contract with REDCon expires after 2022.
The board has 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 diversity, equity and inclusion policies, and its Behavioral Health Workforce Task Force works to increase diversity in the local behavioral health care field.
Other Ohio ADAMHS Boards have declared 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.
Despite these efforts, 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.
Some participants were local judges and attorneys, who learned how racism plays into sentencing for people of color charged with drug offenses, Zeitlow-DeJesus said.
Whether participants integrate what they learn, however, is up to them.
“We’re not responsible for those outcomes," she said.
But Pullin, formerly with the Northeast Ohio Black Health Coalition, said that the few 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. He defended the work of the board has done combating racial disparities in care and said it is still underway.
“This is way more than words on paper,” he said. “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 The Land for Ideastream’s Connecting the Dots Between Race and Health Project.
Copyright 2022 WCPN. To see more, visit WCPN.