In the wake of nationwide protests against police violence and a reckoning about the role of race in America, agencies around the country began examining their roles in systemic racism.
As the Mahoning County Mental Health & Recovery Board and its partner agencies looked at how mental health and addiction services are affected by systemic racism, leaders saw deep-seated problems that will need to be addressed through structural changes and years of work.
In July, after the board declared racism a health crisis in the county, The Business Journal conducted a conference call with Duane Piccirilli, executive director of the mental health board, and the leaders of six area mental-health and addiction treatment agencies.
All acknowledged that their workforce should better represent the communities they work in and said that they have already began the initial steps of rectifying the problem.
“There are so many ways that it’s operationalized, just from the business that we’re in, from a highly impoverished community, transportation issues that affect their ability to access services and all the way to institutionalized racism and distrust,” says Joe Shorokey, CEO of Alta Behavioral Healthcare. “The majority of our licensed mental health staff are white and there’s not the trust from the African American community. They come in and see someone they don’t know if they can trust.”
If there isn’t comfort and understanding between counselor and patient, they say, then treatments can be inadequate and diagnoses made incorrectly, which leads to further problems.
“That travels with them from agency to agency, even if it’s not correct. There’s greater research today than there’s ever been on cultural specificity, understanding the differences in cultures and what’s necessary for recovery to take place,” says Carolyn Givens, executive director of Neil Kennedy Recovery Centers. “Harvard has a wonderful study on the incarceration rate of African American males and the misdiagnosis of oppositional defiant disorder.”
In declaring racism a public health crisis – like the cities of Youngstown and Warren, along with scores of other municipalities and agencies nationwide – the Mahoning County Mental Health & Recovery Board is taking the first step to address the barriers to care and treatment that face people of color, especially Black people. The declaration in mid-June, Piccirilli says, came between a similar proclamation by the Ohio Association of County Behavioral Health Authorities and the celebration in July of National Minority Mental Health Awareness Month.
“We feel strongly about trauma-informed care and one thing we’ve learned about is that you don’t ask someone what’s wrong, you ask them what happened,” Piccirilli say. “When you think about racism, it’s really daily trauma. It’s very important for our leadership to step out, start that conversation and find out what we can do to treat this better.”
Darryl Alexander, executive director of the Youngstown Urban Minority Alcoholism & Drug Abuse Outreach Program, says his career in mental health and addiction services has been a key part in learning how to deal with the emotions caused by the Black experience in the United States – racial profiling, stressful encounters with police, microaggressions and many more. But not everyone has that luxury.
“I have my own experiences, going back to my early 20s until about five years ago. It’s all on the inside. At this point in my life, I know how to deal with it; some of it you can laugh off and some of it’s anger,” Alexander says. “Many people don’t know how to let that out productively. When I get hit with the issues around the violence and protesting, I understand that.”
The American Psychiatric Association found that while Black people have similar rates of mental illness as the total population, they often receive poorer care and lack access to care. They’re more frequently diagnosed with schizophrenia and less frequently diagnosed with other mood disorders, which the association says may be caused by cultural differences in how Black people express symptoms of emotional distress. Black people with mental illnesss are more likely to be incarcerated than people of other races.
Disparities also show up in treatment. A 2015 survey by the Substance Abuse and Mental Health Administration found that just 31% of Black Americans with mental health illness received care – the same rate as Hispanic Americans – well below the 48% rate for White Americans. The American Psychiatric Association report, published in 2017, said that communications between physicians and Black patients are dominated more by the doctor with less patient-centered conversations than similar encounters with White patients. Overall, Black patients are less likely to get guideline-based care, be offered medication therapy or psychotherapy, and use mental health services.
“It’s so overwhelming and it all goes so far back. We can say there are things that need fixed in the educational system so people of color can get advanced degrees and licenses. How do we address that?” Alta’s Shorokey asks. “On the micro level, it’s about trying to understand and see the world through the lens of someone who’s different than us.”
Solving the problem is a two-pronged approach: creating a more diverse workforce and encouraging people with mental health illnesses to seek out care. Flying High Inc. has used funds from the county mental health board to hire three crisis counselors, two of whom are Black women. Their duties, says Executive Director Jeff Magada, include going into neighborhoods to “identify the needs of individuals.
“That could be economic needs or the need for food or for diapers or the need for help with mental health and addiction. Their role is to engage and connect,” he says. “It will purposely connect with the African American community to engage their needs.”
In addition to alcohol and drug treatment, the Youngstown nonprofit offers job training, including a vocational track for participants to become an assistant to a chemical dependency counselor, which can serve as the foot in the door for a career in mental health treatment. Of the eight currently in the class, seven are Black, Magada says.
“We think that’s very big, particularly in this atmosphere where so many people feel the system going against them,” he says.
Getting a start in the field, Alexander adds, is crucial because mental health and addiction treatment today is a highly specialized field that requires certifications, which can be inaccessible without entry-level knowledge.
“As the field has become more specialized, through attrition and age, you lose people of color in terms of specialists and therapists. In terms of infrastructure, that needs to be rebuilt,” Alexander says. “Years ago, you had people who didn’t have credentials but they had value. Because of where the field is now, those people can’t provide services.”
At Help Network of Northeast Ohio, CEO Vince Brancaccio says that while the organization’s staff does a good job of reflecting the population it serves – both in terms of race and sexual orientation – the same reflection doesn’t exist at the top of the leadership structure.
“I’ve sat down with my board to look at diversity on our staff because even by virtue of our accreditation, we have to reflect our community. I’m happy to say that Help Network does among its staff. But we recognize that at the leadership level we don’t have African American or Hispanic representation,” he says.
The Mahoning County Mental Health & Recovery Board, as well as its partner agencies, has engaged groups like the city of Youngstown’s Community Initiative to Reduce Violence and Black-owned barbershops to help fight the stigma around seeking treatment for mental illness.
“We can look at the demographics of the people we serve and see if they’re in highly traumatic situations. If they’re African American males coming in for service, I can tell you that there is a disparity in the individuals we serve,” says Joe Caruso, president and CEO of Compass Family and Community Services. “When you look at the traumas that these African American males are exposed to and how they learn to react to things, that absolutely dictates a need for outreach and education and engagement at all levels to get them what they need.”
Part of the effort is educating police on what Piccirilli calls “mental health first aid.” In recent years, there have been several high-profile shootings by police of people – often Black – in the midst of mental health episodes. The course, open to all police departments in Mahoning County, aims to teach officers how to recognize such events and how to provide help until mental-health professionals can get there. Every police department in the county has at least one officer who has completed the training, Piccirilli says.
“Part of that is diversity training. A lot of young cops come in and we do some role play. We’re working at it and I’m seeing change. …. Some think they’re there because they’ve done something wrong,” he says. “But by the end, they realize we’re not there to make them social workers. We need police officers and when an officer is called, it’s at the level where law enforcement is needed. We want them to understand how people may react and cultural diversity.”
As the county mental health board and the agencies work toward the goals set forth in the declaration, it’s important that the implementation of changes stems from the communities that will be affected by them, all agree.
“I was around in the 1968 movement and Huey Newton and the others who have tried to bring to the forefront some sort of recognition that what’s going on with the disparities in this country is not right. We’ve seen it over and over again,” Givens says. “At some point, you have to call it into question. Now we are. It’s incumbent upon Duane, myself and my colleagues to craft a mental health system that’s fair and equal for all and gives them the quality of care they deserve. If we don’t, we’ll be here in another 10 years.”
Pictured: Just 31% of Black Americans with mental health illnesses receive treatment, according to the Substance Abuse and Mental Health Administration. Those that do seek treatment tend to receive poorer care and are more often misdiagnosed.